Yu Xiao, Johnson Jennifer E, Roman Lee Anne, Key Kent, White Jonné McCoy, Bolder Hannah, Meghea Cristian I
Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, East Lansing, MI, USA.
Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, College of Human Medicine, Grand Rapids, East Lansing, MI, USA; Charles Stewart Mott Department of Public Health, Michigan State University, Flint, MI, USA; Department of Psychiatry and Behavioral Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.
Ann Epidemiol. 2025 May;105:53-58. doi: 10.1016/j.annepidem.2025.04.005. Epub 2025 Apr 8.
To examine whether racial and ethnic disparities in severe maternal morbidity (SMM) increased across all neighborhoods or mainly in resource-deprived neighborhoods before and during the COVID-19 pandemic.
This study used Michigan's statewide linked databases from birth records and Medicaid claims between 01/01/2017 and 10/31/2021 (N = 214,406). Neighborhood deprivation was measured with Area Deprivation Index and categorized into tertiles. Multilevel logistic regressions with an interrupted time series approach were used to compare racial and ethnic disparities in SMM pre-pandemic (January 2017-February 2020) and during the pandemic (March 2020-October 2021) in low, medium, and high deprivation neighborhoods.
The Black-White disparity in the most deprived neighborhoods widened during the pandemic (adjusted risk ratio, aRR [95 % CI]: 1.72 [1.54, 1.92]; excess cases [95 % CI]: 201.7 [159.0, 244.5]) compared to pre-pandemic (aRR [95 % CI]: 1.23 [1.12, 1.35]; excess cases [95 % CI]: 75.4 [41.2, 109.5], p < .001), but persisted (not widened) in the least and medium deprived neighborhoods.
Widening racial and ethnic disparities in SMM during the pandemic were only observed in the most deprived neighborhoods, rather than being universally prevalent across neighborhood contexts. Community-engaged solutions are needed to improve neighborhood conditions and reduce maternal health inequities during times of crisis.
研究在新冠疫情之前及期间，严重孕产妇发病（SMM）方面的种族和族裔差异是在所有社区都有所增加，还是主要在资源匮乏的社区增加。
本研究使用了密歇根州2017年1月1日至2021年10月31日期间（N = 214,406）出生记录和医疗补助申请的全州关联数据库。用地区贫困指数衡量社区贫困程度，并将其分为三分位数。采用具有中断时间序列方法的多水平逻辑回归，比较疫情前（2017年1月至2020年2月）和疫情期间（2020年3月至2021年10月）低、中、高贫困社区中SMM的种族和族裔差异。
与疫情前相比（调整风险比，aRR [95% CI]：1.23 [1.12, 1.35]；超额病例数 [95% CI]：75.4 [41.2, 109.5]，p <.001），疫情期间最贫困社区的黑人与白人差异有所扩大（调整风险比，aRR [95% CI]：1.72 [1.54, 1.92]；超额病例数 [95% CI]：201.7 [159.0, 244.5]），但在最不贫困和中等贫困社区差异持续存在（未扩大）。
疫情期间SMM方面种族和族裔差异的扩大仅在最贫困社区中观察到，而非在所有社区环境中普遍存在。需要采取社区参与的解决方案来改善社区状况，并在危机时期减少孕产妇健康不平等现象。
