Am J Epidemiol. 2021 Sep 1;190(9):1890-1897. doi: 10.1093/aje/kwab077.
Severe maternal morbidity (SMM) is a composite outcome measure that indicates serious, potentially life-threatening maternal health problems. There is great interest in defining SMM using administrative data for surveillance and research. In the United States, one common way of defining SMM at the population level is an index developed by the Centers for Disease Control and Prevention. Modifications to this index (e.g., exclusion of maternal blood transfusion) have been proposed; some research defines SMM using an index introduced by Bateman et al. (Obstet Gynecol. 2013;122(5):957-965). Birth certificate data are also increasingly being used to define SMM. We compared commonly used US definitions of SMM among all California births (2007-2012) using the kappa (κ) statistic and other measures. We also evaluated agreement between maternal morbidity fields on the birth certificate as compared with health insurance claims data. Concordance between the 7 definitions of SMM analyzed was generally low (i.e., κ < 0.41 for 13 of 21 two-way comparisons). Low concordance was particularly driven by the presence/absence of transfusion and claims data versus birth certificate definitions. Low agreement between administrative data-based definitions of SMM highlights that results can be expected to differ between them. Further research on validity of SMM definitions, using more fine-grained data sources, is needed.
严重孕产妇发病率（SMM）是一种综合的结局指标，用于表示严重的、可能危及生命的孕产妇健康问题。人们对使用行政数据进行监测和研究来定义 SMM 非常感兴趣。在美国，一种常见的在人群水平定义 SMM 的方法是使用疾病控制和预防中心开发的指标。已经提出了对该指标的修改（例如，排除产妇输血）；一些研究使用 Bateman 等人引入的指标来定义 SMM（Obstet Gynecol. 2013;122(5):957-965）。出生证明数据也越来越多地被用于定义 SMM。我们使用 κ 统计量和其他措施比较了加利福尼亚州所有出生（2007-2012 年）中常用的美国 SMM 定义。我们还评估了出生证明上的孕产妇发病率字段与医疗保险索赔数据之间的一致性。分析的 7 种 SMM 定义之间的一致性通常较低（即，13 对 21 种双向比较中 κ < 0.41）。一致性低主要是由于输血和索赔数据与出生证明定义的存在/不存在所致。基于行政数据的 SMM 定义之间的低一致性表明，预计它们之间的结果会有所不同。需要使用更精细的数据源进一步研究 SMM 定义的有效性。
