Hacker Francis M, Phillips Jaclyn M, Lemon Lara S, Simhan Hyagriv N
Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh School of Medicine, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania.
Department of Clinical Analytics, University of Pittsburgh Medical Center, Clinical Analytics, Pittsburgh, Pennsylvania.
Am J Perinatol. 2024 May;41(S 01):e2151-e2158. doi: 10.1055/s-0043-1770704. Epub 2023 Jun 26.
Severe maternal morbidity (SMM) has disproportionate frequencies among racial minorities and those of socioeconomic disadvantage, with people of Black race consistently having the highest proportion. Neighborhood level deprivation has been associated with maternal morbidity and mortality, including adverse pregnancy outcomes. We sought to explore the relationship between neighborhood socioeconomic disadvantage and SMM and describe how neighborhood context impacts the relationship between race and SMM.
We performed a retrospective cohort analysis of all delivery admissions in a single health care network from 2015 to 2019. Area deprivation index (ADI) was used to represent neighborhood socioeconomic disadvantage and is a composite index of neighborhood that spans income, education, household characteristics, and housing. The index ranges from 1 to 100 with higher values indicating higher disadvantage. Logistic regression assessed the relationship between ADI and SMM and estimated the effect that ADI has on the relationship between race and SMM.
Of the 63,208 birthing persons in our cohort, the unadjusted incidence of SMM was 2.2%. ADI was significantly associated with SMM, with higher values conferring higher risk for SMM ( < 0.001). The absolute risk of SMM increased roughly by 1.0% from the lowest to highest ADI value. Those of Black race had the highest unadjusted incidence of SMM compared with the referent group (3.4 vs. 2.0%) and highest median ADI (92; interquartile range [IQR]: 20). In the multivariable model, in which the primary exposure was race and ADI was adjusted for, Black race had a 1.7 times odds SMM when compared with White race (95% confidence interval [CI]: 1.5-1.9). This association was attenuated to 1.5 adjusted odds when controlling for ADI (95% CI: 1.3-1.7). Risk attenuation for SMM was not seen in other race categories.
Neighborhood context contributes to SMM but does not explain the majority of racial disparities.
· Neighborhood context is associated with SMM, with higher disadvantage conferring higher risk.. · Compared with White race, all other races had higher rates of SMM, with Black race having the highest.. · Accounting for neighborhood modestly attenuates the magnitude of association of Black race with SMM.. · Neighborhood context contributes to health outcomes but does not explain the majority of disparities..
严重孕产妇发病情况（SMM）在少数族裔和社会经济地位不利的人群中出现的频率不成比例，其中黑人的比例一直最高。社区层面的贫困与孕产妇发病和死亡有关，包括不良妊娠结局。我们试图探讨社区社会经济不利状况与SMM之间的关系，并描述社区环境如何影响种族与SMM之间的关系。
我们对2015年至2019年单一医疗网络中的所有分娩入院病例进行了回顾性队列分析。地区贫困指数（ADI）用于代表社区社会经济不利状况，是一个涵盖收入、教育、家庭特征和住房的社区综合指数。该指数范围为1至100，数值越高表明不利程度越高。逻辑回归分析评估了ADI与SMM之间的关系，并估计了ADI对种族与SMM之间关系的影响。
在我们队列中的63208名分娩者中，SMM的未调整发病率为2.2%。ADI与SMM显著相关，数值越高，SMM的风险越高（<0.001）。从最低ADI值到最高ADI值，SMM的绝对风险大致增加了1.0%。与参照组相比，黑人的SMM未调整发病率最高（3.4%对2.0%），且ADI中位数最高（92；四分位间距[IQR]：20）。在多变量模型中，以种族为主要暴露因素并对ADI进行调整后，与白人相比，黑人发生SMM的几率为1.7倍（95%置信区间[CI]：1.5 - 1.9）。在控制ADI后，这种关联减弱至调整后的几率为1.5（95% CI：1.3 - 1.7）。在其他种族类别中未观察到SMM的风险减弱情况。
社区环境导致了SMM，但并不能解释大部分的种族差异。
· 社区环境与SMM相关，不利程度越高风险越高。· 与白人相比，所有其他种族的SMM发生率更高，其中黑人最高。· 考虑社区因素适度减弱了黑人与SMM关联的程度。· 社区环境对健康结果有影响，但并不能解释大部分差异。
