Mekhala Dissanayake

All Publications

• Effects of hospital and obstetric unit closures on postpartum acute care across county racial composition in rural North Carolina. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association Dissanayake, M. V., Jackson, J. W., Urrutia, R. P., Martin, C. L., Funk, M. J., Wood, M. E. 2026; 42 (1): e70114

  Abstract

  Hospital and obstetric unit closures are concentrated in the rural Southern United States, often where marginalized racial/ethnic groups reside and access to maternal health care is already strained. Given structural racism's role as a fundamental cause of inequities, we hypothesized that closure effects may vary by race and racial composition of county.We used linked North Carolina birth certificates and Medicaid claims from births occurring to rural residents from 2014 to 2019. Using a Trial Emulation Policy Approach with a Difference-in-Difference analysis, we estimated the effects of hospital and obstetric closures on postpartum acute care (maternal emergency department visit or hospital admission) by race and county racial composition. We categorized rural counties as lower (LNHW, <80% White) or higher (HNHW, ≥80% White) Non-Hispanic White.We found declines in postpartum acute care associated with closures: 3.6 percentage points in LNHW counties and 1.8 percentage points in HNHW counties. We also found that marginalized groups experienced the largest declines, for example, Black versus White birthing people in LNHW counties (-7.1 vs -2.5 percentage points).As hospitals and obstetric units continue to close, increasing support in the postpartum period will be crucial for maternal health.

  View details for DOI 10.1111/jrh.70114

  View details for PubMedID 41549567

• Prevalence of male and female permanent contraception and long-acting reversible contraceptives among commercially insured US population, 2010-2022. American journal of obstetrics and gynecology Thel, H., Latour, C. D., Tsevat, D., Dissanayake, M., Wood, M. E., Arora, K. S. 2025

  View details for DOI 10.1016/j.ajog.2025.04.023

  View details for PubMedID 40254277

• Challenges in estimating effects of hypothetical interventions on resources patterned by structural racism: An example in a rural North Carolina Medicaid population. American journal of epidemiology Dissanayake, M. V., Jackson, J. W., Martin, C. L., Urrutia, R. P., Funk, M. J., Wood, M. E. 2025

  Abstract

  Structural racism has likely shaped the geographic distribution and resource allocation of rural populations and marginalized racial/ethnic groups. We sought to 1) quantify disparities in severe maternal morbidity (SMM) and distributions of resources by race and racial composition of county, and 2) determine whether a hypothetical intervention on resources would reduce racial disparities in SMM, using linked birth certificates and claims from Medicaid beneficiaries giving birth from 2014-2019 in rural North Carolina (61 rural counties, 77,665 births). We used ratio of mediator probability weights to enact a hypothetical intervention that would equalize distributions of pregnancy care provider ratios and obstetric units across race and racial composition of county. Despite observed disparities in the distributions of resources and SMM, we were unable to demonstrate that the hypothetical interventions would reduce SMM. This may be due to a lack of common support - marginalized groups never experienced the more optimal extremes of the healthcare resources distributions that privileged groups did. Our findings may have implications for the use of causal inference methods for addressing health disparities more broadly: if distributions of resources among privileged groups are outside those that marginalized groups experience, hypothetical interventions on these distributions cannot be emulated with data.

  View details for DOI 10.1093/aje/kwaf072

  View details for PubMedID 40202506

• Defining, Measuring, and Evaluating Prenatal Care in Insurance Claims Data CURRENT EPIDEMIOLOGY REPORTS Simmons, E., Dissanayake, M. V., Kahrs, J. C., Latour, C. D., Olawore, O., Kucirka, L. M., Wood, M. E. 2024; 11 (1): 73-83

  View details for DOI 10.1007/s40471-023-00341-z

  View details for Web of Science ID 001132749500001

• New long-acting reversible contraceptive insertions more than doubled among a commercially insured, US-based outpatient population from 2010 to 2020 Latour, C. D., Busse, C. E., Dissanayake, M. V., Dejene, S. Z., Knittel, A. K., Wood, M. E., Kinlaw, A. WILEY. 2023: 8

  View details for Web of Science ID 001091511700011

• Postpartum health risks among women with hypertensive disorders of pregnancy, California 2008-2012. Journal of hypertension Murray Horwitz, M. E., Rodriguez, M. I., Dissanayake, M., Carmichael, S. L., Snowden, J. M. 2020

  Abstract

  OBJECTIVES: The aim of this study was to understand the associations between hypertensive disorders of pregnancy (HDP) and postpartum complications throughout the newly defined 12-week postpartum transition.STUDY DESIGN: We conducted a retrospective cohort study of the associations of HDP (any/subtype) with postpartum complications among 2.5 million California births, 2008-2012. We identified complications from discharge diagnoses from maternal hospital encounters (emergency department visits and readmissions) in the 12 weeks after giving birth. We compared rates of complications, overall and by diagnostic category, between groups defined by HDP. In survival analyses, we calculated the adjusted hazard ratios of postpartum complications associated with HDP. We adjusted for maternal age, race/ethnicity, prepregnancy obesity, chronic diabetes, gestational diabetes, insurance, delivery mode, gestational age and birth outcome (term and size).RESULTS: Among women with and without HDP, 12.8 and 7.7%, respectively, had a hospital encounter within 12 weeks of giving birth [adjusted hazard ratio 1.5, 95% confidence interval (95% CI): 1.5-1.5]. HDP was associated with increased risk across all major categories of complications: hypertension-related, adjusted hazard ratio 11.8 (95% CI: 11.2-12.3); childbirth-related, 1.4 (1.3-1.4); and other, 1.4 (1.4-1.4). Risk of any complication differed by hypertensive subtype: chronic hypertension with super-imposed preeclampsia, adjusted hazard ratio 1.8 (95% CI: 1.7-1.8); chronic hypertension, 1.6 (1.6-1.7); preeclampsia/eclampsia, 1.3 (1.3-1.4); and gestational hypertension, 1.2 (1.2-1.3). Over a quarter (28.9%) of maternal hospital encounters occurred more than 6 weeks after giving birth; this did not differ substantially by HDP status.CONCLUSION: Women with HDP are at an increased risk for virtually all postpartum complications, including those not related to hypertension, and may benefit from enhanced and comprehensive postpartum care.

  View details for DOI 10.1097/HJH.0000000000002711

  View details for PubMedID 33230021

• The Association between Hospital Frequency of Labor after Cesarean and Outcomes in California. Women's health issues : official publication of the Jacobs Institute of Women's Health Dissanayake, M. V., Bovbjerg, M. L., Tilden, E. L., Snowden, J. M. 2020; 30 (6): 453-461

  Abstract

  Labor after cesarean (LAC) is an alternative to planned repeat cesarean delivery. The effect of hospital-level factors on LAC frequency and vaginal birth after cesarean (VBAC) has been relatively understudied. It was our goal to determine if hospital frequency of LAC (number of women undergoing LAC/number of women with previous uterine scars) is associated with increased VBAC and associated outcomes among women undergoing LAC.We analyzed 43,331 term, singleton births to women who experienced LAC in California from 2007 to 2010. We conducted multivariable logistic regressions of infant and maternal outcomes for women at hospitals with high LAC frequency (≥median) compared with low LAC frequency (

  View details for DOI 10.1016/j.whi.2020.07.005

  View details for PubMedID 32859469

  View details for PubMedCentralID PMC7704773