Severe Maternal Morbidity among Women in the U. S. Military, 2003–2015

2021 ◽  
Author(s):  
Clinton Hall ◽  
Celeste J. Romano ◽  
Anna T. Bukowinski ◽  
Gia R. Gumbs ◽  
Kaitlyn N. Dempsey ◽  
...  
Keyword(s):  
Health Care ◽  
Alaska Native ◽  
Maternal Morbidity ◽  
White Women ◽  
Full Employment ◽  
Active Duty ◽  
Severe Maternal Morbidity ◽  
Military Women ◽  
Military Health ◽  
Hispanic White

Objective This study aimed to assess trends and correlates of severe maternal morbidity at delivery among active duty women in the U.S. military, all of whom are guaranteed health care and full employment. Study Design Linked military personnel and medical encounter data from the Department of Defense Birth and Infant Health Research program were used to identify a cohort of delivery hospitalizations among active duty military women from January 2003 through August 2015. Cases of severe maternal morbidity were identified by applying 21- and 20-condition algorithms (with and without blood transfusion) developed by the Centers for Disease Control and Prevention. Rates (per 10,000 delivery hospitalizations) were reported overall and by specific condition. Multivariable Poisson regression models estimated associations with demographic, clinical, and military characteristics. Results Overall, 187,063 hospitalizations for live births were included for analyses. The overall 21- and 20-condition severe maternal morbidity rates were 111.7 (n = 2089) and 37.4 (n = 699) per 10,000 delivery hospitalizations, respectively. The 21-condition rate increased by 184% from 2003 to 2015; the 20-condition rate increased by 40%. Compared with non-Hispanic White women, the adjusted 21-condition rate of severe maternal morbidity was higher for Hispanic (adjusted rate ratio [aRR] = 1.28, 95% confidence interval [CI]: 1.13–1.46), non-Hispanic Black (aRR = 1.34, 95% CI: 1.21–1.49), Asian/Pacific Islander (aRR = 1.35, 95% CI: 1.13–1.61), and American Indian/Alaska Native (aRR = 1.39, 95% CI: 1.06–1.82) women. Rates also varied by age, clinical factors, and deployment history. Conclusion Active duty U.S. military women experienced an increase in severe maternal morbidity from 2003 to 2015 that followed national trends, despite protective factors such as stable employment and universal health care. Similar to other populations, military women of color were at higher risk for severe maternal morbidity relative to non-Hispanic White military women. Continued surveillance and further investigation into maternal health outcomes are critical for identifying areas of improvement in the Military Health System. Key Points

Racial/Ethnic Disparities in Intensive Care Admissions in a Pregnant and Postpartum Population, Hawai‘i, 2012-2017

2021 ◽  
pp. 003335492110211
Author(s):  
Pamela Estrada ◽  
Hyeong Jun Ahn ◽  
Scott A. Harvey
Keyword(s):  
Maternal Morbidity ◽  
Clinical Characteristics ◽  
White Women ◽  
Ethnic Disparities ◽  
Severe Maternal Morbidity ◽  
Obstetric Outcomes ◽  
Icu Admission ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Objective Maternal morbidity and mortality is a global concern despite advances in medical care and technology and improved economic resources of nations worldwide. The primary objective of our study was to describe racial/ethnic disparities in severe maternal morbidity by using admission to an intensive care unit (ICU) as a marker. The secondary objective was to evaluate associations between patient characteristics, including obstetric outcomes, and severe maternal morbidity. Methods This retrospective cohort study used a large inpatient database to identify pregnancy and postpartum hospitalizations in Hawai‘i from January 2012 through September 2017. We evaluated associations between sociodemographic and clinical characteristics and race/ethnicity by using χ2 tests. We used multivariable logistic regression to assess associations between race/ethnicity and ICU admission. We used a post hoc analysis to assess associations between ICU admission and obstetric outcomes by race/ethnicity. Results After adjustment, we found a significantly higher ICU admission rate among Asian (adjusted odds ratio [aOR] = 1.30; 95% CI, 1.04-1.62; P = .02), Filipino (aOR = 1.45; 95% CI, 1.17-1.79; P < .001), and Native Hawaiian/Other Pacific Islander (aOR = 1.39; 95% CI, 1.15-1.68; P < .001) women compared with non-Hispanic White women. Multiple clinical characteristics and outcomes were associated with ICU admission, such as preexisting chronic conditions and pregnancy-induced hypertensive disorders. Conclusion We found that severe maternal morbidity represented by ICU admission is higher among Asian, Filipino, and Native Hawaiian/Other Pacific Islander women than among non-Hispanic White women in Hawai’i. Our findings reemphasize the need for health care providers to be vigilant in caring for members of racial/ethnic minority groups and managing their comorbidities.

scholarly journals Volume as an Indicator for Outcomes for Severe Maternal Morbidity in the Military Health System

2021 ◽  
Author(s):  
Aimee Hunter ◽  
Amanda Banaag ◽  
Monica A Lutgendorf ◽  
Col Barton Staat ◽  
Tracey P Koehlmoos
Keyword(s):  
Health System ◽  
Maternal Morbidity ◽  
Healthcare Systems ◽  
Severe Maternal Morbidity ◽  
Military Health System ◽  
Case Volume ◽  
Military Health ◽  
Treatment Facilities ◽  
The Military ◽  
Military Treatment Facilities

ABSTRACT Background Maternal obstetric morbidity is a growing concern in the USA, where rates of maternal morbidity exceed Europe and most developed countries. Prior studies have found that obstetric case volume affects maternal morbidity, with low-volume facilities having higher rates of morbidity. However, these studies were done in civilian healthcare systems that are different from the Military Health System (MHS). This study evaluates whether obstetric case volume impacts severe maternal morbidity (SMM) in military hospitals located in the continental United States. Methods This cross-sectional study included all military treatment facilities (MTFs) (n = 35) that performed obstetric deliveries (n = 102,959) from October 2015 to September 2018. Data were collected from the MHS Data Repository and identified all deliveries for the study time period. Severe maternal morbidity was defined by the Centers for Disease Control. The 30-day readmission rates were also included in analysis. Military treatment facilities were separated into volume quartiles for analysis. Univariate logistic regressions were performed to determine the impact of MTF delivery volume on the probability of SMM and 30-day maternal readmissions. Results The results for all regression models indicate that the MTF delivery volume had no significant impact on the probability of SMM. With regard to 30-day maternal readmissions, using the upper middle quartile as the comparison group due to the largest number of deliveries, MTFs in the lower middle quartile and in the highest quartile had a statistically significant higher likelihood of 30-day maternal readmissions. Conclusion This study shows no difference in SMM rates in the MHS based on obstetric case volume. This is consistent with previous studies showing differences in MHS patient outcomes compared to civilian healthcare systems. The MHS is unique in that it provides families with universal healthcare coverage and access and provides care for approximately 40,000 deliveries annually. There may be unique lessons on volume and outcomes in the MHS that can be shared with healthcare planners and decision makers to improve care in the civilian setting.

scholarly journals Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women

2021 ◽  
Author(s):  
Jennifer Erdrich ◽  
Felina Cordova-Marks ◽  
Angela R. Monetathchi ◽  
Manxia Wu ◽  
Arica White ◽  
...  
Keyword(s):  
Breast Cancer ◽  
American Indian ◽  
Alaska Native ◽  
White Women ◽  
Early Stage ◽  
Breast Conservation ◽  
Lower Percentage ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Hispanic White

Abstract Background Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. Methods Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010–2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. Results From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. Conclusion This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.

scholarly journals Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
K. G. Fernandes ◽  
M. L. Costa ◽  
S. M. Haddad ◽  
M. A. Parpinelli ◽  
M. H. Sousa ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Skin Color ◽  
Maternal Morbidity ◽  
White Women ◽  
Maternal Outcome ◽  
Near Miss ◽  
Severe Maternal Morbidity ◽  
Maternal Near Miss ◽  
Maternal Outcomes ◽  
Severe Maternal Outcome

Background. Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity. Methods. This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PRadj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race. Results. Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis. Conclusion. Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.

scholarly journals Military Health System equalizes overall Severe Maternal Morbidity and other delivery outcomes for Hispanic women

2022 ◽  
Vol 226 (1) ◽  
pp. S500-S501
Author(s):  
Jameaka L. Hamilton ◽  
Kathleen Lundeberg ◽  
Rachel Tindal ◽  
Veronica M. Gonzalez-Brown ◽  
Erin Keyser
Keyword(s):  
Health System ◽  
Maternal Morbidity ◽  
Hispanic Women ◽  
Severe Maternal Morbidity ◽  
Military Health System ◽  
Military Health ◽  
Delivery Outcomes
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