Jennifer Matas, Laura E Mitchell, Jason L Salemi, Cici X Bauer, Cecilia Ganduglia Cazaban
{"title":"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》。","authors":"Jennifer Matas, Laura E Mitchell, Jason L Salemi, Cici X Bauer, Cecilia Ganduglia Cazaban","doi":"10.1055/a-2483-5842","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Study design: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>This study underscores the complex association between individual and county factors associated with SMM, emphasizing the need for multifaced approaches to improve maternal care.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Jennifer Matas, Laura E Mitchell, Jason L Salemi, Cici X Bauer, Cecilia Ganduglia Cazaban\",\"doi\":\"10.1055/a-2483-5842\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Study design: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>This study underscores the complex association between individual and county factors associated with SMM, emphasizing the need for multifaced approaches to improve maternal care.</p>\",\"PeriodicalId\":7584,\"journal\":{\"name\":\"American journal of perinatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-11-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of perinatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2483-5842\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2483-5842","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
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.
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.
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.
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