Frederiksen Brittni N, Lillehoj Catherine J, Kane Debra J, Goodman Dave, Rankin Kristin
Iowa Department of Public Health, Bureau of Family Health, Des Moines, IA, USA.
CDC/CSTE Applied Epidemiology Fellowship, Atlanta, GA, USA.
Matern Child Health J. 2017 Sep;21(9):1834-1844. doi: 10.1007/s10995-017-2301-4.
Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009-2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N = 196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa's 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women <20 years and >34 years compared to women 25-34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus.
目的 描述2009年至2014年爱荷华州全州范围内的严重孕产妇发病率（SMM）趋势，并确定与SMM相关的孕产妇特征，包括总体特征以及按年龄组划分的特征。方法 我们使用2009 - 2014年爱荷华州链接的出生证明和医院出院数据，根据25种情况定义和24种情况定义来计算SMM。24种情况定义与25种情况定义相似，但不包括输血情况。我们使用国际疾病分类第九版临床修正本（ICD - 9 - CM）诊断和程序代码，计算所有分娩住院病例（N = 196,788）的SMM率。我们使用对数二项回归来评估SMM与孕产妇特征之间的关联，包括总体关联以及按年龄组分层的关联。结果 与全国发病率相比，爱荷华州2009年至2014年的25种情况SMM率有所下降。根据25种情况定义，与25 - 34岁的女性相比，年龄小于20岁和大于34岁的女性SMM率显著更高。输血是最常见的指标，子宫切除术和弥散性血管内凝血（DIC）位列前五位情况之中。根据24种情况定义，年轻女性的SMM率最低，老年女性的SMM率最高。与非西班牙裔白人女性相比，种族/族裔少数群体的SMM率也显著更高。支付方是各年龄组中与SMM差异相关的唯一风险因素。在所有模型中，孕早期开始产前护理对SMM具有保护作用。结论 输血、子宫切除术和DIC的高发生率表明爱荷华州需要重点关注减少出血情况。年轻和老年女性以及种族/族裔少数群体被确定为SMM的高危群体，可能需要特别关注。
