Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010
Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010
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DOI：
10.1016/j.ajog.2013.11.039
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发表时间：
2014-05-01
影响因子：
9.8
通讯作者：
Callaghan, William M.
中科院分区：
文献类型：
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作者：
Creanga, Andreea A.;Bateman, Brian T.;Callaghan, William M.
目的：本研究的目的是检查美国分娩住院期间严重产妇发病率的种族和民族差异。研究设计：我们从7个州的州住院患者数据库中确定2008 - 2010年的分娩住院情况。我们使用《国际疾病分类》第九版代码来创建分娩住院期间的严重孕产妇发病率指标。我们计算了输血和不输血时5个种族/族裔群体的严重孕产妇发病率：非西班牙裔白人、非西班牙裔黑人、西班牙裔、亚洲/太平洋岛民和美洲印第安人/阿拉斯加土著妇女。在控制了潜在的混杂因素后，我们拟合泊松回归模型来探索种族/民族与严重孕产妇发病率之间的关系。结果：总体而言，输血和不输血的严重孕产妇发病率分别为150.7和64.3 / 10,000分娩住院。非西班牙裔黑人、西班牙裔、亚洲/太平洋岛民和美洲印第安人/阿拉斯加土著妇女用输血测量的严重发病率分别是非西班牙裔白人妇女的2.1倍、1.3倍、1.2倍和1.7倍（均P < 0.05）；在不输血的情况下测量严重发病率时，观察到类似的增加率。严重发病率的其他显著阳性预测因子为年龄= 30岁、自费或医疗补助、低社会经济地位和存在慢性疾病。结论：严重的孕产妇发病率不成比例地影响种族/少数民族妇女，特别是非西班牙裔黑人妇女。有必要对医院、州和国家各级的严重孕产妇发病率进行系统审查，以指导质量改进干预措施的发展，以减少严重孕产妇发病率的种族/民族差异。
OBJECTIVE: The purpose of this study was to examine racial and ethnic disparities in severe maternal morbidity during delivery hospitalizations in the United States.STUDY DESIGN: We identified delivery hospitalizations from 20082010 in State Inpatient Databases from 7 states. We used International Classification of Diseases, 9th Revision, codes to create severe maternal morbidity indicators during delivery hospitalizations. We calculated the rates of severe maternal morbidity that were measured with and without blood transfusion for 5 racial/ethnic groups: non-Hispanic white, non-Hispanic black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women. Poisson regression models were fitted to explore the associations between race/ethnicity and severe maternal morbidity after we controlled for potential confounders.RESULTS: Overall, severe maternal morbidity rates that were measured with and without blood transfusion were 150.7 and 64.3 per 10,000 delivery hospitalizations, respectively. Non-Hispanic black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women had 2.1, 1.3, 1.2, and 1.7 times (all P < .05), respectively, higher rates of severe morbidity that were measured with blood transfusion compared with non-Hispanic white women; similar increased rates were observed when severe morbidity was measured without blood transfusion. Other significant positive predictors of severe morbidity were age = 30 years, self-pay or Medicaid coverage for delivery, low socioeconomic status, and presence of chronic medical conditions.CONCLUSION: Severe maternal morbidity disproportionally affects racial/ ethnic minority women, especially non-Hispanic black women. There is a need for a systematic review of severe maternal morbidities at the facility, state, and national levels to guide the development of quality improvement interventions to reduce the racial/ ethnic disparities in severe maternal morbidity.