Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada.
Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada.
Am Heart J. 2022 Dec;254:35-47. doi: 10.1016/j.ahj.2022.07.009. Epub 2022 Aug 6.
To synthesize existing evidence on Black-White disparities in the prevalence of severe cardiovascular maternal morbidity.
We searched MEDLINE, EMBASE, and CINAHL for observational studies published before July 31, 2021 that compared the risk of severe cardiovascular maternal morbidity between Black and White women. The outcome was severe cardiovascular maternal morbidity, including acute myocardial infarction, peripartum cardiomyopathy, and stroke during pregnancy, delivery, or postpartum. We extracted relevant information including adjusted and unadjusted effect estimates. We used random-effects models to estimate the pooled association between race and severe cardiovascular maternal morbidity, presented as odds ratios with 95% confidence intervals for the comparison of Black women relative to White women.
We included 18 studies that met the eligibility criteria for systematic review and meta-analysis. All studies were conducted in the United States and included a total of 7,656,876 Black women and 26,412,600 White women. Compared with White women, Black women had an increased risk of any severe cardiovascular maternal morbidity (adjusted odds ratio, 1.90; 95% confidence interval, 1.54-2.33). Black women were at risk of acute myocardial infarction (adjusted odds ratio, 1.38; 95% confidence interval, 1.14-1.68), peripartum cardiomyopathy (adjusted odds ratio, 1.71; 95% confidence interval, 1.51-1.94), and stroke (adjusted odds ratio, 2.13; 95% confidence interval, 1.39-3.26).
Black women have a considerably higher risk of severe cardiovascular maternal morbidity than White women, including acute myocardial infarction, peripartum cardiomyopathy, and stroke. Reducing inequality in adverse cardiovascular outcomes of pregnancy between Black and White women should be prioritized.
综合现有证据，探讨黑人和白人在严重心血管产妇发病率方面的差异。
我们检索了 MEDLINE、EMBASE 和 CINAHL，以获取截至 2021 年 7 月 31 日发表的比较黑人和白人妇女严重心血管产妇发病率风险的观察性研究。结局为严重心血管产妇发病率，包括妊娠、分娩或产后期间的急性心肌梗死、围产期心肌病和中风。我们提取了包括调整和未调整的效应估计值在内的相关信息。我们使用随机效应模型来估计种族与严重心血管产妇发病率之间的关联，呈现出黑人妇女与白人妇女相比的比值比及其 95%置信区间。
我们纳入了 18 项符合系统评价和荟萃分析纳入标准的研究。所有研究均在美国进行，共纳入了 7656876 名黑人妇女和 26412600 名白人妇女。与白人妇女相比，黑人妇女发生任何严重心血管产妇发病率的风险增加（调整后的比值比，1.90；95%置信区间，1.54-2.33）。黑人妇女发生急性心肌梗死的风险增加（调整后的比值比，1.38；95%置信区间，1.14-1.68）、围产期心肌病（调整后的比值比，1.71；95%置信区间，1.51-1.94）和中风（调整后的比值比，2.13；95%置信区间，1.39-3.26）的风险增加。
黑人妇女发生严重心血管产妇发病率的风险明显高于白人妇女，包括急性心肌梗死、围产期心肌病和中风。应优先考虑减少黑人和白人妇女妊娠期间不良心血管结局的不平等。
