Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA.
Division of Neonatal & Developmental Medicine, Department of Pediatrics, and Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA.
Ann N Y Acad Sci. 2022 Dec;1518(1):239-248. doi: 10.1111/nyas.14901. Epub 2022 Sep 27.
Despite long-existing calls to address alarming racial/ethnic gaps in severe maternal morbidity (SMM), research that considers the impact of intersecting social inequities on SMM risk remains scarce. Invoking intersectionality theory, we sought to assess SMM risk at the nexus of racial/ethnic marginalization, weathering, and neighborhood/individual socioeconomic disadvantage. We used birth hospitalization records from California across 20 years (1997-2017, N = 9,806,406) on all live births ≥20 weeks gestation. We estimated adjusted average predicted probabilities of SMM at the combination of levels of race/ethnicity, age, and neighborhood deprivation or individual socioeconomic status (SES). The highest risk of SMM was observed among Black birthing people aged ≥35 years who either resided in the most deprived neighborhoods or had the lowest SES. Black birthing people conceptualized to be better off due to their social standing (aged 20-34 years and living in the least deprived neighborhoods or college graduates) had comparable and at times worse risk than White birthing people conceptualized to be worse off (aged ≥35 years and living in the most deprived neighborhoods or had a high-school degree or less). Our findings highlight the need to explicitly address structural racism as the driver of racial/ethnic health inequities and the imperative to incorporate intersectional approaches.
尽管长期以来一直呼吁解决严重产妇发病率（SMM）中令人震惊的种族/民族差距问题，但考虑到交叉社会不平等对 SMM 风险影响的研究仍然很少。援引交叉性理论，我们试图评估种族/民族边缘化、适应和邻里/个人社会经济劣势交叉点的 SMM 风险。我们使用了 20 年来加利福尼亚州的分娩住院记录（1997-2017 年，N=9806406），涵盖了所有≥20 周妊娠的活产儿。我们估计了种族/民族、年龄和邻里贫困或个人社会经济地位（SES）水平组合下 SMM 的调整平均预测概率。SMM 风险最高的是≥35 岁的黑人分娩人群，他们要么居住在最贫困的社区，要么 SES 最低。由于社会地位（20-34 岁，居住在最贫困的社区或大学毕业）而被认为处境较好的黑人分娩人群，其风险与被认为处境较差的白人分娩人群（≥35 岁，居住在最贫困的社区或高中或以下学历）相当，有时甚至更糟。我们的研究结果强调了明确解决结构性种族主义作为种族/民族健康不平等的驱动因素的必要性，以及必须采用交叉性方法的必要性。
