美国心血管严重孕产妇发病率和分娩死亡率:基于人口的研究
Isabelle Malhamé1,2, Nicholas Czuzoj-Shulman3,4, Haim A Abenhaim3,4
1Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
JACC. Advances
|June 28, 2024
概括
心血管严重孕产妇发病率 (CSMM) 在15年内增加,但病例死亡率下降. 黑人和西班牙裔妇女,以及那些有医疗补助或特定条件的妇女,面临更高的CSMM死亡风险.
科学领域:
- 产科和妇科 产科和妇科
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 心血管疾病是北美孕产妇死亡的主要原因.
- 与心血管疾病 (CSMM) 相关的严重孕产妇发病率 (SMM) 是分娩期间住院治疗的关键问题.
研究的目的:
- 调查心血管严重孕产妇发病率 (CSMM) 和死亡率之间的关联.
- 分析CSMM发病率和病例死亡率的趋势.
- 为了确定体验CSMM的个体中死亡的风险因素.
主要方法:
- 一项队列研究利用了医疗保健成本和利用项目,全国住院患者样本 (NIS) 从1999年到2015年.
- 确定了CSMM的分娩住院情况,并分析了发生率和病例死亡率的时间趋势.
- 后勤回归模型评估了CSMM病例中参与者特征和死亡率之间的关系.
主要成果:
- 超过1370万例分娩住院病例包括11,152例CSMM病例,其中495例导致死亡.
- 每万分娩中CSMM的发病率为8.09,在15年内呈现上升趋势 (P < 0.001).
- 总的来说,CSMM病例死亡率为4.44%,在研究期间显著下降 (P = 0.035).
- 增加的死亡风险与黑人种族 (aOR:1.80),西班牙裔种族 (aOR:1.44),医疗补助保险 (aOR:1.52),产后出血 (aOR:4.06) 和全身性红斑狼 (aOR:2.50) 相关.
结论:
- CSMM的发病率上升反映了产科人口的变化.
- 尽管病例死亡率有所下降,但CSMM仍然是孕产妇死亡的重要原因.
- 特定的人口和临床因素与CSMM后的死亡风险增加有关.
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