美国慢性病对孕产妇死亡贡献的时间变化
Temporal Changes in the Contribution of Chronic Disease to Maternal Mortality in the United States.
作者信息
Sabr Yasser, Lisonkova Sarka, Mayer Chantal, Joseph K S
机构信息
Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada.
Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
出版信息
Paediatr Perinat Epidemiol. 2025 Aug;39(6):527-539. doi: 10.1111/ppe.70034. Epub 2025 Jun 8.
BACKGROUND
Increases in maternal age, obesity and other factors have led to an increase in hypertension, diabetes, and other chronic diseases among pregnant women. However, the impact of chronic diseases on maternal mortality has not been adequately studied.
OBJECTIVES
To quantify the contribution of maternal mortality associated with chronic disease to maternal mortality in the United States in 1999-2002 and 2018-2022.
METHODS
The study was based on maternal deaths in the United States in 1999-2002 and 2018-2022, with data obtained from the mortality and live birth files of the National Center for Health Statistics. Maternal deaths and maternal deaths associated with chronic disease were identified based on the presence of pregnancy-related causes and chronic diseases among the multiple causes of death. Maternal mortality ratios (MMR) and ratios of MMRs and their 95% confidence intervals (CI) were estimated to assess period change. Temporal changes in MMRs were adjusted for maternal age using direct standardisation.
RESULTS
Although overall MMRs were stable, direct obstetrical deaths decreased by 14% (95% CI 9, 23) from 1999-2002 to 2018-2022. Maternal deaths associated with chronic disease increased by 28% (95% CI 17, 40) from 5.41 in 1999-2002 to 6.92 per 100,000 live births in 2018-2022. The temporal increases in chronic disease-related maternal deaths were attenuated but not abolished following adjustment for maternal age (age-adjusted increase 16%, 95% CI 10, 23). MMRs associated with chronic disease increased in all age groups, especially among women aged < 20 and 30-39 years (57% and 17% increase, respectively). Non-Hispanic Black women had the highest MMRs associated with chronic disease (15.8 per 100,000 live births in 2018-2022), while age-adjusted MMRs increased among non-Hispanic White women (45% increase, 95% CI 33, 59).
CONCLUSIONS
A substantial fraction of maternal deaths in the United States is associated with chronic disease, although patterns vary by race/ethnicity.
背景
产妇年龄增加、肥胖及其他因素导致孕妇中高血压、糖尿病和其他慢性病发病率上升。然而，慢性病对孕产妇死亡率的影响尚未得到充分研究。
目的
量化1999 - 2002年和2018 - 2022年美国与慢性病相关的孕产妇死亡对孕产妇死亡的贡献。
方法
该研究基于1999 - 2002年和2018 - 2022年美国的孕产妇死亡情况，数据来自国家卫生统计中心的死亡率和活产记录。根据多死因中与妊娠相关的病因和慢性病的存在情况，确定孕产妇死亡和与慢性病相关的孕产妇死亡。估计孕产妇死亡率（MMR）以及MMR的比值及其95%置信区间（CI）以评估期间变化。使用直接标准化方法对孕产妇年龄调整MMR的时间变化。
结果
尽管总体MMR稳定，但从1999 - 2002年到2018 - 2022年，直接产科死亡下降了14%（95%CI 9，23）。与慢性病相关的孕产妇死亡从1999 - 2002年的每10万活产5.41例增加到2018 - 2022年的6.92例，增加了28%（95%CI 17，40）。在对孕产妇年龄进行调整后，与慢性病相关的孕产妇死亡的时间增加有所减弱但未消除（年龄调整后增加16%，95%CI 10，23）。所有年龄组中与慢性病相关的MMR均增加，尤其是年龄＜20岁和30 - 39岁的女性（分别增加57%和17%）。非西班牙裔黑人女性与慢性病相关的MMR最高（2018 - 2022年为每10万活产15.8例），而年龄调整后的MMR在非西班牙裔白人女性中增加（增加45%，95%CI 33，59）。
结论
在美国，相当一部分孕产妇死亡与慢性病有关，尽管不同种族/族裔的模式有所不同。
Zotero 插件