Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US.
Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US.
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评估美国妇女在分娩后与严重孕产妇发病率相关的因素。
DOI：
10.1001/jamanetworkopen.2020.36148
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Li R
中科院分区：
文献类型：
--
作者：
Chen J;Cox S;Kuklina EV;Ferre C;Barfield W;Li R
在分娩出院后诊断出的新发重度孕产妇发病率的比例是多少？美国女性中与重度孕产妇发病率相关的最常见因素和孕产妇特征是什么？在这项队列研究中，2010年至2014年期间，美国有2667325名分娩住院的女性，分别有14%和16%的商业和医疗补助保险的重度孕产妇发病率在分娩出院后6周内新发。与分娩后严重孕产妇发病率相关的最常见因素和孕产妇特征与分娩时确定的不同。研究结果表明，将严重孕产妇发病率评估的重点扩大到产后出院期间，可以提高对严重孕产妇发病率的理解，并可能为改善孕产妇保健创造机会。以前的努力，以审查严重的孕产妇发病率（SMM）在美国集中在分娩住院。关于分娩后发生的新生SMM知之甚少。研究美国女性分娩出院后新发SMM的发生率、时间、因素和母亲特征。在这项回顾性队列研究中，来自IBM MarketScan Multi-State Medicaid数据库和IBM MarketScan Commercial Claims and Encounters数据库的数据用于构建年龄在15至44岁之间的女性样本，这些女性在2010年1月1日至2014年9月30日期间分娩。严重的孕产妇发病率报告的诊断时间，并检查了相关的孕产妇特征。医疗补助和商业保险样本中的女性被分为3个不同的结果组：（1）分娩、住院及产后无SMM者（参照组），（2）在分娩住院期间表现出至少1个与SMM相关的因素的患者，和（3）那些在分娩出院后表现出任何与新发SMM相关的因素的患者（定义为分娩住院出院后6周[或42天]内首次在住院环境中诊断的SMM，条件是分娩期间未发现与SMM相关的因素）。数据分析时间为2020年2月至7月。SMM诊断的时间。使用疾病控制和预防中心制定的国际疾病分类第九次修订版临床修改的21个与SMM相关的因素的诊断和程序代码来确定患有SMM的妇女。在2010年至2014年期间，美国共有2667325名妇女因分娩住院;其中，809377名妇女（30.3%）有医疗保险（30.3%;平均[SD]年龄，25.6 [5.5]岁; 51.1%白色），1 857 948名女性（69.7%;平均[SD]年龄，30.6 [5.4]岁; 36.4%来自美国南部地区）有商业保险。在那些有医疗补助保险的妇女中，17584名妇女（2.2%）在分娩住院期间经历了SMM，3265名妇女（0.4%）在分娩出院后经历了新发SMM。在那些有商业保险的妇女中，32079名妇女（1.7%）在分娩住院期间发生了SMM，5275名妇女（0.3%）在出院后发生了新发SMM。共计5275例SMM病例SMM病例3265例，占14.1%（15.7%）分别在商业和医疗补助保险的妇女中，在出院后6周内重新发病;其中，在出院后的前2周内，确定了商业保险队列中的3993例（75.7%）和医疗补助队列中的2399例（73.5%）。与SMM相关的最常见因素因诊断时间而异。在医疗补助人群中，非西班牙裔黑人妇女（调整后的比值比[aOR]，1.53; 95%CI，1.48-1.58），西班牙裔女性（aOR，1.46; 95% CI，1.37-1.57），以及其他种族或民族的女性（aOR，1.40; 95%CI，1.33-1.47）在分娩住院期间SMM的发生率高于非西班牙裔白色妇女;然而，只有黑人和白色妇女之间的差异（aOR，1.69; 95% CI，1.57-1.81）持续到出院后。在这项研究中，医疗补助队列中14.1%的SMM病例和商业保险队列中15.7%的SMM病例首次发生在分娩住院后，与SMM发展相关的因素和母亲特征存在显着差异。这些结果表明，需要扩大SMM评估的重点，以产后出院期间。本队列研究评估了美国女性分娩出院后新发重度孕产妇发病率的发生率、时间、因素和孕产妇特征。
What proportion of de novo severe maternal morbidity is diagnosed after delivery discharge, and what are the most common factors and maternal characteristics associated with severe maternal morbidity among women in the US? In this cohort study of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014, 14% and 16% of severe maternal morbidity among those with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after delivery discharge. The most common factors and maternal characteristics associated with severe maternal morbidity after delivery were different than those identified at delivery. The study’s findings suggest that expanding the focus of severe maternal morbidity assessment to the postdelivery discharge period could improve understanding of severe maternal morbidity and may create opportunities to improve maternity care. Previous efforts to examine severe maternal morbidity (SMM) in the US have focused on delivery hospitalizations. Little is known about de novo SMM that occurs after delivery discharge. To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after delivery discharge among women in the US. In this retrospective cohort study, data from the IBM MarketScan Multi-State Medicaid database and the IBM MarketScan Commercial Claims and Encounters database were used to construct a sample of women aged 15 to 44 years who delivered between January 1, 2010, and September 30, 2014. Severe maternal morbidity was reported by the timing of diagnosis, and the associated maternal characteristics were examined. Women in the Medicaid and commercial insurance sample were classified into 3 distinct outcome groups: (1) those without any SMM during the delivery hospitalization and the postdelivery period (reference group), (2) those who exhibited at least 1 factor associated with SMM during the delivery hospitalization, and (3) those who exhibited any factor associated with de novo SMM after delivery discharge (defined as SMM that was first diagnosed in the inpatient setting during the 6 weeks [or 42 days] after discharge from the delivery hospitalization, conditional on no factor associated with SMM being identified during delivery). Data were analyzed from February to July 2020. Timing of SMM diagnosis. Women with SMM were identified using diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification for the 21 factors associated with SMM that were developed by the Centers for Disease Control and Prevention. A total of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014 were identified; of those, 809 377 women (30.3%) had Medicaid insurance (30.3%; mean [SD] age, 25.6 [5.5] years; 51.1% White), and 1 857 948 women (69.7%; mean [SD] age, 30.6 [5.4] years; 36.4% from the southern region of the US) had commercial insurance. Among those with Medicaid insurance, 17 584 women (2.2%) experienced SMM during the delivery hospitalization, and 3265 women (0.4%) experienced de novo SMM after delivery discharge. Among those with commercial insurance, 32 079 women (1.7%) experienced SMM during the delivery hospitalization, and 5275 women (0.3%) experienced de novo SMM after hospital discharge. A total of 5275 SMM cases (14.1%) and 3265 SMM cases (15.7%) among women with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after hospital discharge; of those, 3993 cases (75.7%) in the commercial insurance cohort and 2399 cases (73.5%) in the Medicaid cohort were identified in the first 2 weeks after discharge. The most common factors associated with SMM varied based on the timing of diagnosis. In the Medicaid population, non-Hispanic Black women (adjusted odds ratio [aOR], 1.53; 95% CI, 1.48-1.58), Hispanic women (aOR, 1.46; 95% CI, 1.37-1.57), and women of other races or ethnicities (aOR, 1.40; 95% CI, 1.33-1.47) had higher rates of SMM during delivery hospitalization than non-Hispanic White women; however, only the disparity between Black and White women (aOR, 1.69; 95% CI, 1.57-1.81) persisted into the postdischarge period. In this study, 14.1% of SMM cases in the Medicaid cohort and 15.7% of SMM cases in the commercial insurance cohort first occurred after the delivery hospitalization, with notable disparities in factors and maternal characteristics associated with the development of SMM. These findings suggest a need to expand the focus of SMM assessment to the postdelivery discharge period. This cohort study assesses the incidence, timing, factors, and maternal characteristics associated with de novo severe maternal morbidity after delivery discharge among women in the US.
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