Department of Anesthesiology and the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; the Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa; and the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Obstet Gynecol. 2021 May 1;137(5):791-800. doi: 10.1097/AOG.0000000000004362.
To analyze racial and ethnic disparities in failure to rescue (ie, death) associated with severe maternal morbidity and describe temporal trends.
This was a retrospective cohort study using administrative data. Data for delivery hospitalizations with severe maternal morbidity, as defined by the Centers for Disease Control and Prevention, were abstracted from the 1999-2017 National Inpatient Sample. Race and ethnicity were categorized into non-Hispanic White (reference), non-Hispanic Black, Hispanic, other, and missing. The outcome was failure to rescue from severe maternal morbidity. Disparities were assessed using the failure-to-rescue rate ratio (ratio of the failure-to-rescue rate in the racial and minority group to the failure-to-rescue rate in White women), adjusted for patient and hospital characteristics. Temporal trends in severe maternal morbidity and failure to rescue were assessed.
During the study period, 73,934,559 delivery hospitalizations were identified, including 993,864 with severe maternal morbidity (13.4/1,000; 95% CI 13.3-13.5). Among women with severe maternal morbidity, 4,328 died (4.3/1,000; 95% CI 4.2-4.5). The adjusted failure-to-rescue rate ratio was 1.79 (95% CI 1.77-1.81) for Black women, 1.39 (95% CI 1.37-1.41) for women of other race and ethnicity, 1.43 (95% CI 1.42-1.45) for women with missing race and ethnicity data, and 1.08 (95% CI 1.06-1.09) for Hispanic women. During the study period, the severe maternal morbidity rate increased significantly in each of the five racial and ethnic groups but started declining in 2012. Meanwhile, the failure-to-rescue rate decreased significantly during the entire study period.
Despite improvement over time, failure to rescue from severe maternal morbidity remains a major contributing factor to excess maternal mortality in racial and ethnic minority women.
分析与严重产妇发病率相关的未能挽救（即死亡）的种族和民族差异，并描述其时间趋势。
这是一项使用行政数据的回顾性队列研究。从 1999 年至 2017 年的国家住院患者样本中提取了由疾病控制与预防中心定义的严重产妇发病率的分娩住院数据。种族和民族分为非西班牙裔白人（参考）、非西班牙裔黑人、西班牙裔、其他和缺失。结局是严重产妇发病率的未能挽救。使用未能挽救率比值（种族和少数民族群体的未能挽救率与白人女性的未能挽救率之比）评估差异，并调整了患者和医院特征。评估了严重产妇发病率和未能挽救的时间趋势。
在研究期间，确定了 73934559 次分娩住院治疗，其中 993864 例患有严重产妇发病率（13.4/1000；95%CI 13.3-13.5）。在患有严重产妇发病率的女性中，有 4328 人死亡（4.3/1000；95%CI 4.2-4.5）。黑人女性的调整后未能挽救率比值为 1.79（95%CI 1.77-1.81），其他种族和民族女性为 1.39（95%CI 1.37-1.41），种族和民族数据缺失的女性为 1.43（95%CI 1.42-1.45），西班牙裔女性为 1.08（95%CI 1.06-1.09）。在研究期间，五种种族和民族群体的严重产妇发病率均显著增加，但从 2012 年开始下降。与此同时，整个研究期间未能挽救的比率显著下降。
尽管随着时间的推移有所改善，但严重产妇发病率的未能挽救仍然是导致少数族裔女性产妇死亡率过高的一个主要因素。
