Department of Epidemiology and Biostatistics, University of Georgia, 101 Buck Road, 30602, Athens, Georgia.
Center for Maternal Health Equity, Morehouse School of Medicine, 720 Westview Drive, Atlanta, Georgia.
Sci Rep. 2024 Aug 20;14(1):19297. doi: 10.1038/s41598-024-70130-1.
The objective of this study was to evaluate the racial and ethnic disparities in delivery hospitalizations involving severe maternal morbidity (SMM) by location of residence and community income. We used the 2016 to 2019 Healthcare Cost and Utilization Project National Inpatient Sample. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations with SMM. Using logistic regression models, we examined the association between race and ethnicity and delivery hospitalizations involving SMM. In adjusted analyses, the models were stratified by location of residence and community income and adjusted for patient and hospital characteristics. In rural areas, non-Hispanic Black women (AOR 1.50; 95% CI 1.25-1.79) and women of other races (AOR 1.32; 95% CI 1.03-1.69) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. In micropolitan areas, non-Hispanic Black women (AOR 1.88; 95% CI 1.79-1.97), non-Hispanic Asian/Pacific Islander women (AOR 1.54; 95% CI 1.16-2.05), and women of other races (AOR 1.31; 95% CI 1.03-1.67) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. Non-Hispanic Black women also had increased odds of experiencing a delivery hospitalization involving SMM in communities with the lowest income (quartile 1) (AOR 1.59; 95% CI 1.49-1.66), middle income (quartiles 2 and 3) (AOR 1.81; 95% CI 1.72-1.91), and highest income (AOR 2.09; 95% CI 1.90-2.29) when compared to non-Hispanic White women. We found that location of residence and community income are associated with racial and ethnic differences in SMM in the United States. These factors, outside of individual factors assessed in previous studies, provide a better understanding of some of the structural and systemic factors that may contribute to SMM.
本研究旨在评估居住地点和社区收入对严重产妇发病率（SMM）分娩住院的种族和民族差异。我们使用了 2016 年至 2019 年医疗保健成本和利用项目国家住院样本。国际疾病分类，第十次修订，临床修正代码用于识别 SMM 的分娩住院。使用逻辑回归模型，我们检查了种族和民族与 SMM 分娩住院之间的关联。在调整分析中，模型按居住地点和社区收入分层，并根据患者和医院特征进行调整。在农村地区，与非西班牙裔白人女性相比，非西班牙裔黑人女性（OR1.50；95%CI1.25-1.79）和其他种族女性（OR1.32；95%CI1.03-1.69）发生 SMM 分娩住院的可能性更高。在中小城市地区，与非西班牙裔白人女性相比，非西班牙裔黑人女性（OR1.88；95%CI1.79-1.97）、非西班牙裔亚裔/太平洋岛民女性（OR1.54；95%CI1.16-2.05）和其他种族女性（OR1.31；95%CI1.03-1.67）发生 SMM 分娩住院的可能性更高。非西班牙裔黑人女性在收入最低的社区（四分位数 1）（OR1.59；95%CI1.49-1.66）、中等收入（四分位数 2 和 3）（OR1.81；95%CI1.72-1.91）和最高收入（OR2.09；95%CI1.90-2.29）中，SMM 分娩住院的可能性也高于非西班牙裔白人女性。我们发现，居住地点和社区收入与美国 SMM 的种族和民族差异有关。这些因素，除了以前研究中评估的个体因素外，更好地理解了一些可能导致 SMM 的结构性和系统性因素。
