Departments of Medical Education, Population Health Science & Policy, Obstetrics, Gynecology, and Reproductive Science, and the Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Obstet Gynecol. 2020 Apr;135(4):896-915. doi: 10.1097/AOG.0000000000003762.
To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research.
We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990-2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States.
Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion.
TABULATION, INTEGRATION, AND RESULTS: Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy-eight of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12), and increased incidence of maternal death and severe maternal morbidity. Only 2 of 83 studies investigated associations between these outcomes and socioeconomic, political, and cultural context (eg, public policy), and 20 of 83 studies investigated material and physical circumstances (eg, neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence.
Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth.
PROSPERO, CRD42018102415.
综合美国健康社会决定因素与妊娠相关死亡率和发病率之间关系的文献，并重点介绍干预和未来研究的机会。
我们使用 Ovid MEDLINE、CINAHL、Popline、Scopus 和 ClinicalTrials.gov（1990-2018 年）进行了系统检索，使用与孕产妇死亡率、发病率和健康社会决定因素相关的 MeSH 术语，并将研究范围限于美国。
选择标准包括研究社会决定因素与不良孕产妇结局（包括妊娠相关死亡、严重孕产妇发病率和急诊住院或再入院）之间关系的研究。使用 Covidence，三位作者筛选了摘要，两位作者筛选了全文以确定是否纳入。
数据提取、综合和结果：两位作者从每篇文章中提取数据，并使用描述性方法进行分析。共有 83 项研究符合纳入标准并进行了分析。83 项研究中的 78 项研究检查了社会经济地位或个体因素作为预测因素，表明少数族裔（58/67 项研究有阳性发现）、公共或无保险（21/30）和较低教育水平（8/12）与孕产妇死亡和严重孕产妇发病率增加之间存在关联的证据。只有 83 项研究中的 2 项研究调查了这些结局与社会经济、政治和文化背景（如公共政策）之间的关联，83 项研究中的 20 项研究调查了物质和物理环境（如邻里环境、隔离），这限制了所研究健康社会决定因素的多样性以及对这些证据的评估。
虽然许多其他重要的社会决定因素，包括作用机制，仍有待更深入地研究，但实证研究为种族和民族、保险和教育在妊娠相关死亡率和严重孕产妇发病率风险中的作用提供了证据。
PROSPERO，CRD42018102415。
