Nurse workforce diversity and reduced risk of severe adverse maternal outcomes.
Nurse workforce diversity and reduced risk of severe adverse maternal outcomes.
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DOI：
10.1016/j.ajogmf.2022.100689
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发表时间：
2022-09
影响因子：
6.3
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中科院分区：
文献类型：
--
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医生和护士队伍的种族和民族多元化被认为是解决孕产妇护理中结构性种族主义影响的一个杠杆点，但目前缺乏支持这一建议的经验证据。评估州级注册护士队伍种族和民族多样性与分娩期间严重不良孕产妇结局之间的关联。这项基于人群的横断面研究分析了2017年美国出生证明数据。严重的不良母体结局包括子痫、输血、子宫切除术或入住重症监护室。每个州的少数民族护士的比例从美国社区调查（5年估计，2013-2017）中提取。这一比例分为三个三分位数，第一个三分位数对应于最低比例，第三个三分位数对应于最高比例。使用逻辑回归模型估计了与少数民族护士比例的百分位数相关的严重不良孕产妇结局的粗比值比（OR）和调整后比值比（OR）以及95%置信区间（CI）。在研究的3，668，813份出生证明中，29，174份记录了严重的不良孕产妇结局（每10，000人中有79.5人; 95% CI：78.6，80.4）。少数民族护士的平均州比例为22.1%，从缅因州的3.3%到夏威夷的68.2%不等。对于白色母亲，在少数民族护士比例第一个三分位数的州分娩的严重不良结局的发生率为85.3/10，000，在第三个三分位数的州分娩的发生率为53.9/10，000（风险差异：-31.4/10，000; 95%CI：-34.4，-28.5）。这相当于在第三个三分位数的状态下分娩的严重不良孕产妇结局风险降低37%（粗OR：0.63; 95%CI：0.60，0.66）。观察到黑人母亲的严重不良孕产妇结局风险降低（粗OR：0.65; 95% CI：0.61，0.70），西班牙裔母亲（粗OR：0.51; 95% CI：0.48，0.54），以及亚裔和太平洋岛民母亲（粗OR：0.65; 95% CI：0.58，0.72），但美洲原住民母亲（粗OR：0.89; 95% CI：0.72，1.09）或多种族母亲（粗OR：1.44; 95% CI：1.22，1.69）则不存在。在对患者和医院特征进行调整后，在第三个三分位数的州分娩与白色母亲严重不良结局风险降低32（调整OR，0.68; 95% CI：0.59，0.77），黑人母亲为20%（调整OR，0.80; 95% CI：0.65，0.99），西班牙裔母亲为31%（调整后OR，0.69; 95% CI：0.58，0.82），而亚裔和太平洋岛民母亲为50%（调整后OR，0.50; 95% CI：0.38，0.65）。少数民族的种族和民族护士的比例与严重不良的孕产妇结局的风险之间的关联在美洲原住民母亲和一个以上的种族母亲中没有统计学意义。当输血被排除在结果测量之外时，结果相似。多样化的州注册护士队伍与分娩期间严重不良孕产妇结局的风险降低有关。国家护士队伍中的种族和民族多样性与白色、黑人、西班牙裔和亚洲/太平洋岛民母亲严重不良孕产妇结局的风险降低相关。
Racial and ethnic diversification of the physician and nurse workforce is suggested as a leverage point to address the impact of structural racism in maternal care but empirical evidence supporting this suggestion is currently lacking. To assess the association between state-level registered nurse workforce racial and ethnic diversity and severe adverse maternal outcomes during childbirth. This population-based cross-sectional study analyzed 2017 US Birth Certificate data. Severe adverse maternal outcomes included eclampsia, blood transfusion, hysterectomy, or intensive care unit admission. Proportions of minoritized racial and ethnic nurses in each state were abstracted from the American Community Survey (5-year estimate, 2013–2017). This proportion was categorized into three terciles, with the first tercile corresponding to the lowest proportion and the third tercile to the highest proportion. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of severe adverse maternal outcomes associated with terciles of the state proportion of minoritized racial and ethnic nurses were estimated using logistic regression models. Of the 3,668,813 birth certificates studied, 29,174 recorded severe adverse maternal outcomes (79.5 per 10,000; 95% CI: 78.6, 80.4). The mean state proportion of minoritized racial and ethnic nurses was 22.1%, ranging from 3.3% in Maine to 68.2% in Hawaii. For White mothers, the incidence of severe adverse outcomes was 85.3 per 10,000 for those who gave births in states in the first tercile of the proportion of minoritized racial and ethnic nurses and 53.9 per 10,000 for those who gave birth in states in the third tercile (risk difference: −31.4 per 10,000; 95% CI: −34.4, −28.5). It corresponds to a 37% decreased risk of severe adverse maternal outcomes associated with giving birth in a state in the third tercile (crude OR: 0.63; 95% CI: 0.60, 0.66). Decreased risk of severe adverse maternal outcomes was observed for Black mothers (crude OR: 0.65; 95% CI: 0.61, 0.70), Hispanic mothers (crude OR: 0.51; 95% CI: 0.48, 0.54), and Asian and Pacific Islander mothers (crude OR: 0.65; 95% CI: 0.58, 0.72) but not for Native American mothers (crude OR: 0.89; 95% CI: 0.72, 1.09) or mothers with more than one race (crude OR: 1.44; 95% CI:1.22, 1.69). After adjustment for patients and hospital characteristics, giving birth in states in the third tercile was associated with a 32% reduced risk of severe adverse outcomes for White mothers (adjusted OR, 0.68; 95% CI: 0.59, 0.77), 20% for Black mothers (adjusted OR, 0.80; 95% CI: 0.65, 0.99), 31% for Hispanic mothers (adjusted OR, 0.69; 95% CI: 0.58, 0.82), and 50% for Asian and Pacific Islander mothers (adjusted OR, 0.50; 95% CI: 0.38, 0.65). The associations of the proportion of minoritized racial and ethnic nurses with the risk of severe adverse maternal outcomes were not statistically significant for Native American mothers and more than one race mothers. Results were similar when blood transfusion was excluded from the outcome measure. A diverse state registered nurse workforce is associated with reduced risk of severe adverse maternal outcomes during childbirth. Racial and ethnic diversity in the state nurse workforce is associated with reduced risk of severe adverse maternal outcomes in White, Black, Hispanic, and Asian/Pacific Islander mothers.
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影响因子：
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作者：
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DOI：
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发表时间：
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影响因子：
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通讯作者：
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