tetano
Editor, Senior Moderator
J Racial Ethn Health Disparities
. 2023 Nov 8.
doi: 10.1007/s40615-023-01857-2. Online ahead of print. Cesarean Delivery Outcomes for Patients with Coronavirus Disease-2019 in the USA
Michael Mazzeffi[SUP] 1 [/SUP], David Miller[SUP] 2 [/SUP], Ashley Garneau[SUP] 3 [/SUP], Jessica Sheeran[SUP] 3 [/SUP], Amanda Kleiman[SUP] 3 [/SUP], Sachin H Mehta[SUP] 3 [/SUP], Mohamed Tiouririne[SUP] 3 [/SUP]
Affiliations
Introduction: Coronavirus disease-2019 (COVID-19) may have increased morbidity and mortality in patients having Cesarean delivery (CD) in the USA.
Methods: We performed a retrospective cohort study of patients who had CD in 2020 using the national inpatient sample. After stratification by COVID-19 status, demographics, comorbidities, complications, mortality, and costs were compared.
Results: There were 31,444,222 hospitalizations in the USA in 2020 with a mortality rate of 2.8%. Among these, 1,453,945 patients had COVID-19 and mortality was 13.2%. There were 1,108,755 patients who had CD and 15,550 had COVID-19. Patients with COVID-19 more frequently had Medicaid and were Hispanic. Patients with COVID-19 had more comorbidities including chronic hypertension, diabetes mellitus, pre-eclampsia, and eclampsia. Mortality in CD patients with COVID-19 was 30 in 10,000 patients, while for non-COVID-19 patients, it was 1 in 10,000 patients, P < 0.001. The crude odds ratio for mortality in COVID-19 patients was 32.1 (95% confidence interval = 22.9 to 44.7), P < 0.001 and the adjusted odds ratio was 29.3 (95% confidence interval = 20.7 to 41.4), P < 0.001.
Conclusions: CD patients with COVID-19 had 30-fold higher mortality before widespread vaccination was available with Hispanic and Medicaid patients disproportionately impacted. Potential explanations for this disparity include reduced access to personal protective equipment (e.g., masks) and testing, as well as socio-economic factors. Further research is needed to understand the factors that contributed to disparities in infection and clinical outcomes among obstetric patients during the COVID-19 pandemic. In future pandemics, enhanced efforts will be needed to protect economically disadvantaged women who are pregnant.
Keywords: COVID-19; Disparities; Obstetrics; Women’s health.
. 2023 Nov 8.
doi: 10.1007/s40615-023-01857-2. Online ahead of print. Cesarean Delivery Outcomes for Patients with Coronavirus Disease-2019 in the USA
Michael Mazzeffi[SUP] 1 [/SUP], David Miller[SUP] 2 [/SUP], Ashley Garneau[SUP] 3 [/SUP], Jessica Sheeran[SUP] 3 [/SUP], Amanda Kleiman[SUP] 3 [/SUP], Sachin H Mehta[SUP] 3 [/SUP], Mohamed Tiouririne[SUP] 3 [/SUP]
Affiliations
- PMID: 37938434
- DOI: 10.1007/s40615-023-01857-2
Introduction: Coronavirus disease-2019 (COVID-19) may have increased morbidity and mortality in patients having Cesarean delivery (CD) in the USA.
Methods: We performed a retrospective cohort study of patients who had CD in 2020 using the national inpatient sample. After stratification by COVID-19 status, demographics, comorbidities, complications, mortality, and costs were compared.
Results: There were 31,444,222 hospitalizations in the USA in 2020 with a mortality rate of 2.8%. Among these, 1,453,945 patients had COVID-19 and mortality was 13.2%. There were 1,108,755 patients who had CD and 15,550 had COVID-19. Patients with COVID-19 more frequently had Medicaid and were Hispanic. Patients with COVID-19 had more comorbidities including chronic hypertension, diabetes mellitus, pre-eclampsia, and eclampsia. Mortality in CD patients with COVID-19 was 30 in 10,000 patients, while for non-COVID-19 patients, it was 1 in 10,000 patients, P < 0.001. The crude odds ratio for mortality in COVID-19 patients was 32.1 (95% confidence interval = 22.9 to 44.7), P < 0.001 and the adjusted odds ratio was 29.3 (95% confidence interval = 20.7 to 41.4), P < 0.001.
Conclusions: CD patients with COVID-19 had 30-fold higher mortality before widespread vaccination was available with Hispanic and Medicaid patients disproportionately impacted. Potential explanations for this disparity include reduced access to personal protective equipment (e.g., masks) and testing, as well as socio-economic factors. Further research is needed to understand the factors that contributed to disparities in infection and clinical outcomes among obstetric patients during the COVID-19 pandemic. In future pandemics, enhanced efforts will be needed to protect economically disadvantaged women who are pregnant.
Keywords: COVID-19; Disparities; Obstetrics; Women’s health.