Race, Ethnicity, and Nativity Differentials in Pregnancy-Related Mortality in the United States 1993-2006
Race, Ethnicity, and Nativity Differentials in Pregnancy-Related Mortality in the United States 1993-2006
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DOI：
10.1097/aog.0b013e31825cb87a
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发表时间：
2012-08-01
影响因子：
7.2
通讯作者：
Callaghan, William M.
中科院分区：
文献类型：
--
作者：
Creanga, Andreea A.;Berg, Cynthia J.;Callaghan, William M.
目的：比较1993年至2006年按种族、民族和出生的妊娠相关死亡率的趋势和原因。方法：我们使用来自妊娠死亡率监测系统的数据。对于每个种族、民族和出生组，我们计算了与妊娠相关的死亡率，并评估了与妊娠相关的死亡原因以及妊娠结束与死亡之间的时间。结果：种族、族裔和与出生相关的少数族裔妇女占美国所有活产婴儿的40.7%，但在1993-2006年期间，与妊娠相关的7,487例死亡中占61.8%。在美国和外国出生的白人妇女中，与妊娠相关的死亡率分别为每10万活产9.1和7.5例死亡，在美国和外国出生的西班牙裔妇女中，与妊娠相关的死亡率分别略高，为每10万活产9.6和11.6例死亡。与美国出生的白人女性相比，美国和外国出生的黑人女性的年龄标准化怀孕相关死亡率分别高出5.2倍和3.6倍。然而，在美国出生的白人和黑人妇女中，心血管疾病、心肌病和其他先前存在的疾病是导致死亡的主要原因，产后42天内死亡的原因和时间是相似的。高血压疾病、出血和栓塞是所有其他组妇女妊娠相关死亡的最重要原因。结论：除外国出生的白人妇女外，在调整年龄差异后，所有其他种族、民族和出生群体死于妊娠相关原因的风险都高于美国出生的白人妇女。将护理质量方面纳入医院和各州的孕产妇死亡审查可能有助于确定与妊娠相关的死亡率的种族、民族和出生特异性因素。
OBJECTIVE: To compare trends in and causes of pregnancy-related mortality by race, ethnicity, and nativity from 1993 to 2006.METHODS: We used data from the Pregnancy Mortality Surveillance System. For each race, ethnicity, and nativity group, we calculated pregnancy-related mortality ratios and assessed causes of pregnancy-related death and the time between the end of pregnancy and death.RESULTS: Race, ethnicity, and nativity-related minority women contributed 40.7% of all U.S. live births but 61.8% of the 7,487 pregnancy-related deaths during 1993-2006. Pregnancy-related mortality ratios were 9.1 and 7.5 deaths per 100,000 live births among U.S.-and foreign-born white women, respectively, and slightly higher at 9.6 and 11.6 deaths per 100,000 live births for U.S.-and foreign-born Hispanic women, respectively. Relative to U.S.-born white women, age-standardized pregnancy-related mortality ratios were 5.2 and 3.6 times higher among U.S.-and foreign-born black women, respectively. However, causes and timing of death within 42 days postpartum were similar for U.S.-born white and black women with cardiovascular disease, cardiomyopathy, and other pre-existing medical conditions emerging as chief contributors to mortality. Hypertensive disorders, hemorrhage, and embolism were the most important causes of pregnancy-related death for all other groups of women.CONCLUSION: Except for foreign-born white women, all other race, ethnicity, and nativity groups were at higher risk of dying from pregnancy-related causes than U.S.-born white women after adjusting for age differences. Integration of quality-of-care aspects into hospital-and state-based maternal death reviews may help identify race, ethnicity, and nativity-specific factors for pregnancy-related mortality.