Division of Neonatology, Cleveland Clinic Children's, Cleveland, USA.
Department of Biostatistics and Bioinformatics, The George Washington University - Milken Institute School of Public Health, Washington, USA.
J Neonatal Perinatal Med. 2024;17(4):543-553. doi: 10.3233/NPM-240025.
To examine the association of inpatient maternal mortality with variability in healthcare services delivery such as hospital size, urban/rural designation, teaching/non-teaching status, regional location, and insurance coverage.
This is a pooled, cross-sectional analysis of the National Inpatient Sample (2012-2014). Information on maternal demographics, clinical conditions, and birth outcomes were identified using respective ICD9-CM codes. Bivariate and multivariate analysis using logistic regression models were used to describe maternal characteristics and to calculate the risk of mortality with each independent variable.
The weighted sample included 12,409,939 hospital records (82.6% are 18-34-year-old and 49.5% are Caucasians). Maternal death during hospitalization occurred in 1310 cases (12/100,000 live birth). Women with cardiovascular disorders, hemorrhage or sepsis were 33.6, 4.7, and 5.4 times more likely to suffer inpatient maternal mortality. Compared to small-sized hospitals, delivery at medium or large size hospitals is associated with higher mortality, adjusted odds ratios (aOR) 1.8 (1.4-2.3), and 2.2 (1.8-2.8), respectively. Adjusted OR for inpatient maternal mortality in urban non-teaching or urban teaching compared to rural hospitals were 2.2 (1.7-3.0) and 2.9 (2.2-3.9), respectively. Women in the South have higher maternal mortality compared to Northeast, aOR 1.7 (1.5-2.1). Women coved with public insurance experience higher inpatient maternal mortality compared to those with private insurance, aOR: 2.6 (2.1-3.2) and 1.9 (1.6-2.1), respectively.
Factors related to variability in healthcare delivery may play a role in inpatient maternal mortality. Some could be explained by the case mix and the clinical conditions affecting birthing outcomes. A qualitative analysis is needed to explore how these factors relate to increased maternal mortality in certain hospital settings.
研究医疗服务提供的变异性与住院产妇死亡率的关系，如医院规模、城乡分类、教学/非教学状态、地区位置和保险覆盖范围。
这是一项对 2012 年至 2014 年国家住院患者样本的汇总、横断面分析。使用各自的 ICD9-CM 代码确定产妇人口统计学、临床情况和分娩结果的信息。使用逻辑回归模型进行双变量和多变量分析，以描述产妇特征，并计算每个独立变量的死亡率风险。
加权样本包括 12409939 例医院记录（82.6%为 18-34 岁，49.5%为白种人）。住院期间发生产妇死亡 1310 例（每 10 万活产 12 例）。患有心血管疾病、出血或败血症的妇女发生住院产妇死亡的风险分别增加 33.6、4.7 和 5.4 倍。与小型医院相比，在中型或大型医院分娩与更高的死亡率相关，调整后的优势比（aOR）分别为 1.8（1.4-2.3）和 2.2（1.8-2.8）。与农村医院相比，城市非教学或城市教学医院的住院产妇死亡率调整后的优势比（aOR）分别为 2.2（1.7-3.0）和 2.9（2.2-3.9）。与东北部相比，南部的产妇死亡率更高，aOR 为 1.7（1.5-2.1）。与私人保险相比，享受公共保险的女性住院产妇死亡率更高，aOR：2.6（2.1-3.2）和 1.9（1.6-2.1）。
与医疗服务提供的变异性相关的因素可能在住院产妇死亡率中发挥作用。其中一些可以通过影响分娩结果的病例组合和临床情况来解释。需要进行定性分析，以探讨这些因素如何与某些医院环境中产妇死亡率的增加有关。
