心血管疾病是北美孕产妇死亡的主要原因。
■这项研究的目的是检查分娩住院期间心血管严重孕产妇发病率(CSMM)与死亡率之间的关系。
■我们使用医疗保健成本和利用率项目进行了一项队列研究,全国住院患者样本,并确定了1999年至2015年CSMM的分娩住院情况。我们描述了CSMM发病率及其相关病死率的时间趋势。在有CSMM的个人中,我们使用logistic回归分析评估了参与者特征与死亡率之间的关联.
■在13,791,605次分娩住院中,11,152被CSMM复杂化。其中,495导致死亡。CSMM的总发生率为8.09/10,000分娩住院(95%CI:7.94-8.24),在15年内,每10,000例分娩住院患者从7.76增加到8.38(P<0.001)。CSMM的总病死率为4.44/100CSMM(95%CI:4.06-4.85),在研究期间,每100例CSMM事件从6.55降至2.50(P=0.035)。在CSMM的参与者中,黑人(调整后的赔率比[aOR]:1.80;95%CI:1.39-2.32)和西班牙裔(aOR:1.44;95%CI:1.09-1.90)妇女和有医疗补助保险的妇女(aOR:1.52;95%CI:1.22-1.88),产后出血(AOR:4.06;95%CI:3.05-5.41),或系统性红斑狼疮(aOR:2.50;95%CI:1.31~4.78)的死亡风险增加.
■CSMM的发病率超过15年增加,反映产科人群的转变。虽然在研究期间有所下降,CSMM的病死率仍然升高。确定了与CSMM死亡率相关的几个因素。
UNASSIGNED: Cardiovascular conditions are the leading cause of maternal mortality in North America.
UNASSIGNED: The purpose of this
study was to examine the relationship between cardiovascular severe maternal morbidity (CSMM) and mortality during delivery hospitalization.
UNASSIGNED: We performed a cohort
study using the Health Care Cost and Utilization Project, Nationwide Inpatient Sample, and identified delivery hospitalizations with CSMM from 1999 to 2015. We described temporal trends in the incidence of CSMM and its associated case-fatality. Among individuals with CSMM, we evaluated the association between participant characteristics and mortality using logistic regression analyses.
UNASSIGNED: Of 13,791,605 delivery hospitalizations, 11,152 were complicated by CSMM. Of those, 495 resulted in mortality. The overall incidence of CSMM was 8.09 per 10,000 delivery hospitalizations (95% CI: 7.94-8.24), increasing from 7.76 to 8.38 per 10,000 delivery hospitalizations over 15 years (P < 0.001). The overall case-fatality for CSMM was 4.44 per 100 CSMM (95% CI: 4.06-4.85), decreasing from 6.55 to 2.50 per 100 CSMM events over the
study period (P = 0.035). Among participants with CSMM, Black (adjusted odds ratio [aOR]: 1.80; 95% CI: 1.39-2.32) and Hispanic (aOR: 1.44; 95% CI: 1.09-1.90) women and those with Medicaid insurance (aOR: 1.52; 95% CI: 1.22-1.88), postpartum hemorrhage (aOR: 4.06; 95% CI: 3.05-5.41), or systemic lupus erythematosus (aOR: 2.50; 95% CI: 1.31-4.78) were at increased risk of mortality.
UNASSIGNED: The incidence of CSMM increased over 15 years, reflecting transformations within the obstetric population. Although it decreased during the
study period, case-fatality from CSMM remained elevated. Several factors associated with mortality from CSMM were identified.