Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.
BMJ Open. 2020 Nov 4;10(11):e039260. doi: 10.1136/bmjopen-2020-039260.
To assess the scale of ethnic inequalities in severe maternal morbidity (SMM) rates and quantify the contribution of maternal characteristics to these disparities.
Retrospective cohort study.
Whole-of-population linked administrative data from 2002 to 2015 in Western Australia.
Women with 410 043 birth events (includes all births from the same pregnancy) of 20 weeks' or more gestation, including terminations for congenital anomalies.
Women with SMM were identified based on a composite indicator of SMM using diagnosis and procedure codes developed for use in routinely collected data. Mothers were classified into seven ethnic groups, based on their reported ethnic origin. The associations between maternal ethnic origin and SMM were examined using a log-binomial model, which estimates risk ratios (RRs) and 95% CIs. The Blinder-Oaxaca decomposition technique was employed to partition the disparity in SMM between Aboriginal and Caucasian populations into 'explained' and 'unexplained' components.
During the study period, 9378 SMM cases were documented. In the adjusted model, Aboriginal (RR 1.73, 95% CI 1.59 to 1.87), African (RR 1.64, 95% CI 1.43 to 1.89) and 'other' ethnicity (RR 1.49, 95% CI 1.37 to 1.63) women were at significantly higher risk of SMM compared with Caucasian women. Teenage and older mothers and socioeconomically disadvantaged women were also at greater risk of SMM. Differences in sociodemographic characteristics explained 33.2% of the disparity in SMM between Aboriginal and Caucasian women.
There are distinct disparities in SMM by ethnicity in Western Australia, with a greater risk among Aboriginal and African women. While improvements in SES and a reduction in teenage pregnancy can potentially support a sizeable reduction in SMM rate inequalities, future research should investigate other potential pathways and targeted interventions to close the ethnicity disparity.
评估严重产妇发病率（SMM）率方面的民族不平等程度，并量化产妇特征对这些差异的贡献。
回顾性队列研究。
2002 年至 2015 年西澳大利亚全人群链接行政数据。
妊娠 20 周或以上的 410033 次分娩事件（包括同一妊娠的所有分娩），包括因先天异常而终止妊娠的事件。
使用为常规收集数据开发的诊断和程序代码，根据 SMM 的综合指标确定患有 SMM 的妇女。母亲根据其报告的种族起源分为七个种族群体。使用对数二项式模型检查产妇种族起源与 SMM 之间的关联，该模型估计风险比（RR）和 95%置信区间（CI）。采用布伦纳-奥克萨卡分解技术将 SMM 在土著和白人群体之间的差异划分为“可解释”和“不可解释”部分。
在研究期间，记录了 9378 例 SMM 病例。在调整后的模型中，与白人女性相比，土著（RR1.73，95%CI1.59 至 1.87）、非洲裔（RR1.64，95%CI1.43 至 1.89）和“其他”族裔（RR1.49，95%CI1.37 至 1.63）的女性发生 SMM 的风险明显更高。青少年和老年母亲以及社会经济地位较低的母亲发生 SMM 的风险也更高。社会人口特征的差异解释了 SMM 在土著和白人群体之间差异的 33.2%。
在西澳大利亚，SMM 存在明显的种族差异，土著和非洲裔女性的风险更高。虽然 SES 的改善和减少青少年怀孕可能会支持 SMM 率不平等的大幅减少，但未来的研究应该调查其他潜在途径和有针对性的干预措施，以缩小种族差异。
