Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
J Womens Health (Larchmt). 2022 Nov;31(11):1614-1619. doi: 10.1089/jwh.2021.0427. Epub 2022 Feb 28.
The Centers for Disease Control and Prevention (CDC) cite an increase of 200% in severe maternal morbidity (SMM) in the United States from 1993 to 2014. This study aims to identify the incidence of SMM in the Military Health System (MHS), along with factors that may be correlated with the risk of SMM and 30-day readmissions among universally insured, ethnically diverse women who delivered in military treatment facilities (MTFs). Using the MHS Data Repository, we conducted a cross-sectional study on all women 15 to 54 years of age who delivered at a MTF during fiscal years 2016 to 2018. Using the CDC's list of 21 indicators and corresponding International Classification of Diseases diagnostic and procedure codes, 10th revision (ICD-10) for SMM, hospitalizations with SMM were identified within our selected group at the time of the delivery, as well as the prevalence of overall 30-day maternal readmissions. Multivariable logistic regressions were conducted to determine the likelihood of SMM and 30-day readmissions, with patient demographics at each delivery as predictor variables. Of the total deliveries, 2.58% had maternal readmissions within 30 days and 0.59% had SMM identified. Women 35-39 years of age and ages 40+ had significantly higher odds of SMM during delivery when compared with women 25-29 years of age. Black women were 1.39 times more likely than White women to be diagnosed with SMM during their delivery admission. Black women also had significantly greater odds of a 30-day postpartum readmission when compared with White women. The low rate of SMM in this population, compared with national data, is a significant finding. The overall 30-day readmission rate in this population is also lower than what has been reported in prior studies. In this study population, women 30-34 are also at higher risk for readmission, which is an area for further study to assess for potential risk factors and underlying causes that may be impacting the higher rates in this age group.
疾病控制与预防中心（CDC）报告称，美国严重产妇发病率（SMM）从 1993 年到 2014 年增加了 200%。本研究旨在确定军事医疗系统（MHS）中的 SMM 发病率，以及可能与 SMM 风险相关的因素和在军事治疗设施（MTF）分娩的普遍受保、种族多样化的女性的 30 天再入院率。使用 MHS 数据仓库，我们对 2016 年至 2018 年在 MTF 分娩的所有 15 至 54 岁的女性进行了一项横断面研究。使用 CDC 的 21 项指标清单和相应的国际疾病分类第十版（ICD-10）的诊断和程序代码，在我们选择的分娩时，在选定的组中确定了 SMM 的住院治疗，并确定了总体 30 天产妇再入院的患病率。进行多变量逻辑回归以确定 SMM 和 30 天再入院的可能性，将每个分娩时的患者人口统计学数据作为预测变量。在总分娩中，有 2.58%的产妇在 30 天内再入院，有 0.59%的产妇发生 SMM。与 25-29 岁的女性相比，35-39 岁和 40 岁以上的女性在分娩时发生 SMM 的可能性显著更高。黑人女性在分娩时被诊断为 SMM 的可能性比白人女性高 1.39 倍。与白人女性相比，黑人女性在产后 30 天再入院的可能性显著更高。与全国数据相比，该人群中的 SMM 发生率较低是一个重要发现。该人群的总体 30 天再入院率也低于之前研究报告的水平。在本研究人群中，30-34 岁的女性再入院的风险也更高，这是一个需要进一步研究的领域，以评估可能影响该年龄组更高发病率的潜在风险因素和根本原因。
