Geographic disparities in peripartum cardiomyopathy outcomes.
Geographic disparities in peripartum cardiomyopathy outcomes.
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DOI：
10.1016/j.ajogmf.2022.100788
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发表时间：
2023-02
影响因子：
6.3
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中科院分区：
文献类型：
--
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在美国，超过三分之一的晚期产后妊娠相关死亡是由心肌病引起的，并且患有心肌病的孕妇的结局存在种族差异。潜在的社区因素可能会导致围产期心肌病结局的差异。本研究旨在确定围产期心肌病结局的地理分布和差异，假设生活在社会脆弱性较高社区的患者可能会出现更差的结局。这是一项对 2000 年 1 月至 2017 年 11 月期间在单个中心根据国家心肺血液研究所定义的围产期心肌病患者进行的回顾性队列研究，不包括那些拥有邮政信箱地址的患者，因为邮政信箱地址可能无法反映患者居住的人口普查区。重度围产期心肌病（与不太严重的围产期心肌病）定义为射血分数<30%、死亡、入住重症监护病房、左心室辅助装置或植入式心脏复律除颤器放置或移植。患者地址的美国人口普查区与疾病控制和预防中心的社会脆弱性指数相关联，该指数是一个社区对外部健康压力的脆弱性的 0 到 1 等级，数值越高表明脆弱性越大。社会脆弱性指数包括社会因素，分为社会经济、家庭构成、少数民族地位、住房类型和交通主题。按围产期心肌病严重程度对患者之间的社会脆弱性指数和社会脆弱性指数组成部分进行比较。在原始队列中的 95 名患者中，有 5 名因使用邮政信箱地址而被排除。其余 90 名患者中，56 名符合严重围产期心肌病标准。在基线时，患有和不患有严重围产期心肌病的个体具有相似的年龄、婚姻状况、付款人类型、吸烟情况、分娩胎龄和分娩方式；然而，与患有较不严重围产期心肌病的个体相比，患有严重围产期心肌病的个体更有可能是黑人（vs 29%；P<.007），并且射血分数（EF）在 12 个月内恢复到 ≥55% 的可能性较小（36% vs 62%；P=.02）。与较轻的围产期心肌病患者相比，重度围产期心肌病患者更有可能生活在社会脆弱性指数较高的地区（0.51 vs 0.31；P=0.002），并且失业、贫困、没有高中文凭、单亲家庭、少数民族、无车辆和机构化集体宿舍的居民较多。患有严重围产期心肌病的个体的社区的中位收入低于患有较轻的围产期心肌病的个体的社区。与围产期心肌病不太严重的患者相比，围产期心肌病严重的患者更有可能生活在社会脆弱性更大的社区。为了减少差距和孕产妇死亡率，可能需要将资源用于社会弱势群体。
Cardiomyopathy causes more than a third of late postpartum pregnancy–related deaths in the United States, and racial disparities in outcomes among pregnant individuals with cardiomyopathy exist. Underlying community factors may contribute to disparities in peripartum cardiomyopathy outcomes. This study aimed to identify the geographic distribution of and disparities in peripartum cardiomyopathy outcomes, hypothesizing that patients living in communities with higher social vulnerability may have worse outcomes. This was a retrospective cohort study of patients with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 at a single center, excluding those with a post office box address as a post office box address may not reflect the census tract in which a patient resides. Severe peripartum cardiomyopathy (vs less severe peripartum cardiomyopathy) was defined as ejection fraction <30%, death, intensive care unit admission, left ventricular assist device or implantable cardioverter defibrillator placement, or transplant. The US census tract for the patient’s address was linked to the Centers for Disease Control and Prevention Social Vulnerability Index, a 0 to 1 scale of a community’s vulnerability to external stresses on health, with higher values indicating greater vulnerability. The Social Vulnerability Index includes social factors divided into socioeconomic, household composition, minority status, and housing type and transportation themes. The Social Vulnerability Index and Social Vulnerability Index components were compared among patients by peripartum cardiomyopathy severity. Of 95 patients in the original cohort, 5 were excluded because of the use of a post office box address. Of the remaining 90 patients, 56 met severe peripartum cardiomyopathy criteria. At baseline, individuals with and without severe peripartum cardiomyopathy had similar ages, marital status, payor type, tobacco use, gestational age at delivery, and mode of delivery; however, individuals with severe peripartum cardiomyopathy were more likely to be Black (vs White) (59% vs 29%; P<.007) and less likely to recover ejection fraction (EF) to ≥55% by 12 months (36% vs 62%; P=.02) than individuals with less severe peripartum cardiomyopathy. Patients with severe peripartum cardiomyopathy were more likely to live in areas with a higher Social Vulnerability Index (0.51 vs 0.31; P=.002) and with more residents who were unemployed, impoverished, without a high school diploma, in single-parent households, of minority status, without a vehicle, and in institutionalized group quarters than patients with less severe peripartum cardiomyopathy. The median income was lower in communities of individuals with severe peripartum cardiomyopathy than in communities of individuals with less severe peripartum cardiomyopathy. Patients with severe peripartum cardiomyopathy outcomes were more likely to live in communities with greater social vulnerability than patients with less severe peripartum cardiomyopathy outcomes. To reduce disparities and maternal mortality rates, resources may need to be directed to socially vulnerable communities.
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影响因子：
3.5
作者：
Zaharatos, Julie;St Pierre, Amy;Goodman, David
通讯作者：
Goodman, David
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通讯作者：
Ickovics, Jeannette R.
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McNamara DM;Elkayam U;Alharethi R;Damp J;Hsich E;Ewald G;Modi K;Alexis JD;Ramani GV;Semigran MJ;Haythe J;Markham DW;Marek J;Gorcsan J 3rd;Wu WC;Lin Y;Halder I;Pisarcik J;Cooper LT;Fett JD;IPAC Investigators
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IPAC Investigators