Kawakita Tetsuya, Hayasaka Misa, Robbins Lindsay, Martins Juliana, Saade George
Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences, and the Center for Maternal and Child Health Equity and Advocacy, Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia.
Obstet Gynecol. 2025 May 1;145(5):503-510. doi: 10.1097/AOG.0000000000005890. Epub 2025 Mar 27.
To assess the association between the Social Vulnerability Index (SVI) and racial disparities in pregnancy outcomes across U.S. counties and to quantify these racial disparities.
This was a cross-sectional study using restricted Centers for Disease Control and Prevention data sets, including natality data sets, fetal death data sets, and all-cause mortality data sets from 2016 to 2021. We limited analyses to Black or White individuals aged 15-44 years from 3,114 U.S. counties. Participants were categorized into quartiles based on county-level SVI. The primary outcome was maternal mortality rate while pregnant or within 42 days of the end of pregnancy, and secondary outcomes were pregnancy-related mortality while pregnant or within 365 days of the end of pregnancy, stillbirth, and preterm birth. Mixed-effect generalized linear models with negative binomial distribution were used to quantify disparities, using difference-in-difference analysis to measure the difference in outcomes between Black and White individuals across different levels of social vulnerability (first quartile as referent).
A total of 20,189,328 individuals were included, distributed across SVI quartiles as follows: first quartile 2,558,131, second quartile 4,945,774, third quartile 6,827,503, and fourth quartile 5,857,920. Black individuals experienced significantly higher rates of maternal mortality, pregnancy-related mortality, stillbirth, and preterm birth compared with White individuals regardless of SVI quartiles. Difference-in-difference analyses demonstrated that disparities in maternal mortality rate were significantly larger in the second, third, and fourth quartiles compared with the first quartile (difference-in-difference 14.22 [95% CI, 2.11-26.33], 12.53 [95% CI, 1.26-23.81], and 18.82 [95% CI, 6.67-30.98], respectively). A worsening disparity in pregnancy-related mortality was observed in the fourth quartile, whereas disparities in stillbirth and preterm birth did not show significant differences across SVI quartiles.
Racial disparities in maternal mortality intensified in counties with higher social vulnerability. These findings underscore the need for targeted interventions to address social determinants of health.
评估美国各县社会脆弱性指数（SVI）与妊娠结局种族差异之间的关联，并对这些种族差异进行量化。
这是一项横断面研究，使用了美国疾病控制与预防中心的受限数据集，包括2016年至2021年的出生数据集、胎儿死亡数据集和全因死亡率数据集。我们将分析限制在来自3114个美国县的15至44岁的黑人或白人个体。参与者根据县级SVI分为四分位数。主要结局是妊娠期间或妊娠结束后42天内的孕产妇死亡率，次要结局是妊娠期间或妊娠结束后365天内的妊娠相关死亡率、死产和早产。使用具有负二项分布的混合效应广义线性模型来量化差异，采用差异分析来衡量不同社会脆弱性水平（以第一四分位数为参照）下黑人和白人个体在结局上的差异。
共纳入20189328名个体，按SVI四分位数分布如下：第一四分位数2558131人，第二四分位数4945774人，第三四分位数6827503人，第四四分位数5857920人。无论SVI四分位数如何，黑人个体的孕产妇死亡率、妊娠相关死亡率、死产率和早产率均显著高于白人个体。差异分析表明，与第一四分位数相比，第二、第三和第四四分位数的孕产妇死亡率差异显著更大（差异分别为14.22 [95% CI，2.11 - 26.33]、12.53 [95% CI，1.26 - 23.81]和18.82 [95% CI，6.67 - 30.98]）。在第四四分位数中观察到妊娠相关死亡率差异恶化，而死产和早产差异在SVI四分位数之间未显示出显著差异。
社会脆弱性较高的县，孕产妇死亡率的种族差异加剧。这些发现强调了针对健康的社会决定因素进行有针对性干预的必要性。
