Cosstick Eleanor, Nirmal Rachel, Cross-Sudworth Fiona, Knight Marian, Kenyon Sara
University of Birmingham Medical School, Birmingham B15 2TH, UK.
Institute of Applied Healthcare, University of Birmingham, Birmingham B15 2TT, UK.
EClinicalMedicine. 2022 Jul 29;52:101587. doi: 10.1016/j.eclinm.2022.101587. eCollection 2022 Oct.
Reasons for ethnic disparities in maternal death in the UK are unclear and may be explained by differences in social risk factors and engagement with maternity services.
In this retrospective systematic case note review, we used anonymised medical records from MBRRACE-UK for all Other than White, and White European/Other women plus a random sample of White British/Irish women who died in pregnancy or up to 1 year afterwards from 01/01/2015 to 12/31/2017. We used a standardised data extraction tool developed from a scoping review to explore social risk factors and engagement with maternity services.
Of 489 women identified, 219 were eligible for the study and 196 case notes were reviewed, including 103/119 from Other than White groups, 33/37 White European/Other and a random sample of 60/333 White British/Irish. The presence of three or more social risk factors was 11⋅7% (12/103) in Other than White women, 18⋅2% (6/33) for White European/Other women and 36⋅7% (22/60) in White British/Irish women. Across all groups engagement with maternity services was good with 85⋅5% (148/196) receiving the recommended number of antenatal appointments as was completion of antenatal mental health assessment (123/173, 71⋅1%). 15⋅5% (16/103) of Other than White groups had pre-existing co-morbidities and 51⋅1% (47/92) had previous pregnancy problems while women across White ethnic groups had 3⋅2% (3/93) and 33⋅3% (27/81) respectively. Three or more unscheduled healthcare attendances occurred in 60⋅0% (36/60) of White British/Irish, 39⋅4% (13/33) in White European/Other and 35⋅9% (37/103) of Other than White women. Evidence of barriers to following healthcare advice was identified for a fifth of all women. None of the 17 women who required an interpreter received appropriate provision at all key points throughout their maternity care.
Neither increased social risk factors or barriers to engagement with maternity services appear to underlie disparities in maternal mortality. Management of complex social factors and interpreter services need improvement.
National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands.
英国孕产妇死亡存在种族差异的原因尚不清楚，可能是由社会风险因素和与产科服务的接触差异所导致。
在这项回顾性系统病例记录审查中，我们使用了英国孕产妇和儿童健康保密调查（MBRRACE-UK）中2015年1月1日至2017年12月31日期间所有非白人、白人欧洲/其他女性以及白人英国/爱尔兰女性随机样本的匿名医疗记录，这些女性在孕期或产后1年内死亡。我们使用了从范围审查中开发的标准化数据提取工具，以探索社会风险因素和与产科服务的接触情况。
在确定的489名女性中，219名符合研究条件，审查了196份病例记录，包括非白人组中的103/119份、白人欧洲/其他组中的33/37份以及白人英国/爱尔兰组随机抽取的60/333份。非白人女性中存在三种或更多社会风险因素的比例为11.7%（12/103），白人欧洲/其他女性为18.2%（6/33），白人英国/爱尔兰女性为36.7%（22/60）。在所有组中，与产科服务的接触情况良好，85.5%（148/196）的女性接受了建议的产前检查次数，产前心理健康评估的完成率为71.1%（123/173）。非白人组中有15.5%（16/103）的女性有既往合并症，51.1%（47/92）的女性有既往妊娠问题，而白人种族组的女性分别为3.2%（3/93）和33.3%（27/81）。60.0%（36/60）的白人英国/爱尔兰女性、39.4%（13/33）的白人欧洲/其他女性和35.9%（37/103）的非白人女性有三次或更多次非计划的医疗就诊。在所有女性中，有五分之一的人存在遵循医疗建议的障碍。17名需要口译员的女性中，没有一人在整个产科护理的所有关键环节都得到了适当的服务。
孕产妇死亡率的差异似乎并非由社会风险因素增加或与产科服务接触的障碍所致。复杂社会因素的管理和口译服务需要改进。
英国国家卫生研究院（NIHR）西米德兰兹应用研究合作项目。
