医疗理赔中确定的有健康状况导致残疾风险的女性的妊娠特征及结局
Pregnancy Characteristics and Outcomes among Women at Risk for Disability from Health Conditions Identified in Medical Claims.
作者信息
Clements Karen M, Mitra Monika, Zhang Jianying, Iezzoni Lisa I
机构信息
Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
出版信息
Womens Health Issues. 2016 Sep-Oct;26(5):504-10. doi: 10.1016/j.whi.2016.06.001. Epub 2016 Jul 28.
BACKGROUND
Women with disabilities are at risk for poor birth outcomes. Little is known about specific potentially disabling health conditions and their effects on pregnancies. Using hospital claims, we identified women at risk for disability and evaluated the relationship between disability risk and demographic characteristics, pregnancy risks, and infant and maternal outcomes.
METHODS
The 2006 through 2009 Massachusetts Pregnancy to Early Life Longitudinal data system linked birth certificate and hospital claims one year pre-pregnancy through delivery. Access Risk Classification System categorized International Classification of Diseases, Ninth Revision, Clinical Modification/Current Procedural Terminology codes into disability risk groups (no/limited vs. medium/high). Generalized estimating equations evaluated the association between disability risk and infant and maternal outcomes.
RESULTS
Of 221,867 women, 14,701 (6.6%) were at medium or high risk of disability. Health conditions were classified as circulatory (23%), musculoskeletal (10%), nervous system/sensory (13%), other physical (19%), two or more physical (5%), mental illness (24%), and comorbid mental/physical (6%). Women at risk of disability were more likely than others to have socioeconomic and pregnancy risks, and adverse infant and maternal outcomes. Socioeconomic and risk profile varied by health condition category. Adjusted risk ratios for preterm birth ranged from 1.2 (95% confidence interval [CI], 1.1-1.4) for women with nervous system/sensory diagnoses to 1.6 (95% CI, 1.4-1.9) for women with two or more physical diagnoses; risk ratios for maternal delivery hospitalization for more than 5 days ranged from 1.5 (95% CI, 1.2-1.9) for women with musculoskeletal diagnoses to 3.0 (95% CI, 2.5-3.6) for women with comorbid mental/physical diagnoses.
CONCLUSIONS
Disability risk identified through claims is associated with poor infant and maternal outcomes. Risk profiles vary by underlying health condition.
背景
残疾女性分娩结局不良的风险较高。对于特定的潜在致残健康状况及其对妊娠的影响，我们知之甚少。利用医院理赔数据，我们识别出有残疾风险的女性，并评估了残疾风险与人口统计学特征、妊娠风险以及母婴结局之间的关系。
方法
2006年至2009年马萨诸塞州妊娠至早期生命纵向数据系统将出生证明与妊娠前一年至分娩期间的医院理赔数据相链接。准入风险分类系统将国际疾病分类第九版临床修订本/当前操作术语编码分类为残疾风险组（无/低风险与中/高风险）。广义估计方程评估了残疾风险与母婴结局之间的关联。
结果
在221,867名女性中，14,701名（6.6%）有中度或高度残疾风险。健康状况分为循环系统疾病（23%）、肌肉骨骼疾病（10%）、神经系统/感觉器官疾病（13%）、其他身体疾病（19%）、两种或更多身体疾病（5%）、精神疾病（24%）以及精神/身体合并疾病（6%）。有残疾风险的女性比其他女性更有可能面临社会经济和妊娠风险，以及不良的母婴结局。社会经济状况和风险概况因健康状况类别而异。早产的校正风险比范围为：神经系统/感觉器官疾病诊断的女性为1.2（95%置信区间[CI]，1.1 - 1.4），两种或更多身体疾病诊断的女性为1.6（95%CI，1.4 - 1.9）；产妇分娩住院超过5天的风险比范围为：肌肉骨骼疾病诊断的女性为1.5（95%CI，1.2 - 1.9），精神/身体合并疾病诊断的女性为3.0（95%CI，2.5 - 3.6）。
结论
通过理赔数据识别出的残疾风险与不良的母婴结局相关。风险概况因潜在健康状况而异。
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