Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
PLoS One. 2024 Oct 21;19(10):e0312110. doi: 10.1371/journal.pone.0312110. eCollection 2024.
Despite well-documented racial disparities in maternal health in the United States, gaps remain in characterizing the distribution of these disparities in maternal blood transfusion.
To assess racial disparities in maternal blood transfusion using detailed, self-identified racial groupings in the United States overall and stratified by mode of delivery.
We performed a population-based, retrospective cohort study of full term, live births (2016-2021) using the National Vital Statistics System's Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of maternal blood transfusion by self-identified maternal race in the total population, and among subgroups stratified by mode of delivery. Models were adjusted for maternal and obstetric practice factors.
The study included 17,905,699 deliveries; maternal blood transfusion occurred in 3.4 per 1,000 deliveries. Compared with individuals who identified as White (3.3 per 1,000 transfusion rate), higher odds of transfusion were found among those who identified as American Indian and Alaska Native (AIAN; aOR 2.36, 95% CI 2.23-2.49), Black (aOR 1.15, 95% CI 1.12-1.17), Filipino (aOR 1.33, 95% CI 1.22-1.44), Korean (aOR 1.25, 95% CI 1.10-1.42), and Pacific Islander (aOR 1.63, 95% CI 1.45-1.83). The frequency of transfusion and racial disparities in transfusion varied substantially by mode of delivery. Lower rates of transfusion in Black vs White patients were observed in the spontaneous vaginal delivery (2.2 vs 2.3 per 1000; aOR 0.95, 95% CI 0.92-0.99), forceps (6.8 vs 8.9 per 1000; aOR 0.77, 95% CI 0.60-0.99), vacuum (4.2 vs 5.0 per 1000; aOR 0.85, 95% CI 0.74-0.97, and cesarean delivery with trial of labour (8.8 vs 8.9 per 1000; aOR 0.95, 95% CI 0.91-1.00) groups, while a higher rate was shown among cesarean deliveries without trial of labour (6.8 vs 4.3 per 1000; aOR 1.45, 95% CI 1.40-1.51).
Racial disparities in maternal blood transfusion persist after adjustment for several confounders, particularly for AIAN and Pacific Islander individuals, and vary by mode of delivery.
尽管美国产妇健康方面存在有据可查的种族差异，但在描述产妇输血方面的这些差异分布方面仍存在差距。
使用美国总体上详细的自我认定的种族群体以及按分娩方式分层的方法，评估产妇输血的种族差异。
我们使用国家生命统计系统的出生率文件，对 2016 年至 2021 年足月、活产（17905699 例）进行了基于人群的回顾性队列研究。回归模型用于估计产妇自我认定的种族在总人口中的产妇输血的调整后优势比（aOR）和 95%置信区间（CI），以及按分娩方式分层的亚组中的 aOR 和 95%CI。模型调整了产妇和产科实践因素。
该研究包括 17905699 例分娩；每 1000 例分娩中有 3.4 例接受了输血。与自我认定为白人（输血率为每 1000 例 3.3 例）的个体相比，自我认定为美洲印第安人和阿拉斯加原住民（AIAN；aOR 2.36，95%CI 2.23-2.49）、黑人（aOR 1.15，95%CI 1.12-1.17）、菲律宾人（aOR 1.33，95%CI 1.22-1.44）、韩国人（aOR 1.25，95%CI 1.10-1.42）和太平洋岛民（aOR 1.63，95%CI 1.45-1.83）的输血可能性更高。输血的频率和输血方面的种族差异在很大程度上因分娩方式而异。与白人相比，黑人在自然分娩（2.2 比 2.3 每 1000 例；aOR 0.95，95%CI 0.92-0.99）、产钳（6.8 比 8.9 每 1000 例；aOR 0.77，95%CI 0.60-0.99）、真空（4.2 比 5.0 每 1000 例；aOR 0.85，95%CI 0.74-0.97）和剖宫产伴试产（8.8 比 8.9 每 1000 例；aOR 0.95，95%CI 0.91-1.00）组中输血率较低，而在无试产的剖宫产中输血率较高（6.8 比 4.3 每 1000 例；aOR 1.45，95%CI 1.40-1.51）。
在调整了几个混杂因素后，产妇输血方面仍然存在种族差异，尤其是在 AIAN 和太平洋岛民中，而且这些差异还因分娩方式而异。
