Maternal drug-related death and suicide are leading causes of postpartum death in California
Maternal drug-related death and suicide are leading causes of postpartum death in California
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DOI：
10.1016/j.ajog.2019.05.045
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发表时间：
2019-11-01
影响因子：
9.8
通讯作者：
Margerison, Claire E.
中科院分区：
文献类型：
--
作者：
Goldman-Mellor, Sidra;Margerison, Claire E.
背景：降低孕产妇死亡率是美国和全世界的优先事项。与药物有关的死亡和自杀可能占孕产妇死亡的一个重要的和不断增长的部分，但这些deaths.Objective的发病率和社会人口学的变化信息是稀缺的：我们试图研究在分娩后的12个月内与药物有关的死亡和自杀死亡的发病率，包括社会人口学因素的异质性。研究设计：这项回顾性的、以人群为基础的队列研究随访了2010-2012年期间在加州医院分娩活产婴儿的1，059，713名妇女，以确定孕产妇死亡。使用全州范围内，所有付款人，与医院和死亡data.RESULTS：共有300名妇女在随访期间死亡，死亡率为28.33每10万人年。死亡的主要原因是与产科有关的问题（每100 000人年6.52人）。与毒品有关的死亡是第二大死亡原因（每10万人-年3.68人），自杀是第七大死亡原因（每10万人-年1.42人）;这些死亡合计占所有孕产妇死亡的18%。非西班牙裔白色妇女、医疗保险妇女和居住在小都市地区的妇女特别有可能死于毒品/自杀。三分之二的妇女谁死了，包括74%的那些谁死于药物/自杀，取得了>= 1急诊科或医院就诊之间的分娩和death.CONCLUSION：药物和自杀引起的死亡是一个主要的贡献者死亡率在产后期间，并保证增加临床关注，包括医生和孕产妇死亡率审查委员会的认识作为一个医疗死因。重要的是，急诊科和住院医院的访问可以作为一个点的识别，并最终预防，妇女在这些死亡的风险。
BACKGROUND: Reducing maternal mortality is a priority in the United States and worldwide. Drug-related deaths and suicide may account for a substantial and growing portion of maternal deaths, yet information on the incidence of and sociodemographic variation in these deaths is scarce.OBJECTIVE: We sought to examine incidence of drug-related and suicide deaths in the 12 months after delivery, including heterogeneity by sociodemographic factors. We also explored maternal decedents' health care utilization prior to death.STUDY DESIGN: This retrospective, population-based cohort study followed up 1,059,713 women who delivered a live-born infant in California hospitals during 2010-2012 to ascertain maternal death. Analyses were conducted using statewide, all-payer, longitudinally-linked hospital and death data.RESULTS: A total of 300 women died during follow-up, a rate of 28.33 deaths per 100,000 person-years. The leading cause of death was obstetric-related problems (6.52 per 100,000 person-years). Drug-related deaths were the second leading cause of death (3.68 per 100,000 person-years), and suicide was the seventh leading cause (1.42 per 100,000 person-years); together these deaths comprised 18% of all maternal deaths. Non-Hispanic white women, Medicaid-insured women, and women residing in micropolitan areas were especially likely to die from drugs/suicide. Two thirds of women who died, including 74% of those who died by drugs/suicide, made >= 1 emergency department or hospital visit between their delivery and death.CONCLUSION: Deaths caused by drugs and suicide are a major contributor to mortality in the postpartum period and warrant increased clinical attention, including recognition by physicians and Maternal Mortality Review Committees as a medical cause of death. Importantly, emergency department and inpatient hospital visits may serve as a point of identification of, and eventually prevention for, women at risk for these deaths.