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- Title
Severe Maternal Morbidity and Mortality in Sickle Cell Disease in the National Inpatient Sample, 2012-2018.
- Authors
Early, Macy L.; Eke, Ahizechukwu C.; Gemmill, Alison; Lanzkron, Sophie; Pecker, Lydia H.
- Abstract
Key Points: Question: What are the rates of and risks for severe maternal morbidity (SMM) among birthing people with sickle cell disease (SCD), and what proportion of the increased risk for adverse pregnancy outcomes in SCD is associated with racial disparities encountered by Black patients? Findings: In this cross-sectional study including 3901 deliveries among people with SCD, the maternal mortality rate for people with SCD was 26 times greater than in control deliveries of pregnant people with non-Black race and more than 10 times greater than deliveries among Black pregnant people. Compared with groups without SCD, deliveries among people with SCD had significantly higher odds of SMM, and racial disparities explained, on average, 28.9% of the increased risk in SCD deliveries. Meaning: These results suggest that the risk for SMM is higher in deliveries among people with SCD than those of Black or non-Black control populations with no SCD; nearly one-third of the increased risk may be attributable to racial disparities. This cross-sectional study of deliveries in US hospitals examines pregnancy outcomes for people with sickle cell disease (SCD) and compares adverse outcomes with Black and Non-Black populations without SCD. Importance: Pregnancy outcomes are historically poor among people with sickle cell disease (SCD) in the US, most of whom have Black race. Whether outcomes have improved is unknown. Objective: To tabulate adverse pregnancy outcomes among patients with SCD, comparing outcomes of deliveries among Black people with SCD with those of Black people without SCD and a control non-Black population, and to measure the association of racial disparities with adverse outcomes in SCD pregnancies. Design, Setting, and Participants: This cross-sectional study was a secondary analysis involving data from National Inpatient Sample, a nationally representative sample of 20% of acute hospital admissions in the US, between 2012 and 2018. The data set included all admissions with codes for delivery of a pregnancy among people aged 11 to 55 years. Data were analyzed from September 2021 to August 2022. Exposures: SCD, racial disparities. Main Outcomes and Measures: Severe maternal morbidity (SMM) as measured by the US Centers for Disease Control and Prevention's index alongside other outcomes; multiple logistic regression was used to compare the odds for adverse pregnancy outcomes. Results: The sample included 5 401 899 deliveries, including 3901 deliveries among people with SCD and 742 164 deliveries among people with Black race. Compared with the non-Black control group, patients with SCD and Black patients were younger (mean [SD] age: SCD, 27.2 [5.9] years; Black, 27.1 [6.1] years vs 28.7 [5.9] years) and more likely to have public insurance (SCD, 2609 deliveries [67.3%]; Black, 496 828 deliveries [65.4%] vs 1 880 198 deliveries [40.8%]). The maternal mortality rate in deliveries among people with SCD was 26 times greater than in the non-Black control group and more than 10 times greater than among Black pregnant people without SCD (Per 10 000 deliveries: SCD 13.3; 95% CI, 5.7-31.2; Black race, 1.2; 95% CI, 1.0-1.5; non-Black control 0.5; 95% CI, 0.5-0.6). Compared with the control group, SCD deliveries had higher odds of SMM (adjusted odds ratio [aOR], 7.22; 95% CI, 6.25-8.34; P <.001), especially cerebrovascular events (aOR, 22.00; 95% CI, 15.25-31.72; P <.001) and thromboembolism (aOR, 17.34; 95% CI, 11.55-26.03; P <.001). Racial disparities explained a median (IQR) 28.9% (21.2%-33.1%) of the increased risk in deliveries to people with SCD and between 40% and 50% of the increased risk for acute kidney failure (excess risk [ER], 56.9%; 95% CI, 54.3%-59.3%), intrauterine fetal demise (ER, 47.8%; 95% CI, 46.6%-49.1%), and eclampsia (ER, 42.1%; 95% CI, 37.9%-46.1%). Conclusions and Relevance: In this large cross-sectional study of pregnancy outcomes in people with SCD, the risk for SMM was higher compared with deliveries among people without SCD, especially for thrombotic events, organ failure, and death. Racial disparities were associated with adverse outcomes. Our findings compel scientific, clinical, and political effort to improve outcomes for pregnant people with SCD.
- Subjects
PSYCHOLOGY of Black people; RACISM; CONFIDENCE intervals; CROSS-sectional method; SEVERITY of illness index; PREGNANCY outcomes; CENTERS for Disease Control &; Prevention (U.S.); DESCRIPTIVE statistics; RESEARCH funding; MATERNAL mortality; ADVERSE health care events; HEALTH equity; DATA analysis software; ODDS ratio; SICKLE cell anemia; COMORBIDITY; SECONDARY analysis; DISEASE complications; PREGNANCY
- Publication
JAMA Network Open, 2023, Vol 6, Issue 1, pe2254552
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.54552