Individual and County-level Factors Associated with Severe Maternal Morbidity at Delivery: An Investigation of a Privately Insured Population in the United States, 2008-2018.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

American journal of perinatology Pub Date : 2024-11-25 DOI:10.1055/a-2483-5842

Jennifer Matas, Laura E Mitchell, Jason L Salemi, Cici X Bauer, Cecilia Ganduglia Cazaban

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引用次数: 0

Abstract

Objective: Few studies have explored the impact of county-level variables on severe maternal morbidity (SMM) subtypes. To address this gap, this study used a large commercial database to examine the associations between individual and county-level factors and SMM.

Study design: This retrospective cohort study used data from the Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2008 to 2018. The primary outcomes of this study were any SMM, non-transfusion SMM, and nine specific SMM subtypes. Temporal trends in the prevalence of SMM and SMM subtypes were assessed using Joinpoint Regression. Multilevel logistic regression models were used to investigate the association of individual and county-level factors with SMM.

Results: Between 2008 and 2018, there was not a significant change in the prevalence of any SMM (Annual Percent Change (APC): -0.9, 95% CI: -2.2, 0.5). Significant increases in prevalence were identified for three SMM subtypes: other obstetric (OB) SMM (APC: 10.3, 95% CI: 0.1, 21.5) from 2013 to 2018, renal SMM (APC: 8.5, 95% CI: 5.5, 11.6) from 2008 to 2018, and sepsis (APC: 23.0, 95% CI: 6.5, 42.1) from 2014 to 2018. Multilevel logistic regression models revealed variability in individual and county risk factors across different SMM subtypes. Adolescent mothers (OR: 2.10, 95% CI: 1.29, 3.40) and women in the 40 to 55 (OR: 1.67, 95% CI: 1.12, 2.51) age group were found to be at significant risk of other OB SMM and renal SMM, respectively. For every increase in rank within a county's socioeconomic social vulnerability index (SVI), the risk of respiratory SMM increased 2.8-fold whereas an increase in rank in the racial/ethnic minority SVI was associated with a 1.6-fold elevated risk of blood transfusion.

Conclusion: This study underscores the complex association between individual and county factors associated with SMM, emphasizing the need for multifaced approaches to improve maternal care.

查看原文本刊更多论文

与分娩时严重孕产妇发病率相关的个人和县一级因素：2008-2018年美国私人保险人口调查》。

目的：很少有研究探讨县级变量对严重孕产妇发病率（SMM）亚型的影响。为了填补这一空白，本研究使用了一个大型商业数据库来研究个人和县级因素与 SMM 之间的关联：这项回顾性队列研究使用了 Optum 的去标识化 Clinformatics® Data Mart 数据库 (CDM) 中 2008 年至 2018 年的数据。本研究的主要结果是任何SMM、非输血SMM和九种特定的SMM亚型。采用接合点回归法评估了SMM和SMM亚型患病率的时间趋势。多层次逻辑回归模型用于研究个人和县级因素与SMM的关联：2008年至2018年期间，任何SMM的流行率均无显著变化（年度百分比变化（APC）：-0.9，95% CI：-2.2，0.5）。发现三种 SMM 亚型的患病率有显著增加：2013 年至 2018 年的其他产科 (OB) SMM（APC：10.3，95% CI：0.1，21.5）、2008 年至 2018 年的肾脏 SMM（APC：8.5，95% CI：5.5，11.6）和 2014 年至 2018 年的败血症（APC：23.0，95% CI：6.5，42.1）。多层次逻辑回归模型显示，在不同的SMM亚型中，个人和县级风险因素存在差异。研究发现，青春期母亲（OR：2.10，95% CI：1.29，3.40）和 40 至 55 岁年龄组的女性（OR：1.67，95% CI：1.12，2.51）分别面临其他产科 SMM 和肾脏 SMM 的显著风险。在一个县的社会经济社会脆弱性指数（SVI）中，等级每增加一级，呼吸道SMM的风险就增加2.8倍，而在种族/少数民族SVI中，等级增加与输血风险增加1.6倍有关：本研究强调了与 SMM 相关的个人因素和县域因素之间的复杂关联，强调需要采取多方面的方法来改善孕产妇护理。

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

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.