Inequalities in maternal health: national cohort study of ethnic variation in severe maternal morbidities.
Inequalities in maternal health: national cohort study of ethnic variation in severe maternal morbidities.
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DOI：
10.1136/bmj.b542
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发表时间：
2009-03-03
期刊：
影响因子：
--
通讯作者：
UKOSS
中科院分区：
文献类型：
--
作者：
Knight M;Kurinczuk JJ;Spark P;Brocklehurst P;UKOSS
目的描述英国严重孕产妇发病率在全国范围内的种族差异。使用英国产科监护系统(UKOSS)设计国家队列研究。在英国所有医院都设置了顾问主导的产科病房。研究对象2005年2月至2006年2月间有严重孕产妇发病率的686名妇女。主要结果衡量不同种族中严重孕产妇发病率的比率、风险比和优势比。结果在775例 186例产妇中报告了6 86例严重孕产妇发病，发病率估计为每10万 000产妇89例(95%可信区间82~95)。74%的女性是白人，26%的女性是非白人。白人妇女患严重孕产妇疾病的风险估计为每10万 000中80例，非白人妇女为每100 000中126例(风险差46(27至66)例/100 000；风险比1.58，95%可信区间1.33至1.87)。与白人妇女相比，非洲黑人妇女(风险差108(18至197)例/10万 000产妇；风险比2.35，1.45至3.81)和加勒比黑人妇女(风险差116(59至172)例/10万 000产妇；风险比2.45，1.81至3.31)风险最高。在调整了年龄、社会经济和吸烟状况、体重指数和产次的差异(优势比1.50、1.15和1.96)后，非白人女性的风险仍然很高。结论在英国，严重的孕产妇发病率在非白人妇女中比在白人妇女中更常见，特别是在非洲和加勒比黑人族群中。这一模式与报告的孕产妇死亡率的种族差异非常相似。这些差异可能是由于先前存在的孕产妇医疗因素，或与怀孕、分娩和分娩期间护理有关的因素；它们不太可能是由于年龄、社会经济或吸烟状况、身体质量指数或产次的差异。这向临床医生和政策制定者强调了为少数民族妇女提供量身定制的产科服务和改善获得护理的机会的重要性。需要关于在英国分娩的妇女种族的全国性信息，以便能够对这些不平等现象进行持续的准确研究。
Objective To describe on a national basis ethnic differences in severe maternal morbidity in the United Kingdom. Design National cohort study using the UK Obstetric Surveillance System (UKOSS). Setting All hospitals with consultant led maternity units in the UK. Participants 686 women with severe maternal morbidity between February 2005 and February 2006. Main outcome measures Rates, risk ratios, and odds ratios of severe maternal morbidity in different ethnic groups. Results 686 cases of severe maternal morbidity were reported in an estimated 775 186 maternities, representing an estimated incidence of 89 (95% confidence interval 82 to 95) cases per 100 000 maternities. 74% of women were white, and 26% were non-white. The estimated risk of severe maternal morbidity in white women was 80 cases per 100 000 maternities, and that in non-white women was 126 cases per 100 000 (risk difference 46 (27 to 66) cases per 100 000; risk ratio 1.58, 95% confidence interval 1.33 to 1.87). Black African women (risk difference 108 (18 to 197) cases per 100 000 maternities; risk ratio 2.35, 1.45 to 3.81) and black Caribbean women (risk difference 116 (59 to 172) cases per 100 000 maternities; risk ratio 2.45, 1.81 to 3.31) had the highest risk compared with white women. The risk in non-white women remained high after adjustment for differences in age, socioeconomic and smoking status, body mass index, and parity (odds ratio 1.50, 1.15 to 1.96). Conclusions Severe maternal morbidity is significantly more common among non-white women than among white women in the UK, particularly in black African and Caribbean ethnic groups. This pattern is very similar to reported ethnic differences in maternal death rates. These differences may be due to the presence of pre-existing maternal medical factors or to factors related to care during pregnancy, labour, and birth; they are unlikely to be due to differences in age, socioeconomic or smoking status, body mass index, or parity. This highlights to clinicians and policy makers the importance of tailored maternity services and improved access to care for women from ethnic minorities. National information on the ethnicity of women giving birth in the UK is needed to enable ongoing accurate study of these inequalities.
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DOI：
10.1111/j.1471-0528.2004.00101.x
发表时间：
2004-05-01
影响因子：
5.8
作者：
Brace, V;Penney, G;Hall, M
通讯作者：
Hall, M
DOI：
10.1111/j.1471-0528.2007.01423.x
发表时间：
2007-09-01
影响因子：
5.8
作者：
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通讯作者：
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DOI：
10.1016/s0301-2115(97)00155-3
发表时间：
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期刊：
EUROPEAN JOURNAL OF OBSTETRICS GYNECOLOGY AND REPRODUCTIVE BIOLOGY
影响因子：
--
作者：
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通讯作者：
Gravenhorst, JB
影响因子：
14.6
作者：
Wen, SW;Huang, L;Kramer, MS
通讯作者：
Kramer, MS
影响因子：
2.1
作者：
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通讯作者：
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