孕产妇死亡率中的交叉不平等：审视身体残疾的黑人分娩者面临的复合风险。
Intersectional inequities in maternal mortality: Examining the compounded risks for black birthing individuals with physical disabilities.
作者信息
Akobirshoev Ilhom, Jerome Sarah, Snowden Jonathan M, Slaughter-Acey Jaime, Valentine Anne, Horner-Johnson Willi, Mitra Monika
机构信息
Brandeis University, The Lurie Institute for Disability Policy, 415 South Street, Waltham, MA, 02453, USA.
Brandeis University, The Lurie Institute for Disability Policy, 415 South Street, Waltham, MA, 02453, USA.
出版信息
Disabil Health J. 2025 Apr;18(2):101765. doi: 10.1016/j.dhjo.2024.101765. Epub 2024 Dec 3.
BACKGROUND
People who are Black and have physical disabilities likely face a dual burden of risk for maternal mortality due to enduring systemic oppression rooted in racism and ableism.
OBJECTIVE
To investigate maternal mortality risks among Black birthing individuals with physical disabilities in the United States and assess the potential compounding effect when these marginalized identities intersect.
METHODS
We conducted a historical cohort study using the 2004-2021 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The study included 8,263,997 delivery hospitalizations. We used modified Poisson regression to estimate unadjusted and adjusted relative risks (RR) of maternal mortality by race and physical disability status. We calculated the Relative Excess Risk due to Interaction (RERI) and Attributable Proportion (AP) to assess additive interaction between Black race and physical disability status.
RESULTS
After adjusting for covariates, compared to their White birthing individuals, their Black peers experienced about 2.5 times (RR = 1.48,95%CI:2.08-2.96) the risk of maternal mortality. Compared to birthing individuals without physical disabilities, those with physical disabilities experienced nearly 11 times the (RR = 10.72,95%CI:8.15-14.10) risk of maternal mortality. Our adjusted additive interaction analysis revealed a significant super-additive effect (RERI = 11.3; AP = 0.47); suggesting that the combined effect of having both marginalized identities was greater than the sum of the individual effects of each identity.
CONCLUSIONS
Our findings provide evidence for substantial inequities in maternal mortality by Black race and physical disability status, with evidence of a compounding effect when these marginalized identities intersect. These results underscore the urgent need for intersectional approaches in maternal health interventions and policies.
背景
由于长期存在基于种族主义和能力主义的系统性压迫，黑人残疾人群体可能面临孕产妇死亡的双重风险负担。
目的
调查美国有身体残疾的黑人分娩者的孕产妇死亡风险，并评估这些边缘化身份交叉时的潜在复合效应。
方法
我们使用2004 - 2021年医疗成本与利用项目全国住院样本进行了一项历史性队列研究。该研究包括8263997例分娩住院病例。我们使用修正泊松回归来估计按种族和身体残疾状况划分的孕产妇死亡的未调整和调整后相对风险（RR）。我们计算了交互作用导致的相对超额风险（RERI）和归因比例（AP），以评估黑人种族和身体残疾状况之间的相加交互作用。
结果
在对协变量进行调整后，与白人分娩者相比，黑人分娩者经历孕产妇死亡的风险约为其2.5倍（RR = 1.48，95%CI：2.08 - 2.96）。与无身体残疾的分娩者相比，有身体残疾的分娩者经历孕产妇死亡的风险几乎是其11倍（RR = 10.72，95%CI：8.15 - 14.10）。我们的调整后相加交互作用分析显示出显著的超相加效应（RERI = 11.3；AP = 0.47）；这表明拥有这两种边缘化身份的综合效应大于每种身份个体效应之和。
结论
我们的研究结果为按黑人种族和身体残疾状况划分的孕产妇死亡方面存在重大不平等提供了证据，同时也证明了这些边缘化身份交叉时存在复合效应。这些结果强调了在孕产妇健康干预措施和政策中采用交叉性方法的迫切需求。
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