Severe Maternal Morbidity and Mortality Among Indigenous Women in the United States
Severe Maternal Morbidity and Mortality Among Indigenous Women in the United States
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DOI：
10.1097/aog.0000000000003647
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发表时间：
2020-02-01
影响因子：
7.2
通讯作者：
Admon, Lindsay K.
中科院分区：
文献类型：
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作者：
Kozhimannil, Katy B.;Interrante, Julia D.;Admon, Lindsay K.
目的：描述土著妇女与非西班牙裔白色（白色）妇女相比与分娩有关的严重孕产妇发病率和死亡率，区分农村和城市居民。方法：我们使用了2012-2015年全国住院患者样本的产妇出院数据，对分娩的土著和白色患者进行了汇总的横断面分析。我们使用加权多变量逻辑回归和预测人口界值来测量土著和白色患者的健康状况和严重孕产妇发病率和死亡率（使用国际疾病分类，第九次修订，临床修改诊断和程序代码确定），以检验两组之间的差异，并检验每个种族类别中农村和城市居民之间的差异。结果：我们确定了估计7，561，729例（未加权n= 1，417，500）分娩住院病例纳入分析中。其中，土著妇女估计有101 493人（未加权n= 19 080），白色妇女估计有7 460 236人（未加权n= 1 398 420）。与白色妇女相比，土著妇女的严重孕产妇发病率和死亡率更高（分别为2.0%和1.1%;相对风险[RR] 1.8，95% CI 1.6-2.0）。在每个群体中，农村居民的发病率高于城市居民（农村土著妇女为2.3%，城市土著妇女为1.8%[RR 1.3，95% CI 1.0-1.6];农村白色妇女为1.3%，城市白色妇女为1.2%[RR 1.1，95% CI 1.1-1.2]）。结论：与白色妇女相比，土著妇女的严重孕产妇发病率和死亡率较高。农村土著居民的发病率最高。改善产妇保健的努力应侧重于风险最大的人口，包括农村土著人口。
OBJECTIVE: To describe delivery-related severe maternal morbidity and mortality among indigenous women compared with non-Hispanic white (white) women, distinguishing rural and urban residents. METHODS: We used 2012-2015 maternal hospital discharge data from the National Inpatient Sample to conduct a pooled, cross-sectional analysis of indigenous and white patients who gave birth. We used weighted multivariable logistic regression and predictive population margins to measure health conditions and severe maternal morbidity and mortality (identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes) among indigenous and white patients, to test for differences across both groups, and to test for differences between rural and urban residents within each racial category. RESULTS: We identified an estimated 7,561,729 (unweighted n=1,417,500) childbirth hospitalizations that were included in the analyses. Of those, an estimated 101,493 (unweighted n=19,080) were among indigenous women, and an estimated 7,460,236 (unweighted n=1,398,420) were among white women. The incidence of severe maternal morbidity and mortality was greater among indigenous women compared with white women (2.0% vs 1.1%, respectively; relative risk [RR] 1.8, 95% CI 1.6-2.0). Within each group, incidence was higher among rural compared with urban residents (2.3% for rural indigenous women vs 1.8% for urban indigenous women [RR 1.3, 95% CI 1.0-1.6]; 1.3% for rural white women vs 1.2% for urban white women [RR 1.1, 95% CI 1.1-1.2]). CONCLUSION: Severe maternal morbidity and mortality is elevated among indigenous women compared with white women. Incidence is highest among rural indigenous residents. Efforts to improve maternal health should focus on populations at greatest risk, including rural indigenous populations.