Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study
Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study
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DOI：
10.1016/j.amepre.2019.09.012
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发表时间：
2020-02-01
影响因子：
5.5
通讯作者：
Kaufman, Jay S.
中科院分区：
文献类型：
--
作者：
Hawkins, Summer Sherburne;Ghiani, Marco;Kaufman, Jay S.
简介：最近孕产妇死亡率的上升和持续的差异导致人们猜测为什么美国的孕产妇死亡率高于大多数高收入国家。其目的是检查的影响，在国家一级的因素，considerably与孕产妇死亡率的整体率和种族/ethnication.Methods：这准实验，人口为基础的，差异中的差异研究使用20072015年国家生命统计系统的微数据死亡率文件从38个州和DC。主要暴露是5项州级性健康和生殖健康指标以及6项健康和经济状况。产妇死亡率的定义是每100 000名活产婴儿中怀孕期间或终止妊娠后42天内的妇女死亡人数。使用人种/种族-年龄-州-年份人群作为分母并调整人种/种族、年龄、州和年份，估计差异中差异零膨胀负二项回归模型。2017- 2018年的数据进行了分析。结果：44岁以下妇女中有4,767人死亡，孕产妇死亡率为17.9。将计划生育诊所的比例从州年平均值减少20%，孕产妇死亡率增加了8%（发病率比，1.08; 95% CI=1.04，1.12）。颁布立法限制基于胎龄的堕胎的州使孕产妇死亡率增加了38%（发生率比，1.38; 95% CI=1.03，1.84）。计划生育诊所关闭对所有妇女产生负面影响，增加了6%-15%的死亡率在种族/民族群体，而妊娠期限制主要增加死亡率之间的白色women.Conclusions：最近的财政和立法变化，减少妇女获得计划生育和生殖健康服务，导致孕产妇死亡率上升。(C)2019年美国预防医学杂志。爱思唯尔公司出版All rights reserved.
Introduction: Recent increases in maternal mortality and persistent disparities have led to speculation about why the U.S. has higher rates than most high-income countries. The aim was to examine the impact of changes in state-level factors plausibly linked to maternal mortality on overall rates and by race/ethnicity.Methods: This quasi-experimental, population-based, difference-in-differences study used 20072015 National Vital Statistics System microdata mortality files from 38 states and DC. The primary exposures were 5 state-level sexual and reproductive health indicators and 6 health and economic conditions. Maternal mortality rate was defined as number of deaths of women while pregnant or within 42 days of termination of pregnancy per 100,000 live births. A difference-in-differences zero-inflated negative binomial regression model was estimated using the race/ethnicity-age-state-year population as the denominator and adjusting for race/ethnicity, age, state, and year. Data were analyzed in 2017-2018.Results: There were 4,767 deaths among women up to age 44 years, resulting in a maternal mortality rate of 17.9. Reducing the proportion of Planned Parenthood clinics by 20% from the state-year mean increased the maternal mortality rate by 8% (incidence rate ratio, 1.08; 95% CI=1.04, 1.12). States that enacted legislation to restrict abortions based on gestational age increased the maternal mortality rate by 38% (incidence rate ratio, 1.38; 95% CI=1.03, 1.84). Planned Parenthood clinic closures negatively impacted all women, increasing mortality by 6%-15% across racial/ethnic groups, whereas gestational limits primarily increased mortality among white women.Conclusions: Recent fiscal and legislative changes reducing women's access to family planning and reproductive health services have contributed to rising maternal mortality rates. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.