Severe Maternal Morbidity and Mortality in Sickle Cell Disease in the National Inpatient Sample, 2012-2018.
Severe Maternal Morbidity and Mortality in Sickle Cell Disease in the National Inpatient Sample, 2012-2018.
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2012 - 2018年，国家住院样本中的镰状细胞病中的严重孕产妇发病率和死亡率。
DOI：
10.1001/jamanetworkopen.2022.54552
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发表时间：
2023-02-01
影响因子：
13.8
通讯作者：
Pecker, Lydia H.
中科院分区：
文献类型：
--
作者：
Early, Macy L.;Eke, Ahizechukwu C.;Gemmill, Alison;Lanzkron, Sophie;Pecker, Lydia H.
镰状细胞病（SCD）患者分娩时严重孕产妇发病率（SMM）的发生率和风险是多少？SCD患者不良妊娠结局风险增加的比例与黑人患者遇到的种族差异相关？在这项横断面研究中，包括3901例SCD患者的分娩，SCD患者的孕产妇死亡率是非黑人孕妇控制分娩的26倍，是黑人孕妇分娩的10倍以上。与没有SCD的人群相比，SCD患者的分娩有显著更高的SMM几率，种族差异平均解释了SCD分娩风险增加的28.9%。这些结果表明，与黑人或非黑人对照人群相比，SCD患者的SMM风险更高;近三分之一的风险增加可能归因于种族差异。这项对美国医院分娩的横断面研究检查了镰状细胞病（SCD）患者的妊娠结局，并将不良结局与非SCD黑人和非黑人人群进行了比较。在美国，镰状细胞病（SCD）患者的妊娠结局历来很差，其中大多数是黑人。结果是否有所改善尚不清楚。将SCD患者的不良妊娠结局制成表格，比较SCD黑人与非SCD黑人和对照非黑人人群的分娩结局，并测量种族差异与SCD妊娠不良结局的相关性。这项横断面研究是一项二次分析，涉及国家住院患者样本的数据，这是2012年至2018年美国20%急性住院患者的全国代表性样本。该数据集包括所有11至55岁年龄段的孕妇分娩代码。数据分析时间为2021年9月至2022年8月。SCD，种族差异。严重孕产妇发病率（SMM），由美国疾病控制和预防中心的指数以及其他结果测量;多元logistic回归用于比较不良妊娠结局的几率。样本包括5 401 899次分娩，其中包括SCD患者的3901次分娩和黑人的742 164次分娩。与非黑人对照组相比，SCD患者和黑人患者更年轻（平均[SD]年龄：SCD，27.2 [5.9]岁;黑人，27.1 [6.1]岁vs 28.7 [5.9]岁），更有可能拥有公共保险（SCD，2609次分娩[67.3%];黑人，496828次分娩[65.4%] vs 1880198次分娩[40.8%]）。SCD患者分娩时的孕产妇死亡率是非黑人对照组的26倍，是非SCD黑人孕妇的10倍多（每10000次分娩：SCD 13.3; 95%CI，5.7-31.2;黑人，1.2; 95%CI，1.0-1.5;非黑人对照0.5; 95%CI，0.5-0.6）。与对照组相比，SCD分娩有更高的SMM几率（校正比值比[aOR]，7.22; 95%CI，6.25-8.34; P <0.001），尤其是脑血管事件（aOR，22.00; 95% CI，15.25-31.72; P < .001）和血栓栓塞（aOR，17.34; 95% CI，11.55-26.03; P < .001）。种族差异解释了中位数（IQR）28.9%（21.2%-33.1%）的SCD患者分娩风险增加，40%-50%的急性肾衰竭风险增加（超额风险[ER]，56.9%; 95%CI，54.3%-59.3%）、宫内胎儿死亡（ER，47.8%; 95%CI，46.6%-49.1%）和子痫（ER，42.1%; 95%CI，37.9%-46.1%）。在这项关于SCD患者妊娠结局的大型横断面研究中，SMM的风险高于无SCD患者的分娩风险，尤其是血栓事件、器官衰竭和死亡。种族差异与不良结局相关。我们的研究结果迫使科学，临床和政治努力，以改善妊娠SCD患者的结局。
What are the rates of and risks for severe maternal morbidity (SMM) among birthing people with sickle cell disease (SCD), and what proportion of the increased risk for adverse pregnancy outcomes in SCD is associated with racial disparities encountered by Black patients? In this cross-sectional study including 3901 deliveries among people with SCD, the maternal mortality rate for people with SCD was 26 times greater than in control deliveries of pregnant people with non-Black race and more than 10 times greater than deliveries among Black pregnant people. Compared with groups without SCD, deliveries among people with SCD had significantly higher odds of SMM, and racial disparities explained, on average, 28.9% of the increased risk in SCD deliveries. These results suggest that the risk for SMM is higher in deliveries among people with SCD than those of Black or non-Black control populations with no SCD; nearly one-third of the increased risk may be attributable to racial disparities. This cross-sectional study of deliveries in US hospitals examines pregnancy outcomes for people with sickle cell disease (SCD) and compares adverse outcomes with Black and Non-Black populations without SCD. Pregnancy outcomes are historically poor among people with sickle cell disease (SCD) in the US, most of whom have Black race. Whether outcomes have improved is unknown. To tabulate adverse pregnancy outcomes among patients with SCD, comparing outcomes of deliveries among Black people with SCD with those of Black people without SCD and a control non-Black population, and to measure the association of racial disparities with adverse outcomes in SCD pregnancies. This cross-sectional study was a secondary analysis involving data from National Inpatient Sample, a nationally representative sample of 20% of acute hospital admissions in the US, between 2012 and 2018. The data set included all admissions with codes for delivery of a pregnancy among people aged 11 to 55 years. Data were analyzed from September 2021 to August 2022. SCD, racial disparities. Severe maternal morbidity (SMM) as measured by the US Centers for Disease Control and Prevention’s index alongside other outcomes; multiple logistic regression was used to compare the odds for adverse pregnancy outcomes. The sample included 5 401 899 deliveries, including 3901 deliveries among people with SCD and 742 164 deliveries among people with Black race. Compared with the non-Black control group, patients with SCD and Black patients were younger (mean [SD] age: SCD, 27.2 [5.9] years; Black, 27.1 [6.1] years vs 28.7 [5.9] years) and more likely to have public insurance (SCD, 2609 deliveries [67.3%]; Black, 496 828 deliveries [65.4%] vs 1 880 198 deliveries [40.8%]). The maternal mortality rate in deliveries among people with SCD was 26 times greater than in the non-Black control group and more than 10 times greater than among Black pregnant people without SCD (Per 10 000 deliveries: SCD 13.3; 95% CI, 5.7-31.2; Black race, 1.2; 95% CI, 1.0-1.5; non-Black control 0.5; 95% CI, 0.5-0.6). Compared with the control group, SCD deliveries had higher odds of SMM (adjusted odds ratio [aOR], 7.22; 95% CI, 6.25-8.34; P < .001), especially cerebrovascular events (aOR, 22.00; 95% CI, 15.25-31.72; P < .001) and thromboembolism (aOR, 17.34; 95% CI, 11.55-26.03; P < .001). Racial disparities explained a median (IQR) 28.9% (21.2%-33.1%) of the increased risk in deliveries to people with SCD and between 40% and 50% of the increased risk for acute kidney failure (excess risk [ER], 56.9%; 95% CI, 54.3%-59.3%), intrauterine fetal demise (ER, 47.8%; 95% CI, 46.6%-49.1%), and eclampsia (ER, 42.1%; 95% CI, 37.9%-46.1%). In this large cross-sectional study of pregnancy outcomes in people with SCD, the risk for SMM was higher compared with deliveries among people without SCD, especially for thrombotic events, organ failure, and death. Racial disparities were associated with adverse outcomes. Our findings compel scientific, clinical, and political effort to improve outcomes for pregnant people with SCD.
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