Office of Maternal and Child Health Epidemiology, Maryland Department of Health, Baltimore, MD, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Perinatol. 2018 Aug;38(8):997-1008. doi: 10.1038/s41372-018-0096-9. Epub 2018 Mar 28.
To determine hospital characteristics and quality metrics associated with severe maternal morbidity (SMM) in Maryland.
A population-based observational study of 364,113 statewide delivery hospitalizations during 2010-2015 linked with socio-economic community measures and hospital characteristics and quality measures. Multivariable logistic regression models with generalized estimating equations estimated SMM adjusting for individual, community, and hospital-level factors and clustering within hospitals and residence zip codes.
The SMM prevalence was 197 per 10,000 deliveries. Adjusted SMM risk ratios were higher for younger (<20 years), older (35+ years), non-White non-Hispanic, unmarried, multiple substance users, women with multiple gestations, and chronic medical and mental health conditions than their counterparts. Communities with greater socio-economic disadvantage and hospitals with poorer patient experience and clinical care quality had higher rates of SMM.
Addressing socio-economic disparities and improving quality of care in delivery hospitals are key to reducing the SMM burden in Maryland.
确定与马里兰州严重产妇发病率（SMM）相关的医院特征和质量指标。
对 2010 年至 2015 年期间全州范围内 364113 例分娩住院患者进行基于人群的观察性研究，这些患者与社会经济社区指标以及医院特征和质量指标相关联。使用广义估计方程的多变量逻辑回归模型，在个体、社区和医院水平的因素以及医院和居住邮政编码内的聚类中调整 SMM，对 SMM 进行了调整。
SMM 的患病率为每 10000 例分娩 197 例。与同龄人相比，年龄较小（<20 岁）、年龄较大（35 岁以上）、非白人和非西班牙裔、未婚、多种物质使用者、多胎妊娠以及慢性医疗和心理健康状况的女性的调整后 SMM 风险比更高。社会经济劣势较大的社区和患者体验以及临床护理质量较差的医院的 SMM 发生率更高。
解决社会经济差异并改善分娩医院的护理质量是减轻马里兰州 SMM 负担的关键。
