Structural Racism and Severe Maternal Morbidity in New York State.
Structural Racism and Severe Maternal Morbidity in New York State.
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纽约州的结构性种族主义和严重的孕产妇发病率。
DOI：
10.1177/1179562x19854778
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Kaplan D
中科院分区：
文献类型：
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作者：
Liu SY;Fiorentini C;Bailey Z;Huynh M;McVeigh K;Kaplan D
我们研究了纽约州县级结构性种族主义指标与严重孕产妇发病率 (SMM) 几率之间的关联。我们将 2011 年至 2013 年纽约州卫生部全州规划和研究合作系统 (SPARCS) 的个人住院数据与美国社区调查和维拉司法研究所的县级数据合并 (n = 244 854)。我们样本中每个县的结构性种族主义被构建为女性受教育程度、女性就业和监禁方面的种族不平等（黑人与白人人口的比例）。多级逻辑回归分析估计了每个结构性种族主义指标与 SMM 之间的关联，考虑了个人和医院层面的特征以及设施的聚集。在针对个人和医院层面因素进行调整的模型中，县级女性受教育程度的种族不平等与较小但具有统计学意义的较高 SMM 几率相关（优势比 [OR] = 1.17，95% 置信区间 [CI] = 1.47、1.85）。县级女性就业不平等和监禁不平等的结构性种族主义指标在统计上不显着。检查种族与每个结构性种族主义指标的潜在影响测量修改的交互项也表明没有统计差异。对孕产妇差异的研究应考虑结构性种族主义的多个维度，将其作为 SMM 的促成原因，并作为潜在干预的额外领域。
We examined the association between county-level structural racism indicators and the odds of severe maternal morbidity (SMM) in New York State. We merged individual-level hospitalization data from the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) with county-level data from the American Community Survey and the Vera Institute of Justice from 2011 to 2013 (n = 244 854). Structural racism in each county included in our sample was constructed as the racial inequity (ratio of black to white population) in female educational attainment, female employment, and incarceration. Multilevel logistic regression analysis estimated the association between each of these structural racism indicators and SMM, accounting for individual- and hospital-level characteristics and clustering in facilities. In the models adjusted for individual- and hospital-level factors, county-level racial inequity in female educational attainment was associated with small but statistically significant higher odds of SMM (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.47, 1.85). County-level structural racism indicators of female employment inequity and incarceration inequity were not statistically significant. Interaction terms examining potential effect measure modification by race with each structural racism indicator also indicated no statistical difference. Studies of maternal disparities should consider multiple dimensions of structural racism as a contributing cause to SMM and as an additional area for potential intervention.