County-Level Associations Between Pregnancy-Related Mortality Ratios and Contextual Sociospatial Indicators.
County-Level Associations Between Pregnancy-Related Mortality Ratios and Contextual Sociospatial Indicators.
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DOI：
10.1097/aog.0000000000004749
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发表时间：
2022-05-01
影响因子：
7.2
通讯作者：
Goodman, David A.
中科院分区：
文献类型：
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作者：
Barrera, Chloe M.;Kramer, Michael R.;Merkt, Peter T.;Petersen, Emily E.;Brantley, Mary D.;Eckhaus, Lindsay;Beauregard, Jennifer L.;Goodman, David A.
这项基于人口的妊娠相关死亡回溯性研究发现，县级社会空间指标总体上与妊娠相关死亡率有关，并按种族和民族分类。描述不同社会空间指标在与妊娠相关的死亡率方面的县级差异。我们利用怀孕死亡率监测系统中可用的邮政编码或县数据，对2011-2016年间15-44岁的非西班牙裔黑人、西班牙裔(所有种族)和非西班牙裔白人女性的所有与怀孕相关的死亡和所有活产进行了横断面多水平分析。暴露包括31个基于概念的、特定于县的社会空间指标，这些指标是从公开的数据来源收集的，并被归类为以下领域：人口、一般、生殖和行为健康；社会资本和支持；以及社会经济背景。我们计算了县级怀孕相关死亡率(每100,000名活产死亡人数)每1个单位的绝对差异。居住在每个社会空间指标总体水平较低的县与较低水平的妇女之间的中位数绝对差异增加，并按种族和族裔分层。与怀孕有关的死亡率因县而异，因种族和民族而异。许多社会空间指标与与孕妇年龄、人口大小和人口普查区域无关的特定县的妊娠相关死亡率有关。在各个领域，最有害的指标是低出生体重儿的百分比(绝对比率差6.44；95%可信区间5.36-7.51)、失业成年人百分比(绝对比率差4.98；95%可信区间3.91-6.05)和食物不安全(绝对比率差4.92；95%可信区间4.14-5.70)。最具保护性的指标是较高的家庭收入中位数(RD−2.76；95%CI−3.28至−2.24)、受过大学教育的成年人比例(RD−2.28；95%CI−2.81至−1.75)和自住家庭百分比(RD−1.66；95%CI−2.29至−1.03)。这些联系的大小因种族和民族而异。这项分析确定了与怀孕有关的死亡率的社会空间指标，并显示了与怀孕有关的死亡与居住地之间的联系，总体上并按种族和民族分层。了解与妊娠相关死亡率有关的县级背景可能是建立公共卫生证据的重要一步，以便为在地方一级降低妊娠相关死亡率的行动提供信息。
This retrospective population-based study of pregnancy-related deaths found county-level sociospatial indicators to be associated with pregnancy-related mortality ratios overall and by race and ethnicity. To characterize county-level differences in pregnancy-related mortality as a function of sociospatial indicators. We conducted a cross-sectional multilevel analysis of all pregnancy-related deaths and all live births with available ZIP code or county data in the Pregnancy Mortality Surveillance System during 2011–2016 for non-Hispanic Black, Hispanic (all races), and non-Hispanic White women aged 15–44 years. The exposures included 31 conceptually-grounded, county-specific sociospatial indicators that were collected from publicly available data sources and categorized into domains of demographic; general, reproductive, and behavioral health; social capital and support; and socioeconomic contexts. We calculated the absolute difference of county-level pregnancy-related mortality ratios (deaths per 100,000 live births) per 1-unit increase in the median absolute difference between women living in counties with higher compared with lower levels of each sociospatial indicator overall and stratified by race and ethnicity. Pregnancy-related mortality varied across counties and by race and ethnicity. Many sociospatial indicators were associated with county-specific pregnancy-related mortality ratios independent of maternal age, population size, and Census region. Across domains, the most harmful indicators were percentage of low-birth-weight births (absolute ratio difference [RD] 6.44; 95% CI 5.36–7.51), percentage of unemployed adults (RD 4.98; 95% CI 3.91–6.05), and food insecurity (RD 4.92; 95% CI 4.14–5.70). The most protective indicators were higher median household income (RD −2.76; 95% CI −3.28 to −2.24), percentage of college-educated adults (RD −2.28; 95% CI −2.81 to −1.75), and percentage of owner-occupied households (RD −1.66; 95% CI −2.29 to −1.03). The magnitude of these associations varied by race and ethnicity. This analysis identified sociospatial indicators of pregnancy-related mortality and showed an association between pregnancy-related deaths and place of residence overall and stratified by race and ethnicity. Understanding county-level context associated with pregnancy-related mortality may be an important step towards building public health evidence to inform action to reduce pregnancy-related mortality at local levels.