University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota; the Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and the Department of Obstetrics and Gynecology and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Obstet Gynecol. 2020 Feb;135(2):294-300. doi: 10.1097/AOG.0000000000003647.
To describe delivery-related severe maternal morbidity and mortality among indigenous women compared with non-Hispanic white (white) women, distinguishing rural and urban residents.
We used 2012-2015 maternal hospital discharge data from the National Inpatient Sample to conduct a pooled, cross-sectional analysis of indigenous and white patients who gave birth. We used weighted multivariable logistic regression and predictive population margins to measure health conditions and severe maternal morbidity and mortality (identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes) among indigenous and white patients, to test for differences across both groups, and to test for differences between rural and urban residents within each racial category.
We identified an estimated 7,561,729 (unweighted n=1,417,500) childbirth hospitalizations that were included in the analyses. Of those, an estimated 101,493 (unweighted n=19,080) were among indigenous women, and an estimated 7,460,236 (unweighted n=1,398,420) were among white women. The incidence of severe maternal morbidity and mortality was greater among indigenous women compared with white women (2.0% vs 1.1%, respectively; relative risk [RR] 1.8, 95% CI 1.6-2.0). Within each group, incidence was higher among rural compared with urban residents (2.3% for rural indigenous women vs 1.8% for urban indigenous women [RR 1.3, 95% CI 1.0-1.6]; 1.3% for rural white women vs 1.2% for urban white women [RR 1.1, 95% CI 1.1-1.2]).
Severe maternal morbidity and mortality is elevated among indigenous women compared with white women. Incidence is highest among rural indigenous residents. Efforts to improve maternal health should focus on populations at greatest risk, including rural indigenous populations.
描述与非西班牙裔白人（白人）妇女相比，土著妇女在分娩相关的严重产妇发病率和死亡率方面的情况，并区分农村和城市居民。
我们使用了 2012 年至 2015 年全国住院患者样本中的产妇住院数据，对分娩的土著和白人患者进行了汇总、横断面分析。我们使用加权多变量逻辑回归和预测人群边缘来衡量土著和白人患者的健康状况以及严重产妇发病率和死亡率（使用国际疾病分类，第九版，临床修正诊断和程序代码识别），以测试两组之间的差异，并测试每个种族类别的农村和城市居民之间的差异。
我们确定了估计有 7561729 例（未加权 n=1417500）分娩住院治疗包括在分析中。其中，估计有 101493 例（未加权 n=19080）发生在土著妇女中，估计有 7460236 例（未加权 n=1398420）发生在白人妇女中。与白人妇女相比，土著妇女的严重产妇发病率和死亡率更高（分别为 2.0%和 1.1%；相对风险 [RR] 1.8，95%置信区间 1.6-2.0）。在每个群体中，农村居民的发病率高于城市居民（农村土著妇女为 2.3%，城市土著妇女为 1.8%[RR 1.3，95%置信区间 1.0-1.6]；农村白人妇女为 1.3%，城市白人妇女为 1.2%[RR 1.1，95%置信区间 1.1-1.2]）。
与白人妇女相比，土著妇女的严重产妇发病率和死亡率较高。发病率在农村土著居民中最高。改善产妇健康的努力应侧重于风险最高的人群，包括农村土著人群。
