Maternal Outcomes by Race for Women Aged 40 Years or Older.
Maternal Outcomes by Race for Women Aged 40 Years or Older.
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40 岁或以上女性按种族划分的产妇结果。
DOI：
10.1097/aog.0000000000002751
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发表时间：
2018
影响因子：
7.2
通讯作者：
Friedman,AlexanderM
中科院分区：
文献类型：
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作者：
Booker,WhitneyA;Gyamfi-Bannerman,Cynthia;Sheen,Jean-Ju;Wright,JasonD;Siddiq,Zainab;D'Alton,MaryE;Friedman,AlexanderM
目的：为了澄清种族是如何与不利的孕产妇结局和风险的年龄为40岁或以上的women.METHODS：这项回顾性队列研究使用了1998年至2014年的全国住院患者样本。纳入了40-54岁的女性。人种和种族分类为非西班牙裔白色、非西班牙裔黑人、西班牙裔、亚裔或太平洋岛民、美洲原住民、其他和未知。在40岁或以上的女性中，按种族评估了严重孕产妇发病率和总体共病风险的时间趋势，以及常见的妊娠并发症，包括先兆子痫、妊娠期糖尿病和剖宫产。调整后的模型被创建来评估与严重发病率相关的因素。结果：共有1,724,694例分娩被纳入本分析。在研究期间，严重的孕产妇发病率从1998-2000年的1.6%增加到2013 - 2014年的3.0%。黑人妇女在研究期开始（1998-2000年为2.4%）和结束（2013-2014年为4.9%）时的严重发病率最高。在同一时期，基于医疗条件和其他因素的合并症风险按种族整体和个体增加。从1998-2003年到2010-2014年，黑人女性在急性肾衰竭，弥散性血管内凝血，输血和子宫切除术的风险方面也经历了绝对最大的增长。研究结束时，黑人、白色和西班牙裔妇女的妊娠并发症包括先兆子痫、剖宫产和妊娠期糖尿病比研究开始时更常见。与白色人种相比，黑人总体重度发病率的校正风险比为1.81（95% CI 1.76-1.87）。黑人妇女的死亡风险大大高于白色妇女（风险比4.71，95%CI 3.36-6.61），西班牙裔妇女的死亡风险（风险比2.13，95%CI 1.48-3.07）的两倍以上的白色women.CONCLUSION：虽然黑人妇女年龄超过40岁的不良后果和严重的发病率的风险增加，这种差异是较小的幅度比报告的死亡风险。
OBJECTIVE:To clarify how race is associated with adverse maternal outcomes and risk for women aged 40 years or older.METHODS:This retrospective cohort study used the Nationwide Inpatient Sample for the years 1998–2014. Women aged 40–54 years were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. Temporal trends in severe maternal morbidity and overall comorbid risk by race in women aged 40 years or older were evaluated as were common pregnancy complications including preeclampsia, gestational diabetes, and cesarean delivery. Adjusted models were created to assess factors associated with severe morbidity.RESULTS:A total of 1,724,694 deliveries were included in this analysis. Severe maternal morbidity increased over the study period from 1.6% in 1998–2000 to 3.0% from 2013 to 2014. Black women had the highest rates of severe morbidity at both the beginning (2.4% in 1998–2000) and the end (4.9% in 2013–2014) of the study period. During this same period, comorbid risk based on medical conditions and other factors increased overall and individually by race. Black women also experienced the absolute largest increase from 1998–2003 to 2010–2014 in risk for acute renal failure, disseminated intravascular coagulation, transfusion, and hysterectomy. Pregnancy complications including preeclampsia, cesarean delivery, and gestational diabetes were more common at the end compared with the beginning of the study for black, white, and Hispanic women. The adjusted risk ratio for overall severe morbidity for black compared with white race was 1.81 (95% CI 1.76–1.87). Black women had a substantially higher risk of death than white women (risk ratio 4.71, 95% CI 3.36–6.61), and Hispanic women had more than twice the risk of death (risk ratio 2.13, 95% CI 1.48–3.07) as white women.CONCLUSION:Although black women older than 40 years were at increased risk for adverse outcomes and severe morbidity, this differential was of smaller magnitude than reported mortality risk.