Pregnancy and Emergency Department Utilization in North Carolina, 2016-2021: A Population-Based Surveillance Study.
Pregnancy and Emergency Department Utilization in North Carolina, 2016-2021: A Population-Based Surveillance Study.
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DOI：
10.1016/j.focus.2023.100142
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发表时间：
2023-12
期刊：
影响因子：
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通讯作者：
Urrutia, Rachel P
中科院分区：
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作者：
Nazzal, Elizabeth M;Waller, Anna E;Meyer, Michelle L;Ising, Amy I;Jones-Vessey, Kathleen;Urrutia, Eugene;Urrutia, Rachel P
怀孕期间使用急诊室与更差的出生结局相关。在北卡罗来纳州，与怀孕有关的急诊就诊人数正在增加。2016-2021年，15-44岁女性的就诊中共有10.1%与妊娠有关。在2016-2021年的妊娠相关就诊中，15.5%导致住院。急诊和住院率因人口因素而异。妊娠相关的投诉是育龄妇女急诊的常见原因。妊娠期间使用急诊室与母亲和婴儿的出生结局较差相关。我们使用2016年至2021年期间全州北卡罗来纳州急诊科监测数据，描述与使用急诊科治疗妊娠相关问题和随后入院相关的社会人口学因素。北卡罗来纳州疾病事件跟踪和流行病学收集工具是一个综合征监测系统，包括北卡罗来纳州民用急性护理机构的所有急诊室就诊情况。我们分析了2016年1月1日至2021年12月31日期间，居住在北卡罗来纳州、年龄在15-44岁之间、至少有1个ICD-10-CM代码的女性患者的所有急诊科就诊（分析发生在2021年7月至2022年10月）。如果分配的ICD-10-CM代码表明妊娠，则每次急诊科访视均归类为妊娠相关。我们根据年龄、种族、民族、居住县和保险对访视进行分层，并使用单样本t检验将其与估计的妊娠人口比例进行比较。我们使用多变量logistic回归来确定妊娠相关就诊是否更可能与入院相关，然后确定妊娠相关急诊就诊的社会人口学预测因素。包括640多万次急诊就诊（N= 6，471，197）;百分之十点一（n= 655，476）与妊娠相关，显著高于北卡罗来纳州任何给定时间估计妊娠的女性比例（4.6%，p<0.0001），并随时间增加（2016年为8.6%，2021年为11.1%，p<0.0001）。对于25-44岁的患者，妊娠相关访视低于预期，而对于15-24岁的患者、黑人和居住在农村或郊区的患者，妊娠相关访视高于预期。妊娠相关急诊就诊的比例高于非妊娠相关急诊就诊的比例（15.6% vs 7.0%，AOR=3.06 [95% CI=3.03，3.09]）。与白色患者相比，黑人患者的妊娠相关急诊就诊率为0.58倍（95% CI=0.57，0.59）。怀孕期间使用急诊室是常见的。育龄妇女因怀孕到急诊室就诊的比例正在增加，因怀孕诊断从急诊室住院的比例也在增加。使用公共卫生监测数据库，如北卡罗来纳州疾病事件跟踪和流行病学收集工具，可能有助于确定改善孕产妇保健差异的机会，特别是与获得保健有关的机会。
Emergency department use during pregnancy is associated with worse birth outcomes. Pregnancy-associated emergency department visits are increasing in North Carolina. A total of 10.1% of visits for women aged 15–44 years were pregnancy-associated in 2016–2021. Of pregnancy-associated visits in 2016–2021, 15.5% resulted in hospital admission. Emergency visit and hospital admission rates differed on the basis of demographic factors. Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency department surveillance data between 2016 and 2021 to describe the sociodemographic factors associated with the use of emergency department for pregnancy-associated problems and subsequent hospital admission. North Carolina Disease Event Tracking and Epidemiologic Collection Tool is a syndromic surveillance system that includes all emergency department encounters at civilian acute-care facilities in North Carolina. We analyzed all emergency department visits between January 1, 2016 and December 31, 2021 for female patients aged 15–44 years residing in North Carolina with at least 1 ICD-10-CM code (analysis occurred in July 2021–October 2022). Each emergency department visit was categorized as pregnancy-associated if assigned ICD-10-CM code(s) indicated pregnancy. We stratified visits by age, race, ethnicity, county of residence, and insurance and compared them with estimated pregnant population proportions using 1-sample t-tests. We used multivariable logistic regression to determine whether pregnancy-associated visits were more likely to be associated with hospital admission and then to determine sociodemographic predictors of admission among pregnancy-associated emergency department visits. More than 6.4 million emergency department visits were included (N=6,471,197); 10.1% (n=655,476) were pregnancy-associated, significantly higher than the proportion of women estimated to be pregnant at any given time in North Carolina (4.6%, p<0.0001) and increased over time (8.6% in 2016 vs 11.1% in 2021, p<0.0001). Pregnancy-associated visits were lower than expected for ages 25–44 years and higher than expected for those aged 15–24 years, for those of Black race, and for patients residing in rural or suburban areas. The proportion admitted was higher for pregnancy-associated emergency department visits than for nonpregnancy associated (15.6% vs 7.0%, AOR=3.06 [95% CI=3.03, 3.09]). Pregnancy-associated emergency department visits for patients of Black race had 0.58 times (95% CI=0.57, 0.59) the odds of admission compared with White patients. Emergency department utilization during pregnancy is common. The proportion of pregnancy-associated emergency department visits among reproductive-age women is increasing, as are inpatient admissions from the emergency department for pregnancy-associated diagnoses. Use of public health surveillance databases such as the North Carolina Disease Event Tracking and Epidemiologic Collection Tool may help identify opportunities for improving disparities in maternal health care, especially related to access to care.