Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas.
Am J Perinatol. 2024 May;41(S 01):e477-e485. doi: 10.1055/s-0042-1756141. Epub 2022 Sep 2.
Our aim was to evaluate the impact of social determinants of health (SDoH) risk factors on stillbirth among pregnancy-related hospitalizations in the United States.
We conducted a cross-sectional analysis of delivery-related hospital discharges using annualized data (2016-2017) from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The International Classification of Diseases, 10th Revision ICD-10-CM codes were used to select women with singleton stillbirth. Z-codes were utilized to identify SDoH risk factors and their subtypes. The association between SDoH risk factors and stillbirth was assessed using survey logistic regression models.
We analyzed 8,148,646 hospitalizations, out of which 91,140 were related to stillbirth hospitalizations, yielding a stillbirth incidence of 1.1%. An increased incidence was observed for non-Hispanic (NH) Blacks (1.7%) when compared with NH Whites (1.0%). The incidence of stillbirth was greater in hospitalizations associated with SDoH risk factors compared with those without risk factors [2.0% vs. 1.1% ( <0.001)]. Among patients with SDoH risk factors, the rate of stillbirth was highest in those designated as NH other (3.0%). Mothers that presented with SDoH risk factors had a 60% greater risk of stillbirth compared with those without (odds ratio [OR] = 1.61 [95% confidence interval (CI) = 1.33-1.95], < 0.001). The SDoH issues that showed the most significant risk for stillbirth were: occupational risk (OR = 7.05 [95% CI: 3.54-9.58], < 0.001), upbringing (OR = 1.87 [95% CI: 1.23-2.82], < 0.001), and primary support group and family (OR = 5.45 [95% 3.84-7.76], < 0.001).
We found pregnancies bearing SDoH risk factors to be associated with a 60% elevated risk for stillbirth. Future studies should target a variety of risk reduction strategies aimed at modifiable SDoH risk factors that can be widely implemented at both the population health level as well as in the direct clinical setting.
· Health disparities exist in stillbirth rates, especially among NH Black women.. · Social determinants of health risk factors increase the risk of stillbirth.. · There is a need for further study on the impact of specific SDoH risk factors on stillbirth risk..
我们旨在评估健康社会决定因素（SDoH）风险因素对美国妊娠相关住院患者中死胎的影响。
我们使用医疗保健成本和利用项目的全国住院患者样本的年度数据（2016-2017 年）进行了与分娩相关的住院患者的横断面分析。国际疾病分类，第 10 版 ICD-10-CM 代码用于选择单胎死胎的女性。Z 代码用于识别 SDoH 风险因素及其亚型。使用调查逻辑回归模型评估 SDoH 风险因素与死胎之间的关联。
我们分析了 8148646 例住院患者，其中 91140 例与死胎住院患者相关，死胎发生率为 1.1%。与非西班牙裔（NH）白人（1.0%）相比，非西班牙裔黑人（NH）黑人的发生率更高（1.7%）。与无 SDoH 风险因素的住院患者相比，存在 SDoH 风险因素的住院患者的死胎发生率更高[2.0%比 1.1%（<0.001）]。在存在 SDoH 风险因素的患者中，被指定为 NH 其他（3.0%）的患者的死胎率最高。与无 SDoH 风险因素的患者相比，存在 SDoH 风险因素的母亲发生死胎的风险高 60%（优势比[OR] = 1.61 [95%置信区间（CI）= 1.33-1.95]，<0.001）。对死胎风险最大的 SDoH 问题是：职业风险（OR = 7.05 [95%CI：3.54-9.58]，<0.001）、养育方式（OR = 1.87 [95%CI：1.23-2.82]，<0.001）和主要支持群体和家庭（OR = 5.45 [95% 3.84-7.76]，<0.001）。
我们发现，患有 SDoH 风险因素的妊娠与死胎风险增加 60%有关。未来的研究应针对各种旨在降低风险的策略，针对可广泛实施于人群健康水平和直接临床环境中的可改变的 SDoH 风险因素。
· 死胎率存在健康差异，尤其是在非西班牙裔黑人女性中。· SDoH 风险因素增加了死胎的风险。· 需要进一步研究特定 SDoH 风险因素对死胎风险的影响。
