Preeclampsia outcomes at delivery and race
Preeclampsia outcomes at delivery and race
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DOI：
10.1080/14767058.2019.1581522
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发表时间：
2020-11-01
影响因子：
1.8
通讯作者：
Friedman, Alexander M.
中科院分区：
文献类型：
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作者：
Gyamfi-Bannerman, Cynthia;Pandita, Ambika;Friedman, Alexander M.
目的：本研究的目的是评估种族如何与子痫前期患者的不良妊娠结局相关。研究设计：这项回顾性队列研究使用了2012-2014年来自卫生保健研究和质量局的全国（全国）住院患者样本（NIS）。年龄在15-54岁的诊断为先兆子痫的妇女被包括在内。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。沿着分析了基于疾病控制和预防中心标准的严重发病率的总体风险以及特定结局的风险，如卒中、急性心力衰竭或肺水肿、子痫和急性肾衰竭。严重发病的风险按共病风险分层，并按种族进行比较。建立对数线性回归模型，以评估重度发病率的风险，风险比和相关的95%置信区间作为效应指标。结果：从2012年到2014年，共有101，741名患有先兆子痫的妇女被纳入这项分析。非西班牙裔黑人女性的严重发病率（9.8%）显著高于非西班牙裔白色、西班牙裔和所有其他女性（分别为6.1%、7.7%和7.5%，p <0.01）。与非西班牙裔白色、西班牙裔和所有其他女性相比，非西班牙裔黑人的中风风险更高（每10，000例分娩分别为17.1 vs 6.5，12.7和9.3，p <0.01）和肺水肿或心力衰竭（每10，000例分娩分别为56.2 vs 32.7、30.2和38.4，p <0.01）。非西班牙裔黑人女性也比非西班牙裔白色女性更容易发生肾衰竭（每10,000例分娩中有136.4例对60.4例，p <0.01）。调整合并症后，黑人妇女仍然有较高的严重发病风险（p <0.01）。与非黑人妇女相比，黑人妇女的死亡风险更高（分别为121.8/100，000次分娩，95%CI 69.7-212.9 vs 24.1/100，000次分娩，95%CI 14.6-39.8，p <0.01）。
Objective:The objective of this study was to assess how race is associated with adverse maternal outcomes in the setting of preeclampsia. Study design:This retrospective cohort study utilized the National (Nationwide) Inpatient Sample (NIS) from the Agency for Health care Research and Quality for the years 2012-2014. Women aged 15-54 with a diagnosis of preeclampsia were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. The overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria was analyzed along with the risk for specific outcomes such as stroke, acute heart failure or pulmonary edema, eclampsia, and acute renal failure. The risk for severe morbidity was stratified by comorbid risk and compared by race. Log-linear regression models were created to assess risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect. Results:A total of 101,741 women with preeclampsia from 2012 to 2014 were included in this analysis. The risk for severe morbidity was significantly higher among non-Hispanic black women (9.8%) than non-Hispanic white, Hispanic, and all other women, respectively (6.1, 7.7, and 7.5%, respectively,p < .01). For non-Hispanic black compared to non-Hispanic white, Hispanic, and all other women, risk was higher for stroke (17.1 versus 6.5, 12.7, and 9.3 per 10,000 deliveries, respectively,p < .01) and pulmonary edema or heart failure (56.2 versus 32.7, 30.2, and 38.4 per 10,000 deliveries, respectively,p < .01). Non-Hispanic black women were also more likely than non-Hispanic white women to experience renal failure (136.4 versus 60.4 per 10,000 deliveries,p < .01). Adjusting for comorbidity, black women remained at higher risk for severe morbidity (p < .01). The risk for death was higher for black compared to non-black women (121.8 per 100,000 deliveries, 95% CI 69.7-212.9 versus 24.1 per 100,000 deliveries, 95% CI 14.6-39.8, respectively,p < .01) Conclusion:Black women were at higher risk for severe morbidity and mortality associated with preeclampsia.