- Here's a study you might find interesting. Obesity, diabetes (linked to obesity) were by far the Archived Message
Posted by gnpbfubbgre
on May 9, 2022, 12:44:58, in reply to "Further evidence that we have the best healthcare in the world"
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drivers they found, with socioeconomic factors secondary. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5935-2 In the most parsimonious final model that included only predictor variables associated with maternal mortality at P < 0.05, time trends in obesity, diabetes, high school education, African American race, and fewer than 10 prenatal care visits, along with the revised death certificate indicator variable, were all significantly positively associated with state-level trends in maternal mortality (Table 2). Implementation of the revised death certificate was associated with an estimated increase in maternal mortality of more than 6 deaths per 100,000 births. Meanwhile, a 1% increase in prevalence of obesity among women of childbearing age was associated with a + 0.24 unit increase in maternal mortality rate. A 1% increase in diabetes prevalence among women of childbearing age was associated with a + 0.39 unit change in maternal mortality. High school non-completion, African American race among childbearing women, and attending fewer than 10 prenatal visits were also positively associated with maternal mortality. Our analysis examines state-level maternal mortality rates and their associations with many potential risk factors. Factors such as advancing maternal age, better ascertainment of maternal deaths, increased prevalence of obesity and chronic health conditions, and changes in cesarean section rates have been proposed to explain the increase in maternal mortality over the last two decades [3, 8, 10,11,12,13, 17]. In our study, maternal health factors including obesity and diabetes were associated with increasing maternal mortality, while trends in maternal age and cesarean-section rates were not in multivariable models where associations with other factors were stronger. Maternal obesity, as measured by high body mass index, has been consistently reported to increase the risk of pregnancy complications, including thromboembolic disease, gestational diabetes mellitus, and hypertensive disorders of pregnancy [18,19,20,21,22,23,24,25,26]. Reports issued by state maternal mortality review panels in Virginia, Florida, and California have reported obesity as a risk factor for maternal mortality [6, 27, 28]. Elevated BMI also increases the risk of non-pregnancy-related chronic health conditions, including diabetes mellitus, identified in our study and elsewhere as a risk factor for maternal mortality [18, 21]. Chronic hypertension, cesarean section rates, and self-reported health status were also significantly associated with maternal mortality in our initial analyses, but were excluded from the final multi-level model because of the comparatively stronger associations of maternal mortality with other variables collinear with these factors. Taken together, our findings about the importance of mothers’ chronic conditions suggest additional emphasis is warranted to promote the general pre-conception health of women of childbearing age. To be sure, this endeavor is complicated by the fact that 45% of births in the U.S. are unintended [29]. There was also some change in the death certificate in 2003 that made this more visible. The 2003 Revision of the U.S. Standard Certificate of Death introduced a checkbox to identify the pregnancy status of female decedents, changing maternal death identification. Similar changes have been reported to increase the number of maternal deaths reported, and perhaps leading to over-reporting [3, 17, 33, 34, 35]. It is possible that prior to the uniform checkbox, many pregnant decedents were not identified during completion of the death certificate, and therefore fewer maternal deaths were counted than occurred. The implementation of the new certificate likely addresses this prior ascertainment bias and therefore has increased measures of maternal mortality.  Previous Message |
- Buttcrack May 9, 2022, 8:32:27