Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set.
Peripartum Maternal Hepatitis B Care in a US Nationwide Data Set.
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美国全国数据集中的围产期孕产妇乙型肝炎护理。
DOI：
10.1097/mcg.0000000000001122
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发表时间：
2019
影响因子：
2.9
通讯作者：
Oken,Emily
中科院分区：
文献类型：
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作者：
Chang,MatthewS;Wharam,JFrank;Zhang,Fang;LeCates,RobertF;Morton-Eggleston,Emma;Tuomala,RuthE;Rutherford,AnnaE;Mutinga,MuthokaL;Andersson,KarinL;BrownJr,RobertS;Ukomadu,Chinweike;Oken,Emily
背景：在怀孕期间进行乙肝B病毒（HBV）筛查是预防婴儿垂直传播的标准护理，但母亲本身可能无法接受适当的follow-up.Goals：使用国家数据库，我们试图确定产妇围产期随访率与HBV专家，并确定与缺乏follow-up.Materials and Methods相关的因素：我们确定了2000年至2012年分娩的妇女，并根据国际疾病分类诊断为HBV-9个代码，使用国家数据库（Optum），来自所有50个州的0至64岁的4600万成员的商业保险索赔。我们的主要结果是随访期间或怀孕后的HBV专家（胃肠病学/传染病）。结果：HBV的患病率为0.27%（2558/959,747怀孕），中位随访时间为45个月。只有21%的妇女接受了围产期HBV专家随访。在多变量回归分析中，1年围产期随访的预测因素包括年龄较小[比值比（OR），0.97/y; 95%置信区间（CI），0.94，0.99]，亚裔/种族（OR，1.56 vs.白色; 95% CI，1.13，2.17），居住在东北部（OR，1.70; 95% CI，1.09，2.66）和中西部（OR，1.73; 95% CI，1.07，2.81）与西部。1年时检测HBV DNA和丙氨酸氨基转移酶的预测因素包括亚洲人种（OR，1.72; 95% CI，1.23，2.41），分娩后2年内接受过初级保健医生访视（OR，1.63; 95%CI，1.19，2.22），和围产期HBV专家随访1年内（OR，15.68; 95%CI，11.38，21.60）。结论：产妇HBV专家随访率极低，在这个大的，不同的队列代表所有美国地区。转诊到HBV专家是适当的产后HBV实验室检测的最强预测因子。在没有保险的人群中，随访率可能更低。
Background:Hepatitis B virus (HBV) screening during pregnancy is standard of care to prevent vertical transmission to infants, yet the mothers themselves may not receive appropriate follow-up.Goals:Using a national database, we sought to determine rates of maternal peripartum follow-up with a HBV specialist and identify factors associated with a lack of follow-up.Materials and Methods:We identified women who delivered in 2000 to 2012 and were diagnosed with HBV according to International Classification of Diseases-9 codes using a national database (Optum) derived from commercial insurance claims with∼ 46 million members ages 0 to 64 in all 50 states. Our primary outcome was follow-up during or after pregnancy with a HBV specialist (gastroenterology/infectious diseases).Results:The prevalence of HBV was 0.27%(2558/959,747 pregnancies), and median follow-up was 45 months. Only 21% of women had peripartum HBV specialist follow-up. On multivariable regression, predictors of peripartum follow-up at 1-year included younger age [odds ratio (OR), 0.97/y; 95% confidence interval (CI), 0.94, 0.99], Asian race/ethnicity (OR, 1.56 vs. white; 95% CI, 1.13, 2.17), and residing in the Northeast (OR, 1.70; 95% CI, 1.09, 2.66) and Midwest (OR, 1.73; 95% CI, 1.07, 2.81) versus West. Predictors of testing for HBV DNA and alanine aminotransferase at 1 year included Asian race (OR, 1.72; 95% CI, 1.23, 2.41), a primary care physician visit within 2 years of delivery (OR, 1.63; 95% CI, 1.19, 2.22), and peripartum HBV specialist follow-up within 1 year (OR, 15.68; 95% CI, 11.38, 21.60).Conclusions:Maternal HBV specialist follow-up rates were extremely low in this large, diverse cohort representing all United States regions. Referral to a HBV specialist was the strongest predictor of appropriate postpartum HBV laboratory testing. Follow-up rates may be even lower in uninsured populations.