Racial Disparity in Severe Maternal Morbidity Associated with Hypertensive Disorders in Washington State: A Retrospective Cohort Study.

IF 1.8 4区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Maternal and Child Health Journal Pub Date : 2024-07-01 Epub Date: 2024-02-26 DOI:10.1007/s10995-024-03920-8

Catherine M Albright, Laura Sienas, Mindy Pike, Suzan Walker, Jane Hitti

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Abstract

Objectives: To evaluate the relationship between hypertensive (HTN) disorders and severe maternal morbidity (SMM). To understand whether there is differential prevalence of HTN disorders by race and whether the relationship between HTN disorders and SMM is modified by race and ethnicity.

Methods: We performed a retrospective cohort study using patient-level rates of SMM for pregnancies at all 61 non-military hospitals in Washington State from 10/2015 to 9/2016. Data were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the association of HTN disorders and SMM (with and without transfusion) overall and by race. The population-attributable fraction of HTN disorders on SMM within each racial/ethnic group was calculated.

Results: Of 76,965 deliveries, 864 (1.1%) had any SMM diagnosis or procedure. All racial and ethnic minorities, except white and Asian, were disproportionally affected by preeclampsia with severe features (SF) and SMM. Overall, and within each racial/ethnic group, the SMM rate was higher among pregnancies with any HTN disorder compared to no HTN disorder (2.8 vs. 0.9%, OR 3.1, 95% CI 2.7-3.6). Race and ethnicity significantly modified the association. Overall and within each racial/ethnic group, there was a dose-response relationship between the type of HTN disorder and SMM, with more severe HTN disorders leading to a greater risk of SMM. The population-attributable fraction of HTN disorders on SMM was 20.6% for Black individuals versus 17.5% overall. The findings were similar when reclassifying transfusion-only SMM as no SMM.

Conclusions: In Washington, HTN disorders are associated with SMM in a dose-dependent fashion with the greatest impact among Black individuals.

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华盛顿州与高血压疾病相关的严重孕产妇发病率的种族差异：一项回顾性队列研究。

目的：评估高血压（HTN）疾病与严重孕产妇发病率（SMM）之间的关系：评估高血压（HTN）疾病与严重孕产妇发病率（SMM）之间的关系。了解高血压（HTN）疾病的患病率是否因种族而异，以及高血压（HTN）疾病与严重孕产妇发病率（SMM）之间的关系是否因种族和民族而改变：我们利用华盛顿州所有 61 家非军事医院在 2015 年 10 月至 2016 年 9 月期间的 SMM 患者水平比率进行了一项回顾性队列研究。数据来自华盛顿州综合医院摘要报告系统。计算调整后的几率比 (OR) 和 95% 置信区间 (CI)，以评估高血压疾病与 SMM（输血和不输血）的整体关联性和种族关联性。计算了每个种族/人种组中高血压、高血脂和高血糖疾病对 SMM 的人口贡献率：在 76965 例分娩中，有 864 例（1.1%）确诊为 SMM 或进行了 SMM 治疗。除白人和亚裔外，所有少数种族和族裔都不成比例地受到具有严重特征的子痫前期（SF）和SMM的影响。总体而言，在每个种族/族裔群体中，与无高血压疾病的孕妇相比，患有任何高血压疾病的孕妇的子痫前期症状发生率更高（2.8% 对 0.9%，OR 3.1，95% CI 2.7-3.6）。种族和民族在很大程度上改变了这种关联。总体而言，以及在每个种族/族裔群体中，高血压疾病类型与SMM之间存在剂量反应关系，高血压疾病越严重，SMM风险越高。高血压和高血脂症对SMM的影响在人群中可归因于高血压和高血脂症的比例，黑人为20.6%，而总体为17.5%。如果将只输血的SMM重新归类为无SMM，结果也类似：结论：在华盛顿州，高血压、高血脂和心律失常与 SMM 呈剂量依赖关系，对黑人的影响最大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Maternal and Child Health Journal PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

3.20

自引率

4.30%

发文量

271

期刊介绍： Maternal and Child Health Journal is the first exclusive forum to advance the scientific and professional knowledge base of the maternal and child health (MCH) field. This bimonthly provides peer-reviewed papers addressing the following areas of MCH practice, policy, and research: MCH epidemiology, demography, and health status assessment Innovative MCH service initiatives Implementation of MCH programs MCH policy analysis and advocacy MCH professional development. Exploring the full spectrum of the MCH field, Maternal and Child Health Journal is an important tool for practitioners as well as academics in public health, obstetrics, gynecology, prenatal medicine, pediatrics, and neonatology. Sponsors include the Association of Maternal and Child Health Programs (AMCHP), the Association of Teachers of Maternal and Child Health (ATMCH), and CityMatCH.