Departments of Obstetrics and Gynecology and Psychiatry, the Institute for Healthcare Policy and Innovation, and the Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, Michigan; the VA Ann Arbor Healthcare System, Ann Arbor, Michigan; the Departments of Internal Medicine and Pediatrics, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis, Minnesota; the Departments of Obstetrics and Gynecology and Psychiatry, Virginia Commonwealth University, Richmond, Virginia; and the Department of Anesthesiology, University of Arkansas, Little Rock, Arkansas.
Obstet Gynecol. 2018 Nov;132(5):1158-1166. doi: 10.1097/AOG.0000000000002937.
To describe racial and ethnic disparities in the incidence of severe maternal morbidity during delivery hospitalizations in the United States.
We conducted a pooled, cross-sectional analysis of 2012-2015 data from the National Inpatient Sample to define the prevalence of chronic conditions and incidence of severe maternal morbidity among deliveries to non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, and Native American or Alaska Native women. We used weighted multivariable logistic regression and predictive margins to generate prevalence and incidence estimates. Adjusted rate ratios and differences were calculated to quantify disparities across racial and ethnic categories. Subgroup analyses were performed to examine the incidence of severe maternal morbidity among deliveries to women with comorbid physical health conditions, behavioral health conditions, and multiple chronic conditions within each racial and ethnic category.
The incidence of severe maternal morbidity was significantly higher among deliveries to women in every racial and ethnic minority category compared with deliveries among non-Hispanic white women. Severe maternal morbidity occurred in 231.1 (95% CI 223.6-238.5) and 139.2 (95% CI 136.4-142.0) per 10,000 delivery hospitalizations among non-Hispanic black and non-Hispanic white women, respectively (P<.001). When excluding cases in which blood transfusion was the only indicator of severe maternal morbidity, only deliveries to non-Hispanic black women had a higher incidence of severe maternal morbidity compared with deliveries among non-Hispanic white women: 50.2 (95% CI 47.6-52.9) and 40.9 (95% CI 39.6-42.3) per 10,000 delivery hospitalizations, respectively (risk ratio 1.2 [95% CI 1.2-1.3], risk difference 9.3 [95% CI 6.5-12.2] per 10,000 delivery hospitalizations; P<.001 for each comparison). Among deliveries to women with comorbid physical and behavioral health conditions, significant differences in severe maternal morbidity were identified among racial and ethnic minority compared with non-Hispanic white women and the largest disparities were identified among women with multiple chronic conditions.
Programs for reducing racial and ethnic disparities in severe maternal morbidity may have the greatest effect focusing on women at highest risk for blood transfusion and maternity care management for women with comorbid chronic conditions, particularly multiple chronic conditions.
描述美国分娩住院期间严重产妇发病率的种族和民族差异。
我们对 2012-2015 年国家住院患者样本中的数据进行了汇总、横断面分析，以确定非西班牙裔白人、非西班牙裔黑人、西班牙裔、亚洲或太平洋岛民以及美洲原住民或阿拉斯加原住民女性分娩时慢性疾病的患病率和严重产妇发病率。我们使用加权多变量逻辑回归和预测边际来生成患病率和发病率估计值。计算调整后的率比和差异，以量化各个种族和民族类别的差异。进行亚组分析，以检查在每个种族和民族类别中，患有合并身体健康状况、行为健康状况和多种慢性疾病的女性分娩时严重产妇发病率的情况。
与非西班牙裔白人女性分娩相比，所有少数族裔女性分娩的严重产妇发病率明显更高。非西班牙裔黑人和非西班牙裔白人女性分娩的严重产妇发病率分别为每 10000 例分娩住院 231.1（95%CI 223.6-238.5）和 139.2（95%CI 136.4-142.0）（P<.001）。当排除输血是严重产妇发病率唯一指标的病例时，只有非西班牙裔黑人女性分娩的严重产妇发病率高于非西班牙裔白人女性：每 10000 例分娩住院分别为 50.2（95%CI 47.6-52.9）和 40.9（95%CI 39.6-42.3）（风险比 1.2[95%CI 1.2-1.3]，风险差异每 10000 例分娩住院 9.3[95%CI 6.5-12.2]；每例比较均 P<.001）。在患有合并身体健康和行为健康状况的女性分娩中，与非西班牙裔白人女性相比，少数族裔女性的严重产妇发病率存在显著差异，而患有多种慢性疾病的女性差异最大。
减少严重产妇发病率的种族和民族差异的计划可能会通过重点关注有输血风险和合并慢性疾病（尤其是多种慢性疾病）的产妇护理管理的高危女性，而取得最大效果。
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