Knight Marian, Bunch Kathryn, Kenyon Sara, Tuffnell Derek, Kurinczuk Jennifer J
National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Institute of Health Sciences, University of Birmingham, Birmingham, UK.
Paediatr Perinat Epidemiol. 2020 Jul;34(4):392-398. doi: 10.1111/ppe.12640. Epub 2020 Feb 3.
Disparities have been documented in maternal mortality rates between women from different ethnic, age and socio-economic groups in the UK. It is unclear whether there are differential changes in these rates amongst women from different groups over time. The objectives of this analysis were to describe UK maternal mortality rates in different age, ethnic and socio-economic groups between 2009 and 2017, and to identify whether there were changes in the observed inequalities, or different trends amongst population subgroups.
Maternal mortality rates with 95% confidence intervals (CI) in specific age, deprivation and ethnic groups were calculated using numbers of maternal deaths as numerator and total maternities as denominator. Relative risks (RR) with 95% CI were calculated and compared using ratios of relative risk. Change over time was investigated using non-parametric tests for trend across ordered groups.
Women from black and Asian groups had a higher mortality rate than white women in most time periods, as did women aged 35 and over and women from the most deprived quintile areas of residence. There was evidence of an increasing trend in maternal mortality amongst black women and a decrease in mortality amongst women from the least deprived areas, but no trends over time in any of the other ethnic, age or IMD groups were seen. There was a widening of the disparity between black and white women (RR 2.59 in 2009-11 compared with 5.27 in 2015-17, ratio of the relative risks 2.03, 95% CI 1.11, 3.72).
The clear differences in the patterns of maternal mortality amongst different ethnic, age and socio-economic groups emphasise the importance of research and policies focussed specifically on women from black and minority ethnic groups, together with other disadvantaged groups, to begin to reduce maternal mortality in the UK.
英国不同种族、年龄和社会经济群体的女性之间，孕产妇死亡率存在差异已被记录在案。目前尚不清楚不同群体的女性死亡率随时间推移是否存在差异变化。本分析的目的是描述2009年至2017年英国不同年龄、种族和社会经济群体的孕产妇死亡率，并确定观察到的不平等现象是否有变化，或不同人群亚组之间是否存在不同趋势。
以孕产妇死亡人数为分子、总生育数为分母，计算特定年龄、贫困程度和种族群体的孕产妇死亡率及95%置信区间（CI）。计算相对风险（RR）及95%CI，并使用相对风险比率进行比较。使用非参数检验对有序组的趋势进行时间变化调查。
在大多数时间段内，黑人和亚裔群体的女性死亡率高于白人女性，35岁及以上的女性以及居住在最贫困五分位数地区的女性也是如此。有证据表明黑人女性的孕产妇死亡率呈上升趋势，而最不贫困地区的女性死亡率有所下降，但在其他任何种族、年龄或收入剥夺分级（IMD）群体中均未发现随时间变化的趋势。黑人和白人女性之间的差距在扩大（2009 - 2011年RR为2.59，而2015 - 2017年为5.27，相对风险比率为2.03，95%CI为1.11, 3.72）。
不同种族、年龄和社会经济群体的孕产妇死亡模式存在明显差异，这凸显了专门针对黑人和少数族裔女性以及其他弱势群体开展研究和制定政策的重要性，以便开始降低英国的孕产妇死亡率。
