From the *Divisions of General Obstetrics & Gynecology and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; †Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois; and ‡Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Anesth Analg. 2017 Mar;124(3):879-886. doi: 10.1213/ANE.0000000000001778.
Asian American/Pacific Islanders (AAPIs) are the fastest-growing racial group in the United States. Despite a higher socioeconomic status, AAPI women experience higher rates of maternal morbidity and mortality.
Using the National Inpatient Sample, we performed a retrospective cohort analysis of women who were hospitalized for delivery from 2002 to 2013. The primary outcome variable was inpatient mortality rate, and the presence of severe maternal morbidities was estimated using the Bateman Comorbidity Index, a validated tool for predicting obstetric morbidity.
AAPI women presenting for delivery between 2003 and 2012 were older, more likely to reside in a zip code in the top quartile of annual income, be privately insured than Caucasian women, and less likely to have a higher Bateman Comorbidity Index. However, AAPI women had a higher likelihood of postpartum hemorrhage (3.4% vs 2.7%, P < .001), uterine atony, severe perineal lacerations, and severe maternal morbidities. Procedures such as transfusion, hysterectomy, and mechanical ventilation were also more common in AAPI women. Furthermore, AAPI women had a higher mortality rate that persisted despite adjustment for an apparently higher income and comorbidities (odds ratio 1.72, 95% confidence interval: 1.14-2.59, P = .01).
Despite having a higher socioeconomic status, AAPI women had higher rates of maternal mortality during hospitalization for delivery. This increase persisted even after adjustment for factors known to affect peripartum outcomes. Further investigation is needed to better clarify the causes of racial differences in maternal morbidity and mortality.
亚裔美国人/太平洋岛民（AAPI）是美国增长最快的种族群体。尽管 AAPI 女性具有较高的社会经济地位，但她们的孕产妇发病率和死亡率却更高。
我们使用国家住院患者样本，对 2002 年至 2013 年期间因分娩住院的女性进行了回顾性队列分析。主要结局变量为住院死亡率，使用 Bateman 合并症指数来估计严重产妇合并症的存在，Bateman 合并症指数是一种预测产科合并症的有效工具。
2003 年至 2012 年期间因分娩而就诊的 AAPI 女性年龄较大，更有可能居住在年收入最高四分之一的邮政编码区，私人保险的比例高于白人女性，Bateman 合并症指数较高的比例较低。然而，AAPI 女性产后出血的可能性更高（3.4%比 2.7%，P<.001）、宫缩乏力、严重会阴裂伤和严重产妇合并症。输血、子宫切除术和机械通气等程序在 AAPI 女性中也更为常见。此外，尽管 AAPI 女性的收入和合并症似乎更高，但她们的死亡率仍然更高（优势比 1.72，95%置信区间：1.14-2.59，P=0.01）。
尽管 AAPI 女性具有较高的社会经济地位，但在分娩住院期间，她们的孕产妇死亡率更高。即使在调整了已知影响围产期结局的因素后，这种增加仍然存在。需要进一步调查以更好地阐明产妇发病率和死亡率的种族差异的原因。
