Racial disparities in comorbidity and severe maternal morbidity/mortality in the United States: an analysis of temporal trends
Racial disparities in comorbidity and severe maternal morbidity/mortality in the United States: an analysis of temporal trends
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DOI：
10.1111/aogs.13245
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发表时间：
2018-01-01
影响因子：
4.3
通讯作者：
Ronksley, Paul
中科院分区：
文献类型：
--
作者：
Metcalfe, Amy;Wick, James;Ronksley, Paul
介绍。近年来，美国严重的孕产妇发病率和死亡率有所上升。这一趋势并非在所有种族群体中都是一致的。这背后的原因以及先前存在的疾病、妊娠相关疾病和严重的产妇发病率/死亡率之间的关系尚未得到充分探讨。材料和方法。1993年至2012年期间分娩住院的年度数据来自全国住院患者样本（NIS），占美国各地医院出院样本的20%。采用卡方检验的趋势来检验受产科合并症评分定义的合并症影响的妊娠比例的时间模式，并按产妇种族分层。使用逻辑回归来确定合并症的时间增加对严重产妇发病率/死亡率的影响。结果。1993年，34.3%的孕妇合并症评分为1分；到2012年，这一比例显著上升至44.1% （p < 0.001）。所有种族之间的基线差异（白人33.7%，黑人34.5%，西班牙裔28.0%，亚洲/太平洋岛民28.1%）。尽管所有种族都有显著的增加，但白人的相对变化率最低（增加26.1%），亚洲/太平洋岛民的相对变化率最高（增加49.1%）。随着时间的推移，孕产妇严重发病/死亡的几率稳步增加；然而，调整产科合并症评分显著减弱了这种相关性。结论。在美国孕妇中，既存的合并症和妊娠相关疾病的比率正在增加，并且因种族而有很大差异。这些趋势为了解美国妊娠日益复杂提供了有价值的见解，并解释了观察到的严重产妇发病率/死亡率增加的一部分。
Introduction. Severe maternal morbidity and mortality have increased in the USA in recent years. This trend has not been consistent across all racial groups. The reasons behind this, and the relation between preexisting conditions, pregnancy-associated disease and severe maternal morbidity/mortality, have not been fully explored. Material and methods. Annual data on delivery hospitalizations between 1993 and 2012 were obtained from the Nationwide Inpatient Sample (NIS), representing a 20% sample of hospital discharges from across the USA. Chi-square tests for trend were used to examine temporal patterns in the proportion of pregnancies affected by comorbidities as defined by the Obstetric Comorbidity Score and were stratified by maternal race. Logistic regression was used to determine the impact of temporal increases in comorbidity on severe maternal morbidity/mortality. Results. In 1993, 34.3% of pregnancies had a comorbidity score of 1; this significantly increased to 44.1% by 2012 (p < 0.001). Baseline differences were observed between all races (Whites 33.7%, Blacks 34.5%, Hispanics 28.0%, Asian/Pacific Islanders 28.1%). Although significant increases were observed for all races, the relative rate of change was lowest for Whites (26.1% increase) and highest for Asian/Pacific Islanders (49.1% increase). The odds of severe maternal morbidity/mortality have steadily increased over time; however, adjustment for Obstetric Comorbidity Score significantly attenuates this correlation. Conclusion. The rate of both preexisting comorbidities and pregnancy-associated disease is increasing in pregnant women in the USA and varies substantially by race. These trends provide valuable insight into the increasing complexity of pregnancy in the USA and explain a proportion of the observed increase in severe maternal morbidity/mortality.