Horner-Johnson Willi, Garg Bharti, Snowden Jonathan M, Caughey Aaron B, Slaughter-Acey Jaime, Akobirshoev Ilhom, Mitra Monika
Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon, USA.
Oregon Health & Science University - Portland State University, School of Public Health, Portland, Oregon, USA.
J Womens Health (Larchmt). 2025 May;34(5):590-600. doi: 10.1089/jwh.2024.0694. Epub 2024 Dec 20.
People with physical disabilities are at increased risk of adverse perinatal outcomes, including severe maternal morbidity (SMM). Risks may be even greater for disabled people in minoritized racial or ethnic groups, but little is known about this intersection. We analyzed linked hospital discharge and vital records data from California, 2008-2020. We identified physical disabilities using diagnosis codes for maternal congenital anomalies, major injuries, musculoskeletal disorders, or nervous system disorders. We compared birthing persons in five groups (Black and Hispanic with and without physical disabilities, White with physical disabilities) to a reference group of non-Hispanic Whites without disabilities. We used Poisson regression to assess associations with SMM and other outcomes, with and without adjusting for sociodemographic and clinical covariates. Disabled Black and Hispanic birthing persons had particularly high relative risks (RRs) of SMM (Black disabled RR = 6.13, 95% confidence interval [CI]: 4.94, 7.61; Hispanic disabled RR = 3.67, 95% CI: 3.29, 4.10) as compared with nondisabled White persons. These risks were greater than those for nondisabled Black (RR = 2.05, 95% CI: 1.99, 2.11), nondisabled Hispanic (RR = 1.36, 95% CI: 1.34, 1.39), and disabled White birthing persons (RR = 2.44, 95% CI: 2.16, 2.77). For most other outcomes, risks were also largest for disabled Black birthing persons, followed by disabled Hispanic birthing persons. Black and Hispanic people with physical disabilities are highly likely to experience SMM and are at increased risk for other complications and adverse outcomes. Efforts are needed to understand underlying causes of these disparities and develop policies and practices to eliminate them.
身体残疾者出现不良围产期结局的风险增加，包括严重孕产妇发病率（SMM）。对于少数族裔或种族群体中的残疾人来说，风险可能更高，但对此交叉情况知之甚少。我们分析了2008年至2020年加利福尼亚州相关的医院出院和生命记录数据。我们使用孕产妇先天性异常、重大损伤、肌肉骨骼疾病或神经系统疾病的诊断代码来确定身体残疾情况。我们将五组分娩者（有身体残疾和无身体残疾的黑人和西班牙裔、有身体残疾的白人）与无残疾的非西班牙裔白人参考组进行比较。我们使用泊松回归来评估与SMM和其他结局的关联，同时调整和不调整社会人口统计学和临床协变量。与无残疾的白人相比，残疾黑人和西班牙裔分娩者出现SMM的相对风险（RRs）特别高（黑人残疾RR = 6.13，95%置信区间[CI]：4.94，7.61；西班牙裔残疾RR = 3.67，95% CI：3.29，4.10）。这些风险高于无残疾的黑人（RR = 2.05，95% CI：1.99，2.11）、无残疾的西班牙裔（RR = 1.36，95% CI：1.34，1.39）以及残疾白人分娩者（RR = 2.44，95% CI：2.16，2.77）。对于大多数其他结局，残疾黑人分娩者的风险也最大，其次是残疾西班牙裔分娩者。有身体残疾的黑人和西班牙裔很可能会出现SMM，并且出现其他并发症和不良结局的风险也会增加。需要努力了解这些差异的根本原因，并制定政策和措施来消除它们。
