Nazzal Elizabeth M, Waller Anna E, Meyer Michelle L, Ising Amy I, Jones-Vessey Kathleen, Urrutia Eugene, Urrutia Rachel P
University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
AJPM Focus. 2023 Aug 13;2(4):100142. doi: 10.1016/j.focus.2023.100142. eCollection 2023 Dec.
Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency department surveillance data between 2016 and 2021 to describe the sociodemographic factors associated with the use of emergency department for pregnancy-associated problems and subsequent hospital admission.
North Carolina Disease Event Tracking and Epidemiologic Collection Tool is a syndromic surveillance system that includes all emergency department encounters at civilian acute-care facilities in North Carolina. We analyzed all emergency department visits between January 1, 2016 and December 31, 2021 for female patients aged 15-44 years residing in North Carolina with at least 1 ICD-10-CM code (analysis occurred in July 2021-October 2022). Each emergency department visit was categorized as pregnancy-associated if assigned ICD-10-CM code(s) indicated pregnancy. We stratified visits by age, race, ethnicity, county of residence, and insurance and compared them with estimated pregnant population proportions using 1-sample -tests. We used multivariable logistic regression to determine whether pregnancy-associated visits were more likely to be associated with hospital admission and then to determine sociodemographic predictors of admission among pregnancy-associated emergency department visits.
More than 6.4 million emergency department visits were included (N=6,471,197); 10.1% (=655,476) were pregnancy-associated, significantly higher than the proportion of women estimated to be pregnant at any given time in North Carolina (4.6%, <0.0001) and increased over time (8.6% in 2016 vs 11.1% in 2021, <0.0001). Pregnancy-associated visits were lower than expected for ages 25-44 years and higher than expected for those aged 15-24 years, for those of Black race, and for patients residing in rural or suburban areas. The proportion admitted was higher for pregnancy-associated emergency department visits than for nonpregnancy associated (15.6% vs 7.0%, AOR=3.06 [95% CI=3.03, 3.09]). Pregnancy-associated emergency department visits for patients of Black race had 0.58 times (95% CI=0.57, 0.59) the odds of admission compared with White patients.
Emergency department utilization during pregnancy is common. The proportion of pregnancy-associated emergency department visits among reproductive-age women is increasing, as are inpatient admissions from the emergency department for pregnancy-associated diagnoses. Use of public health surveillance databases such as the North Carolina Disease Event Tracking and Epidemiologic Collection Tool may help identify opportunities for improving disparities in maternal health care, especially related to access to care.
与妊娠相关的不适是育龄女性前往急诊科就诊的常见原因。孕期急诊科就诊与母婴不良分娩结局相关。我们利用2016年至2021年北卡罗来纳州全州范围的急诊科监测数据，描述与因妊娠相关问题使用急诊科及随后住院相关的社会人口学因素。
北卡罗来纳州疾病事件追踪与流行病学收集工具是一个症候群监测系统，包括北卡罗来纳州民用急性护理机构的所有急诊科就诊情况。我们分析了2016年1月1日至2021年12月31日期间居住在北卡罗来纳州、年龄在15 - 44岁且至少有1个ICD - 10 - CM编码的女性患者的所有急诊科就诊情况（分析于2021年7月至2022年10月进行）。如果分配的ICD - 10 - CM编码表明妊娠，则每次急诊科就诊被分类为与妊娠相关。我们按年龄、种族、族裔、居住县和保险对就诊情况进行分层，并使用单样本z检验将其与估计的妊娠人口比例进行比较。我们使用多变量逻辑回归来确定与妊娠相关的就诊是否更有可能与住院相关，然后确定妊娠相关急诊科就诊中住院的社会人口学预测因素。
纳入了超过640万次急诊科就诊（N = 6,471,197）；10.1%（= 655,476）与妊娠相关，显著高于北卡罗来纳州任何给定时间估计的妊娠女性比例（4.6%，P < 0.0001），且随时间增加（2016年为8.6%，2021年为11.1%，P < 0.0001）。25 - 44岁人群与妊娠相关的就诊低于预期，15 - 24岁人群、黑人种族人群以及居住在农村或郊区的患者与妊娠相关的就诊高于预期。与妊娠相关的急诊科就诊的住院比例高于非妊娠相关就诊（15.6%对7.0%，调整后比值比 = 3.06 [95%置信区间 = 3.03, 3.09]）。与白人患者相比，黑人种族患者的妊娠相关急诊科就诊住院几率为0.58倍（95%置信区间 = 0.57, 0.59）。
孕期急诊科就诊很常见。育龄女性中与妊娠相关的急诊科就诊比例在增加，因妊娠相关诊断从急诊科住院的比例也在增加。使用北卡罗来纳州疾病事件追踪与流行病学收集工具等公共卫生监测数据库可能有助于识别改善孕产妇医疗保健差异的机会，特别是与获得医疗服务相关的差异。
