Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan.
Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan; Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan; Department of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan.
Am J Prev Med. 2024 May;66(5):850-859. doi: 10.1016/j.amepre.2023.11.016. Epub 2023 Nov 22.
Few studies have examined whether neighborhood deprivation is associated with severe maternal morbidity (SMM) in already socioeconomically disadvantaged populations. Little is known about to what extent neighborhood deprivation accounts for Black-White disparities in SMM. This study investigated these questions among a statewide Medicaid-insured population, a low-income population with heightened risk of SMM.
Data were from Michigan statewide linked birth records and Medicaid claims between 01/01/2016 and 12/31/2019, and were analyzed between 2022 and 2023. Neighborhood deprivation was measured with the Area Deprivation Index at census block group and categorized as low, medium, or high deprivation. Multilevel logistic models were used to examine the association between neighborhood deprivation and SMM. Fairlie nonlinear decomposition was conducted to quantify the contribution of neighborhood deprivation to SMM racial disparity.
People in the most deprived neighborhoods had higher odds of SMM than those in the least deprived neighborhoods (aOR [95% CI]: 1.27 [1.15, 1.40]). Such association was observed in Black (aOR [95% CI]: 1.34 [1.07, 1.67]) and White (aOR [95% CI]: 1.26 [1.12, 1.42]) racial subgroups. Decomposition showed that of 57.5 (cases per 10,000) explained disparity in SMM, neighborhood deprivation accounted for 23.1 (cases per 10,000; 95% CI: 16.3, 30.0) or two-fifths (40.2%) of the Black-White disparity. Analysis on SMM excluding blood transfusion showed consistent but weaker results.
Neighborhood deprivation may be used as an effective tool to identify at-risk individuals within a low-income population. Community-engaged interventions aiming at improving neighborhood conditions may be helpful to reduce both SMM prevalence and racial inequity in SMM.
很少有研究探讨邻里贫困是否与已经处于社会经济劣势的人群中的严重产妇发病率（SMM）有关。对于邻里贫困在 SMM 中的黑-白差异中占多大程度，知之甚少。本研究在密歇根州全州范围内的医疗补助保险人群中调查了这些问题，这是一个 SMM 风险较高的低收入人群。
数据来自密歇根州 2016 年 1 月 1 日至 2019 年 12 月 31 日期间的全州出生记录和医疗补助索赔，并于 2022 年至 2023 年进行分析。邻里贫困程度通过普查块组的区域贫困指数进行衡量，并分为低、中、高贫困程度。使用多水平逻辑模型来检验邻里贫困与 SMM 之间的关联。进行了 Fairlie 非线性分解，以量化邻里贫困对 SMM 种族差异的贡献。
与最贫困社区的人相比，最贫困社区的人更有可能患有 SMM（调整后的优势比[95%CI]：1.27[1.15,1.40]）。在黑人（调整后的优势比[95%CI]：1.34[1.07,1.67]）和白人（调整后的优势比[95%CI]：1.26[1.12,1.42]）种族亚组中观察到这种关联。分解表明，在 SMM 中，有 57.5（每 10000 例中的病例数）可以解释 SMM 差异，邻里贫困占 23.1（每 10000 例中的病例数；95%CI：16.3,30.0）或五分之二（40.2%）的黑-白差异。不包括输血的 SMM 分析显示出一致但较弱的结果。
邻里贫困可用作在低收入人群中识别高危个体的有效工具。旨在改善邻里条件的社区参与干预措施可能有助于降低 SMM 的流行率和 SMM 中的种族不平等。
