美国孕产妇死亡率的时空模式与监测假象：一项基于人群的研究

Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study.

作者信息

Joseph K S, Lisonkova Sarka, Boutin Amélie, Muraca Giulia M, Razaz Neda, John Sid, Sabr Yasser, Simon Sophie, Kögl Johanna, Suarez Elizabeth A, Chan Wee-Shian, Mehrabadi Azar, Brandt Justin S, Schisterman Enrique F, Ananth Cande V

机构信息

Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.

School of Population and Public Health, University of British Columbia, Vancouver, Canada.

出版信息

Lancet Reg Health Am. 2024 Oct 4;39:100902. doi: 10.1016/j.lana.2024.100902. eCollection 2024 Nov.

DOI:10.1016/j.lana.2024.100902

PMID:39430883

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11489048/

Abstract

BACKGROUND

Reports of high and rising maternal mortality ratios (MMR) in the United States have caused serious concern. We examined spatiotemporal patterns in cause-specific MMRs, in order to obtain insights into the cause for the increase.

METHODS

The study included all maternal deaths recorded by the Centers for Disease Control and Prevention from 1999 to 2021. Changes in overall and cause-specific MMRs were quantified nationally; in low-vs high-MMR states (i.e., MMRs <20 vs ≥26 per 100,000 live births in 2018-2021); and in California vs Texas (populous states with low vs high MMRs). Cause-specific MMRs included those due to unambiguous causes (e.g., selected obstetric causes such as pre-eclampsia/eclampsia) and less-specific/potentially incidental causes (e.g., "other specified pregnancy-related conditions", chronic hypertension, and malignant neoplasms).

FINDINGS

MMRs increased from 9.60 (n = 1543) in 1999-2002 to 23.5 (n = 3478) per 100,000 live births in 2018-2021. The temporal increase in MMRs was smaller in low-MMR states (from 7.82 to 14.1 per 100,000 live births) compared with high-MMR states (from 11.1 to 31.4 per 100,000 live births). MMRs due to selected obstetric causes decreased to a similar extent in low-vs high-MMR states, whereas the increase in MMRs from less-specific/potentially incidental causes was smaller in low- vs high-MMR states (MMR ratio (RR) 5.57, 95% CI 4.28, 7.25 vs 7.07, 95% CI 5.91, 8.46), and in California vs Texas (RR 1.67, 95% CI 1.03, 2.69 vs 10.8, 95% CI 6.55, 17.7). The change in malignant neoplasm-associated MMRs was smaller in California vs Texas (RR 1.21, 95% CI 0.08, 19.3 vs 91.2, 95% CI 89.2, 94.8). MMRs from less-specific/potentially incidental causes increased in all race/ethnicity groups.

INTERPRETATION

Spatiotemporal patterns of cause-specific MMRs, including similar reductions in unambiguous obstetric causes of death and variable increases in less-specific/potentially incidental causes, suggest misclassified maternal deaths and overestimated maternal mortality in some US states.

FUNDING

This work received no funding.

摘要

背景

美国孕产妇死亡率（MMR）居高不下且不断上升的报告引发了严重关注。我们研究了特定病因MMR的时空模式，以深入了解其上升原因。

方法

该研究纳入了疾病控制与预防中心记录的1999年至2021年期间的所有孕产妇死亡病例。对全国范围内、低MMR与高MMR州（即2018 - 2021年每10万例活产中MMR<20与≥26）以及加利福尼亚州与得克萨斯州（人口众多、MMR一低一高的州）的总体及特定病因MMR变化进行了量化。特定病因MMR包括明确病因导致的（如某些产科病因，如子痫前期/子痫）以及不太明确/可能偶然的病因导致的（如“其他特定的妊娠相关疾病”、慢性高血压和恶性肿瘤）。

研究结果

MMR从1999 - 2002年的9.60（n = 1543）上升至2018 - 2021年的每10万例活产23.5（n = 3478）。低MMR州MMR的时间增幅（从每10万例活产7.82升至14.1）小于高MMR州（从每10万例活产11.1升至31.4）。低MMR与高MMR州中，因某些产科病因导致的MMR下降幅度相似，而低MMR与高MMR州中，由不太明确/可能偶然病因导致的MMR增幅较小（MMR比率（RR）5.57，95% CI 4.28，7.25 对比7.07，95% CI 5.91，8.46），加利福尼亚州与得克萨斯州亦是如此（RR 1.67，95% CI 1.03，2.69 对比10.8，95% CI 6.55，17.7）。加利福尼亚州与得克萨斯州中，与恶性肿瘤相关的MMR变化较小（RR 1.21，95% CI 0.08，19.3 对比91.2，95% CI 89.2，94.8）。所有种族/族裔群体中，由不太明确/可能偶然病因导致的MMR均有所上升。