Evaluation of US State-Level Variation in Hypertensive Disorders of Pregnancy.
Evaluation of US State-Level Variation in Hypertensive Disorders of Pregnancy.
复制标题
DOI：
10.1001/jamanetworkopen.2020.18741
复制
发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Guo N
中科院分区：
文献类型：
--
作者：
Butwick AJ;Druzin ML;Shaw GM;Guo N
慢性高血压、妊娠高血压疾病和子痫的患病率在美国各州是否有所不同？在这项对2017年在美国活产的3659553名妇女的横断面研究中，如果同一名妇女在子痫患病率较高和较低的州分娩，其子痫的中位几率要高出2.4倍。慢性高血压和妊娠高血压疾病的中位优势比明显较低。本研究的结果表明，尽管控制了多种患者特征，但美国各州子痫患病率存在实质性差异。妊娠期高血压疾病是美国孕产妇和围产期发病的重要原因。然而，美国各州慢性高血压、妊娠高血压或子痫前期和子痫患病率的差异程度仍不清楚。研究美国各州慢性高血压、妊娠高血压疾病（包括妊娠高血压或先兆子痫）和子痫患病率的变化程度。从2019年9月1日至2020年2月1日，使用2017年美国出生证明数据进行了一项横断面研究。以人群为基础的样本包括3 659 553名活产妇女。使用多水平多变量logistic回归评估各州慢性高血压、妊娠高血压疾病和子痫的具体患病率，并使用中位优势比（MOR）评估各州的差异。在3 659 553名女性中，20岁以下女性185 932人（5.1%），20 - 24岁女性727 573人（19.9%），25 - 29岁女性1 069 647人（29.2%），30 - 34岁女性1 037 307人（28.3%），35 - 39岁女性523 607人（14.3%），40岁及以上女性115 487人（3.2%）。大多数妇女有医疗补助（42.8%）或私人保险（49.4%）。夏威夷的慢性高血压调整患病率最低（1.0%,95% CI, 0.9%-1.2%），阿拉斯加的调整患病率最高（3.4%,95% CI, 3.0%-3.9%）。马萨诸塞州妊娠期高血压疾病的调整患病率最低（4.3%;95% CI, 4.1%-4.6%），路易斯安那州最高（9.3%;95% CI, 8.9%-9.8%）。特拉华州调整后的子痫患病率最低（0.03%;95% CI, 0.01%-0.09%），夏威夷最高（2.8%;95% CI, 2.2%-3.4%）。子痫的州际差异程度很高（MOR, 2.36; 95% CI, 1.88-2.82），表明如果同一名妇女在美国子痫患病率较高与较低的州分娩，子痫的中位几率要高出2.4倍。慢性高血压（MOR, 1.27; 95% CI, 1.20-1.33）和妊娠期高血压疾病（MOR, 1.17; 95% CI, 1.13-1.21）的状态之间存在适度差异。本研究的结果表明，在考虑了患者水平和州水平的变量后，子痫的患病率存在显著的州水平差异。这些数据可以为未来的公共卫生调查提供信息，以确定子痫变异性的原因。本横断面研究考察了美国各州孕妇高血压疾病患病率的变化。
Does the prevalence of chronic hypertension, hypertensive disorders of pregnancy, and eclampsia vary across the US by state? In this cross-sectional study of 3 659 553 women who had live births in the US in 2017, the median odds of eclampsia were 2.4-fold higher if the same woman delivered in a state with a higher vs lower prevalence of eclampsia. The median odds ratios were substantially lower for chronic hypertension and hypertensive disorders of pregnancy. The findings of this study suggest that substantial variation among states exists in the prevalence of eclampsia across the US, despite controlling for multiple patient characteristics. Hypertensive disorders of pregnancy are important causes of maternal and perinatal morbidity in the US. However, the extent of statewide variation in the prevalence of chronic hypertension, pregnancy-induced hypertension or preeclampsia, and eclampsia in the US remains unknown. To examine the extent of statewide variation in the prevalence of chronic hypertension, hypertensive disorders of pregnancy (including pregnancy-induced hypertension or preeclampsia), and eclampsia in the US. A cross-sectional study using 2017 US birth certificate data was conducted from September 1, 2019, to February 1, 2020. A population-based sample of 3 659 553 women with a live birth delivery was included. State-specific prevalence of chronic hypertension, hypertensive disorders of pregnancy, and eclampsia was assessed using multilevel multivariable logistic regression, with the median odds ratio (MOR) to evaluate statewide variation. Of the 3 659 553 women, 185 932 women (5.1%) were younger than 20 years, 727 573 women (19.9%) were aged between 20 and 24 years, 1 069 647 women (29.2%) were aged between 25 and 29 years, 1 037 307 women (28.3%) were aged between 30 and 34 years, 523 607 women (14.3%) were aged between 35 and 39 years, and 115 487 women (3.2%) were 40 years or older. Most women had Medicaid (42.8%) or private insurance (49.4%). Hawaii had the lowest adjusted prevalence of chronic hypertension (1.0%; 95% CI, 0.9%-1.2%), and Alaska had the highest (3.4%; 95% CI, 3.0%-3.9%). Massachusetts had the lowest adjusted prevalence of hypertensive disorders of pregnancy (4.3%; 95% CI, 4.1%-4.6%), and Louisiana had the highest (9.3%; 95% CI, 8.9%-9.8%). Delaware had the lowest adjusted prevalence of eclampsia (0.03%; 95% CI, 0.01%-0.09%), and Hawaii had the highest (2.8%; 95% CI, 2.2%-3.4%). The degree of statewide variation was high for eclampsia (MOR, 2.36; 95% CI, 1.88-2.82), indicating that the median odds of eclampsia were 2.4-fold higher if the same woman delivered in a US state with a higher vs lower prevalence of eclampsia. Modest variation between states was observed for chronic hypertension (MOR, 1.27; 95% CI, 1.20-1.33) and hypertensive disorders of pregnancy (MOR, 1.17; 95% CI, 1.13-1.21). The findings of this study suggest that after accounting for patient-level and state-level variables, substantial state-level variation exists in the prevalence of eclampsia. These data can inform future public-health inquiries to identify reasons for the eclampsia variability. This cross-sectional study examines statewide variations in the prevalence of hypertensive disorders in pregnant women across the US.
登录
查看更多内容
DOI：
10.1136/bmj.f6564
发表时间：
2013-11-07
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Ananth CV;Keyes KM;Wapner RJ
通讯作者：
Wapner RJ
影响因子：
3.3
作者：
Dietz, Patricia;Bombard, Jennifer;Farr, Sherry
通讯作者：
Farr, Sherry
影响因子：
1.9
作者：
Larsen, K;Petersen, JH;Endahl, L
通讯作者：
Endahl, L
影响因子：
7.2
作者：
通讯作者：
--
影响因子：
7.2
作者：
Sibai, BM
通讯作者：
Sibai, BM