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Journal article
Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study
Lancet Regional Health - Americas (Online), v 39, 100902
Nov 2024
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Reports of high and rising maternal mortality ratios (MMR) in the United States have caused serious concern. We examined spatiotemporal patterns in cause-specific MMRs, in order to obtain insights into the cause for the increase.
The study included all maternal deaths recorded by the Centers for Disease Control and Prevention from 1999 to 2021. Changes in overall and cause-specific MMRs were quantified nationally; in low-vs high-MMR states (i.e., MMRs <20 vs ≥26 per 100,000 live births in 2018–2021); and in California vs Texas (populous states with low vs high MMRs). Cause-specific MMRs included those due to unambiguous causes (e.g., selected obstetric causes such as pre-eclampsia/eclampsia) and less-specific/potentially incidental causes (e.g., “other specified pregnancy-related conditions”, chronic hypertension, and malignant neoplasms).
MMRs increased from 9.60 (n = 1543) in 1999–2002 to 23.5 (n = 3478) per 100,000 live births in 2018–2021. The temporal increase in MMRs was smaller in low-MMR states (from 7.82 to 14.1 per 100,000 live births) compared with high-MMR states (from 11.1 to 31.4 per 100,000 live births). MMRs due to selected obstetric causes decreased to a similar extent in low-vs high-MMR states, whereas the increase in MMRs from less-specific/potentially incidental causes was smaller in low- vs high-MMR states (MMR ratio (RR) 5.57, 95% CI 4.28, 7.25 vs 7.07, 95% CI 5.91, 8.46), and in California vs Texas (RR 1.67, 95% CI 1.03, 2.69 vs 10.8, 95% CI 6.55, 17.7). The change in malignant neoplasm-associated MMRs was smaller in California vs Texas (RR 1.21, 95% CI 0.08, 19.3 vs 91.2, 95% CI 89.2, 94.8). MMRs from less-specific/potentially incidental causes increased in all race/ethnicity groups.
Spatiotemporal patterns of cause-specific MMRs, including similar reductions in unambiguous obstetric causes of death and variable increases in less-specific/potentially incidental causes, suggest misclassified maternal deaths and overestimated maternal mortality in some US states.
This work received no funding.
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Details
- Title
- Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study
- Creators
- K.S. Joseph (Corresponding Author) - University of British ColumbiaSarka Lisonkova - University of British ColumbiaAmélie Boutin - Université LavalGiulia M. Muraca - McMaster UniversityNeda Razaz - Karolinska InstitutetSid John - University of British ColumbiaYasser Sabr - University of British ColumbiaSophie Simon - University of British ColumbiaJohanna Kögl - University of British ColumbiaElizabeth A. Suarez - Rutgers, The State University of New JerseyWee-Shian Chan - University of British ColumbiaAzar Mehrabadi - Dalhousie UniversityJustin S. Brandt - Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, USAEnrique F. Schisterman - University of PennsylvaniaCande V. Ananth - Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Publication Details
- Lancet Regional Health - Americas (Online), v 39, 100902
- Publisher
- Elsevier; AMSTERDAM
- Number of pages
- 13
- Grant note
Declaration of interests KSJ is supported by an Investigator award from the BC Children's Hospital Research Institute. AB is supported by a Junior 1 Research Scholar Award from the Fonds de recherche du Quebec-Sante. SS and SJ are funded from a grant from the Canadian Institutes of Health Research. CVA is supported, in part, by the National Heart, Lung, and Blood Institute (R01-HL150065) and the National Institute of Environmental Health Sciences (R01-ES033190) , National Institutes of Health.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:001331663500001
- Scopus ID
- 2-s2.0-85205420947
- Other Identifier
- 991021910601804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Health Care Sciences & Services
- Public, Environmental & Occupational Health