Howland Renata E, Angley Meghan, Won Sang Hee, Wilcox Wendy, Searing Hannah, Liu Sze Yan, Johansson Emily White
New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
New York City Health + Hospitals/Kings County, 451 Clarkson Avenue, Brooklyn, NY, 111203, USA.
Matern Child Health J. 2019 Mar;23(3):346-355. doi: 10.1007/s10995-018-2682-z.
Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. Study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008-2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences.
目标 严重孕产妇发病（SMM）是识别和监测改善孕产妇健康工作的一项重要指标。研究已确定了包括种族/族裔在内的独立风险因素；然而，对社会经济因素的调节作用的调查有限。研究目的是量化SMM风险因素，并确定社会经济地位是否会改变种族/族裔对SMM风险的影响。方法 我们使用了2008 - 2012年纽约市的出生证明，并将其与孕产妇分娩的医院出院记录相匹配。SMM是使用疾病控制和预防中心开发的一种算法来定义的。混合效应逻辑回归模型根据人口统计学、社会经济和健康特征估计SMM风险。最终模型按医疗补助状况（作为收入的代理指标）、教育程度和邻里贫困程度进行分层。结果 在588,232例匹配的医院分娩中，有13,505例（每10,000例中有229.6例）发生了SMM。SMM发生率因产妇年龄、出生地、教育程度、收入、既往慢性病、孕前体重状况、产前检查开始的孕周、产次和胎次而异。种族/族裔与SMM始终存在显著关联。虽然SMM风险的种族差异在所有社会经济群体中都存在，但与非拉丁裔白人相比，低收入的拉丁裔和亚太岛民的风险更高。同样，居住在最贫困社区会增加非拉丁裔黑人和拉丁裔的SMM风险。实践结论 纽约市的SMM决定因素反映了全国趋势，包括种族/族裔差异。然而，即使在收入和教育水平最高的群体中，这些差异仍然存在，这表明需要其他途径来解释种族/族裔差异。
