路易斯安那州的产妇保健荒漠与妊娠相关死亡率。
Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana.
机构信息
Mary Amelia Community Women's Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Mary Amelia Community Women's Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
出版信息
Womens Health Issues. 2021 Mar-Apr;31(2):122-129. doi: 10.1016/j.whi.2020.09.004. Epub 2020 Oct 14.
BACKGROUND
Maternal mortality is an issue of growing concern in the United States, where the incidence of death during pregnancy and postpartum seems to be increasing. The purpose of this analysis was to explore whether residing in a maternity care desert (defined as a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with risk of death during pregnancy and up to 1 year postpartum among women in Louisiana from 2016 to 2017.
METHODS
Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all pregnancy-associated deaths verified by the Louisiana Department of Health (n = 112 from 2016 to 2017) and geocoded live births occurring in Louisiana during the same time period (n = 101,484), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory spatial analysis to identify significant associations between place of residence and risk of death.
RESULTS
We found that the risk of death during pregnancy and up to 1 year postpartum owing to any cause (pregnancy-associated mortality) and in particular death owing to obstetric causes (pregnancy-related mortality) was significantly elevated among women residing in maternity care deserts compared with women in areas with greater access (adjusted risk ratio [aRR] for pregnancy-associated mortality, 1.91; 95% confidence interval [CI], 1.15-3.18; aRR for pregnancy-related mortality, 3.37; 95% CI, 1.71-6.65). A large racial inequity in risk persisted above and beyond differences in geographic access to maternity care (non-Hispanic Black vs. non-Hispanic White aRR for pregnancy-associated mortality, 2.22; 95% CI, 1.39-3.56; aRR for pregnancy-related mortality, 2.66; 95% CI, 1.16-6.12).
CONCLUSIONS
Ensuring access to maternity care may be an important step toward maternal mortality prevention, but may alone be insufficient for achieving maternal health equity.
背景
孕产妇死亡率是美国日益关注的问题，美国妊娠和产后期间的死亡率似乎在不断上升。本分析的目的是探讨在路易斯安那州，2016 年至 2017 年期间，居住在产妇护理荒漠（定义为没有提供产科护理的医院，也没有妇产科医生或认证的注册护士助产士提供者的县）是否与妊娠期间和产后 1 年内的死亡风险相关。
方法
使用 March of Dimes 提供的数据，根据获得产妇护理的程度对路易斯安那州的各县进行分类。使用经路易斯安那州卫生部验证的所有妊娠相关死亡数据（2016 年至 2017 年期间为 112 例）和同期在路易斯安那州发生的活产儿的地理编码数据（101484 例），我们拟合了调整后的改良泊松回归模型，采用广义估计方程和探索性空间分析来确定居住地与死亡风险之间的显著关联。
结果
我们发现，与在获得更多产妇护理的地区的女性相比，居住在产妇护理荒漠的女性在妊娠期间和产后 1 年内死于任何原因（妊娠相关死亡），特别是死于产科原因（妊娠相关死亡）的风险显著升高（妊娠相关死亡的调整后风险比 [aRR]，1.91；95%置信区间 [CI]，1.15-3.18；妊娠相关死亡的 aRR，3.37；95% CI，1.71-6.65）。在考虑到产妇护理地理获得差异之外，风险仍然存在很大的种族不平等（非西班牙裔黑人 vs. 非西班牙裔白人妊娠相关死亡的 aRR，2.22；95% CI，1.39-3.56；妊娠相关死亡的 aRR，2.66；95% CI，1.16-6.12）。
结论
确保产妇护理的获得可能是预防孕产妇死亡的重要步骤，但可能不足以实现孕产妇健康公平。
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