Neighborhood Racial And Economic Polarization, Hospital Of Delivery, And Severe Maternal Morbidity.
Neighborhood Racial And Economic Polarization, Hospital Of Delivery, And Severe Maternal Morbidity.
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DOI：
10.1377/hlthaff.2019.00735
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发表时间：
2020-05
期刊：
影响因子：
9.7
通讯作者：
Howell, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Janevic, Teresa;Zeitlin, Jennifer;Egorova, Natalia;Hebert, Paul L.;Balbierz, Amy;Howell, Elizabeth A.
最近的国家和州立法提请注意孕产妇死亡率和严重孕产妇发病率方面的明显种族/族裔差异，后者被定义为在分娩期间有危及生命的状况或挽救生命的程序。使用2012-14年纽约市出生和住院数据，我们研究了种族和经济空间极化是否与SMM率相关，以及分娩医院是否部分解释了这种关联。相对于富裕的白人，贫困黑人集中度最高的邮政编码中的妇女每100次分娩中有4.0例SMM，而在集中度最低的社区中，每100次分娩中有1.7例SMM（风险差异=每100例2.4例）。这一差异的35%归因于分娩医院。在高度两极分化的社区中，妇女最有可能在位于类似两极分化社区的医院分娩。针对种族和经济空间极化的住房政策可能会解决SMM的根本原因，而医院质量的改善可能会减轻这种极化的影响。
Recent national and state legislation has called attention to stark racial/ethnic disparities in maternal mortality and severe maternal morbidity (SMM), the latter of which is defined as having a life-threatening condition or life-saving procedure during childbirth. Using linked New York City birth and hospitalization data for 2012–14, we examined whether racial and economic spatial polarization is associated with SMM rates, and whether the delivery hospital partially explains the association. Women in ZIP codes with the highest concentration of poor blacks relative to wealthy whites experienced 4.0 cases of SMM per 100 deliveries, compared with 1.7 cases per 100 deliveries among women in the neighborhoods with the lowest concentration (risk difference = 2.4 cases per 100). Thirty-five percent of this difference was attributable to the delivery hospital. Women in highly polarized neighborhoods were most likely to deliver in hospitals located in similarly polarized neighborhoods. Housing policy that targets racial and economic spatial polarization may address a root cause of SMM, while hospital quality improvement may mitigate the impact of such polarization.
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