Accurate information is critical to the development of preventive measures to address the profound racial/ethnic disparities in maternal mortality in the United States.
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The purpose of this study was to use this set of confirmed maternal deaths to re-examine racial and ethnic disparities in US maternal mortality, to identify the leading causes of maternal death by race and ethnicity, and to identify the specific causes of death that contributed the most to racial and ethnic disparities.
#Dockets dying light codes 2017 code
17 To correct for overreporting errors, we analyzed the cause of death literals (actual words written on the death certificate) to identify cases in which the decedent’s pregnancy or postpartum status was not only identified by the pregnancy checkbox or a maternal mortality code on the death certificate but was also confirmed by specific terms written in the cause-of-death section of the death certificate-hereafter known as confirmed maternal deaths. To address these challenges, we developed a different cause-of-death coding method to increase the specificity of causes identified while greatly reducing the number of maternal deaths coded to ill-defined causes. 15, 16 With so many deaths coded to ill-defined causes, it is impossible to accurately identify the leading causes of maternal death or the percent contribution of individual causes of death to maternal mortality disparities. Studies found that 40% to 50% of maternal deaths were coded to ill-defined causes that do not provide any information as to the actual cause of death. 14Īnother problem identified in vital statistics maternal mortality data is the large and increasing number of deaths coded to ill-defined causes. 11, 12 However, recent validity studies found that the pregnancy checkbox also led to overreporting of maternal deaths (i.e., reproductive-aged women were counted as a maternal death with no indication of pregnancy upon further validation), ranging from 21% in a 4-state study 13 to 50% in a Texas study. 8, 9 With the 2003 standard revision of birth and death certificates, a pregnancy checkbox was added to address this underreporting, 10 and, as a result, more maternal deaths were captured on the death certificate. Before 2003, the concern about accuracy of vital statistics data focused mainly on underreporting of maternal deaths. 7 However, concerns about the accuracy of US vital statistics data used to measure maternal mortality have persisted for decades. Vital statistics provide the official US maternal mortality estimates and also identify cases for more detailed review for other maternal mortality data systems such as the Pregnancy Mortality Surveillance System and maternal mortality review committees. Compounding the challenges has been a lack of clarity in the measurement of maternal mortality. 3 The breadth and persistence of these racial disparities have led to clinical, 4 policy, 5 and programmatic 6 initiatives. 1 These disparities have persisted, averaging 4 times higher for Black compared with White mothers as recently as 1990 to 1996, 2 with the most recent publication of 2018 maternal mortality rates showing a disparity of 2.5 times. In 1933, all states reported maternal deaths for the first time, and the mortality rate for Black mothers (1000 per 100 000 births) was 1.8 times the rate for White mothers (564 per 100 000). Significant disparities in maternal mortality between White and Black mothers have been recorded as long as national data have been available. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity.Ĭonclusions.
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Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. We examined racial and ethnic disparities both overall and by primary cause. Primary cause of death was identified and recoded using cause-of-death literals.
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We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. We analyzed 2016–2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. To better understand racial and ethnic disparities in US maternal mortality.