Violence As a Direct Cause of and Indirect Contributor to Maternal Death.
Violence As a Direct Cause of and Indirect Contributor to Maternal Death.
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暴力是孕产妇死亡的直接原因和间接原因。
DOI：
10.1089/jwh.2019.8072
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Theall,KatherineP
中科院分区：
文献类型：
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作者：
Wallace,MaeveE;Friar,Norah;Herwehe,Jane;Theall,KatherineP
背景：在美国，怀孕和产后死亡是一个紧迫且日益令人关注的问题。与产科相关的死亡率正在上升，与怀孕相关的凶杀仍然是死亡的主要原因。目前尚不清楚妇女的生活环境如何影响她们在怀孕期间和产后期发生产科死亡或暴力死亡的风险。本研究旨在量化妊娠期间和产后 1 年内因产科相关原因导致的死亡和暴力死亡的发生率，并确定州级暴力犯罪率与妊娠相关死亡率和妊娠相关凶杀发生率之间的关联。 材料和方法：我们对 2011 年至 2015 年参与国家暴力死亡报告系统的 17 个州的所有妊娠相关凶杀案进行了回顾性生态分析。与怀孕相关的死亡率是根据国家卫生统计中心提供的数据，根据同一州和年份发布的死亡记录中潜在死亡原因的国际疾病分类 10 代码确定的。我们对暴力和非暴力孕产妇死亡的死者进行了特征分析（分别为 n=174 和 1,617）。对每个州与怀孕相关的死亡率和与怀孕相关的凶杀案的五年死亡率（每 100,000 名活产婴儿的死亡人数）进行了估计。泊松回归模型估计了暴力犯罪与孕产妇死亡之间的关联，并根据地区社会经济条件进行了调整。结果：在暴力犯罪率较高的州，妊娠相关死亡率和妊娠相关凶杀率均较高（相对风险 [RR] = 1.05，95% 置信区间 [CI] = 1.01–1.12；RR = 1.17，95% CI = 1.01–1.34）。结论：广泛的全民暴力预防工作可能有助于降低产科和暴力原因造成的孕产妇死亡率。
Background:Death during pregnancy and postpartum in the United States is an issue of urgent and growing concern. Mortality from obstetric-related causes is on the rise, and pregnancy-associated homicide remains a leading cause of death. It is unknown how the context in which women live contributes to their risk of obstetric or violent death during pregnancy and the postpartum period. This study aimed to quantify incidence of mortality from obstetric-related causes and violent death during pregnancy and up to 1-year postpartum, and to identify associations between state-level violent crime rates and incidence of pregnancy-related mortality and pregnancy-associated homicide.Materials and Methods:We conducted a retrospective, ecologic analysis of all pregnancy-associated homicides in 17 states participating in the National Violent Death Reporting System from 2011 to 2015. Pregnancy-related mortality was identified by International Classification of Diseases-10 code for underlying cause of death in death records issued in the same states and years, data provided by the National Center for Health Statistics. We characterized decedents of both violent and nonviolent maternal death (n= 174 and 1,617, respectively). Five-year mortality ratios (deaths per 100,000 live births) were estimated for both pregnancy-related mortality and pregnancy-associated homicide in every state. Poisson regression models estimated associations between violent crime and maternal death, adjusting for area-level socioeconomic conditions.Results:Both pregnancy-related mortality and pregnancy-associated homicide ratios were higher in states with higher rates of violent crime (relative risk [RR] = 1.05, 95% confidence interval [CI] = 1.01–1.12; RR = 1.17, 95% CI = 1.01–1.34, respectively).Conclusion:Broad population-wide violence prevention efforts may help reduce incidence of maternal mortality from both obstetric and violent causes.