Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care?
Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care?
复制标题
DOI：
10.1111/j.1471-0528.2008.01860.x
复制
发表时间：
2008-10-01
影响因子：
5.8
通讯作者：
Bouvier-Colle, M-H
中科院分区：
文献类型：
--
作者：
Philibert, M.;Deneux-Tharaux, C.;Bouvier-Colle, M-H
目的 检验以下假设：考虑到个人特征后，法国外国籍妇女的产后孕产妇死亡风险仍然显着较高，并检验死亡妇女所接受的护理质量是否因国籍而异。设计一项全国性病例对照研究。以法国大都市为背景。人口 1996 年至 2001 年期间共有 267 名死于孕产妇死亡的妇女作为病例，并作为代表性样本（n = 13 186）方法 采用多变量逻辑回归计算粗略比值比和调整比值比，并使用卡方检验或 Fisher 精确检验根据国籍比较病例的护理质量。主要结果指标与国籍和护理质量相关的产后孕产妇死亡比值比。结果 考虑到个体特征后，外国妇女产后孕产妇死亡的风险是其两倍。来自撒哈拉以南非洲的女性的比值比为 5.5 (95% CI: 3.3-9.0)，而来自亚洲、北美和南美的女性的比值比为 3.3 (95% CI: 1.7-6.5)。其他欧洲和北非妇女的产后孕产妇死亡风险不存在显着过高。外国女性死于高血压或感染的风险是其四倍。在死亡的女性中，外国女性的护理通常被认为不是最佳的（78％对57％）。 结论 在考虑到个人特征后，外国女性的产后孕产妇死亡风险仍然过高，这对于某些民族和某些死因（主要是高血压疾病）尤其重要。这些结果表明，迫切需要特别关注产前护理、高血压筛查和产前管理的早期登记，特别是撒哈拉以南非洲国籍的妇女。
Objectives To test the hypothesis that the risk of postpartum maternal death in France remains significantly higher for women of foreign nationality after individual characteristics are taken into account and to examine whether the quality of care received by the women who died differs according to nationality.Design A national case-control study.Setting Metropolitan France.Population A total of 267 women who died of maternal death from 1996 to 2001 as cases and a representative sample (n = 13 186) of women who gave birth in 1998 as controls.Methods Crude and adjusted odd ratios were calculated with multivariate logistic regression, and the quality of care for cases was compared according to nationality with chi-square tests or Fisher's exact tests.Main outcome measures Odd ratio for postpartum maternal death associated with nationality and quality of care.Results After taking individual characteristics into account, the risk of postpartum maternal death was twice as high for foreign women. The odds ratio was 5.5 (95% CI: 3.3-9.0) for women from sub-Saharan Africa and 3.3 (95% CI: 1.7-6.5) for those from Asia, North and South America. There was no significant excess risk of postpartum maternal death for the other European and North Africa women. The risk of dying from hypertensive disorder or infection was four times higher for foreign women. Among women who died, care was more often considered not optimal for foreign women (78 versus 57%).Conclusions The excess risk of postpartum maternal death persisted for foreign women after individual characteristics were taken into account and was especially important for some nationalities and for some causes of death, primarily hypertensive disorders. These results point to an immediate need to pay special attention to early enrolment in prenatal care, screening and prenatal management of hypertension, especially in women of sub-Saharan African nationality.