Racial and Ethnic Disparities in Severe Maternal Morbidity in the United States
Racial and Ethnic Disparities in Severe Maternal Morbidity in the United States
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DOI：
10.1007/s40615-019-00577-w
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发表时间：
2019-08-01
影响因子：
3.9
通讯作者：
Geller, Stacie E.
中科院分区：
文献类型：
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作者：
Liese, Kylea L.;Mogos, Mulubrhan;Geller, Stacie E.
严重孕产妇发病率 (SMM) 比孕产妇死亡常见 50 至 100 倍，并且在美国少数族裔/种族女性中增加得不成比例。然而，关于严重孕产妇疾病的类型和时间如何影响少数民族妇女的具体知识却知之甚少。本研究调查了 2002 年至 2014 年美国 (US) 产前 (AP)、产时 (IP) 和产后 (PP) 住院期间严重孕产妇发病率的种族/民族差异。我们在全国住院患者样本中确定了 AP、IP 和 PP 住院情况。使用描述性统计总结了社会人口统计、行为和医院特征、保险、合并症和 SMM 发生率的分布。通过 Joinpoint 回归，对住院时间的 SMM 趋势进行了检查并按种族进行分层。多变量逻辑回归评估了种族和 SMM 之间的关联。我们发现黑人女性在所有怀孕间隔期间发生 SMM 的比例最高，在调整所有辅助因素后，AP 期间发生 SMM 的风险增加了 70%。在 PP 时期，西班牙裔女性患 SMM 的风险比白人女性低 19%。 SMM 中的种族/民族差异因时间和 SMM 类型而异。需要进行系统调查，以了解黑人妇女面临的风险以及与 PP 中西班牙裔妇女相关的保护因素。解决孕产妇发病率和死亡率方面的种族差异需要针对黑人妇女制定国家政策和举措，解决危及生命的产科并发症的具体类型和发生时间。
Severe maternal morbidity (SMM) is 50 to 100 times more common than maternal death, and has increased disproportionately among ethnic/racial minority women in the United States. However, specific knowledge about how the types and timing of severe maternal morbidities deferentially affect ethnic/racial minority women is poorly understood. This study examines racial/ethnic disparities in severe maternal morbidity during antepartum (AP), intrapartum (IP), and postpartum (PP) hospital admissions in the United States (US) for 2002-2014. We identified AP, IP, and PP hospitalizations in the National Inpatient Sample. Distribution of sociodemographic, behavioral and hospital characteristics, insurance, comorbidities, and SMM occurrence was summarized using descriptive statistics. Through Joinpoint regression, temporal SMM trends of hospitalizations were examined and stratified by race. Multivariate logistic regression assessed the association between race and SMM. We found black women have the highest proportion of SMM across all pregnancy intervals with a 70% greater risk of SMM during AP after adjusting for all cofactors. In the PP period, Hispanic women's risk of SMM is 19% less when compared to white women. Racial/ethnic disparities in SMM vary in timing and SMM type. Systematic investigation is needed to understand risks to black women and the protective factors associated with Hispanic women in the PP. Addressing racial disparities in maternal morbidity and mortality requires national policies and initiatives tailored to black women that address the specific types and timings of life-threatening obstetric complications.