Effects of Hurricane Michael on Access to Care for Pregnant Women and Associated Pregnancy Outcomes.
Effects of Hurricane Michael on Access to Care for Pregnant Women and Associated Pregnancy Outcomes.
复制标题
DOI：
10.3390/ijerph18020390
复制
发表时间：
2021-01-06
影响因子：
--
通讯作者：
Harville EW
中科院分区：
文献类型：
--
作者：
Pan K;Beitsch L;Gonsoroski E;Sherchan SP;Uejio CK;Lichtveld MY;Harville EW
背景：灾难与更糟糕的围产期结局相关，可能是由于产前护理不足（PNC）。方法：使用2017-2019年佛罗里达人口动态统计数据，我们比较了飓风迈克尔前后PNC的使用情况。我们将各县分为受影响最严重的（A区）和受影响较轻的（B区和C区）。我们研究了迈克尔对围产期结局的影响是否因产妇护理的可用性而异，并使用Baron和Kenny方法评估延迟PNC启动是否介导围产期结局。采用对数二项回归和半参数线性回归，控制产妇和邮政编码制表地区的特点。结果如下：与迈克尔之前的一年期相比，迈克尔之后的一年期内，所有地区的第一次PNC周都较晚，其中A区的变化最大（调整后差异0.112，95%CI：0.055-0.169），其中妇女总体上不太可能接受国家保险（aRR = 0.994，95%CI = 0.990-0.998），PNC不足的可能性更大（aRR = 1.193，95%CI = 1.127-1.264）。Michael对围产期结局的影响在A区的产科护理可用性方面没有显著差异。延迟PNC启动似乎介导了Michael后小于胎龄儿（SGA）出生的风险增加。结论：A区妇女启动PNC较晚，PNC不足的可能性较高。延迟PNC启动可能部分解释SGA风险增加。
Background: Disasters are associated with worse perinatal outcomes, perhaps due to inadequate prenatal care (PNC). Methods: Using 2017–2019 Florida vital statistics, we compared PNC use before and after Hurricane Michael. We categorized counties as most affected (Area A) or less affected (Area B and C). We examined whether Michael’s effects on perinatal outcomes varied by maternity care availability and used the Baron and Kenny method to assess whether delayed PNC initiation mediated perinatal outcomes. Log-binomial regression and semi-parametric linear regression were used, controlling for maternal and ZIP code tabulation area characteristics. Results: Compared to the one-year period pre-Michael, the week of the first PNC was later in all areas in the one-year period post-Michael, with the largest change in Area A (adjusted difference 0.112, 95% CI: 0.055–0.169), where women were less likely to receive PNC overall (aRR = 0.994, 95% CI = 0.990–0.998) and more likely to have inadequate PNC (aRR = 1.193, 95% CI = 1.127–1.264). Michael’s effects on perinatal outcomes did not vary significantly by maternity care availability within Area A. Delayed PNC initiation appeared to mediate an increased risk in small for gestational age (SGA) births after Michael. Conclusion: Women in Area A initiated PNC later and had a higher likelihood of inadequate PNC. Delayed PNC initiation may partially explain increased risk of SGA.
登录
查看更多内容
影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
影响因子：
2.3
作者：
Giarratano, Gloria;Harville, Emily W.;de Mendoza, Veronica Barcelona;Savage, Jane;Parent, Charlotte M.
通讯作者：
Parent, Charlotte M.
影响因子：
2.7
作者：
Harville, Emily W.;Tran, Tri;Buekens, Pierre
通讯作者：
Buekens, Pierre
影响因子：
3.5
作者：
Rosales-Rueda, Maria
通讯作者：
Rosales-Rueda, Maria
影响因子：
4.9
作者：
Grubesic, Tony H;Matisziw, Timothy C
通讯作者：
Matisziw, Timothy C