Shiliang Liu1, K S Joseph2, Sharon Bartholomew1, John Fahey3, Lily Lee4, Alexander C Allen5, Michael S Kramer6, Reg Sauve7, David C Young8, Robert M Liston9. 1. Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa online. 2. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; School of Population and Public Health, University of British Columbia, Vancouver BC. 3. Reproductive Care Program of Nova Scotia, Halifax NS. 4. British Columbia Perinatal Health Program, Vancouver BC. 5. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax NS. 6. Department of Pediatrics, McGill University, Montreal QC; Department of Epidemiology and Biostatistics, McGill University, Montreal QC; Canadian Institutes of Health Research, Ottawa ON. 7. Department of Pediatrics, University of Calgary, Calgary AB; Department of Community Health Sciences, University of Calgary, Calgary AB. 8. Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS. 9. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Abstract
OBJECTIVE: To identify temporal trends and regional variations in severe maternal morbidity in Canada using routine hospitalization data. METHODS: We used a previously identified set of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10CA) and Canadian Classification of Interventions (CCI) codes to estimate rates of severe maternal morbidity in Canada (excluding Quebec) for 2003 to 2007 using the Discharge Abstract Database of the Canadian Institute for Health Information (CIHI). Rates and 95% confidence intervals were calculated by year and within each province and territory and contrasted using the chi-square or Fisher exact test. RESULTS: The overall rate of severe maternal morbidity was 13.8 per 1000 deliveries (95% CI 13.6 to 14.0). Five provinces or territories had rates that were significantly higher than those in the rest of the country: Newfoundland and Labrador (19.0 per 1000; 95% CI 17.2 to 20.8), Saskatchewan (16.9 per 1000; 95% CI 15.9 to 18.0), Alberta (15.4 per 1000; 95% CI 14.9 to 15.9), Northwest Territories (22.5 per 1000; 95% CI 18.0 to 27.7), and Nunavut (20.2 per 1000; 95% CI 14.2 to 27.8). Rates of some illnesses declined (e.g., eclampsia rates decreased from 12.4 in 2003 to 5.7 per 10 000 deliveries in 2007, P<0.001), while others increased (e.g., postpartum hemorrhage with blood transfusion rates increased from 36.6 in 2003 to 44.3 per 10 000 deliveries in 2007, P<0.001). Interprovincial/territorial contrasts showed several disparities with respect to specific maternal illnesses. CONCLUSION: The observed temporal trends and regional disparities in severe maternal morbidity may represent important population health phenomena, and further investigation is required to assess their importance.
OBJECTIVE: To identify temporal trends and regional variations in severe maternal morbidity in Canada using routine hospitalization data. METHODS: We used a previously identified set of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10CA) and Canadian Classification of Interventions (CCI) codes to estimate rates of severe maternal morbidity in Canada (excluding Quebec) for 2003 to 2007 using the Discharge Abstract Database of the Canadian Institute for Health Information (CIHI). Rates and 95% confidence intervals were calculated by year and within each province and territory and contrasted using the chi-square or Fisher exact test. RESULTS: The overall rate of severe maternal morbidity was 13.8 per 1000 deliveries (95% CI 13.6 to 14.0). Five provinces or territories had rates that were significantly higher than those in the rest of the country: Newfoundland and Labrador (19.0 per 1000; 95% CI 17.2 to 20.8), Saskatchewan (16.9 per 1000; 95% CI 15.9 to 18.0), Alberta (15.4 per 1000; 95% CI 14.9 to 15.9), Northwest Territories (22.5 per 1000; 95% CI 18.0 to 27.7), and Nunavut (20.2 per 1000; 95% CI 14.2 to 27.8). Rates of some illnesses declined (e.g., eclampsia rates decreased from 12.4 in 2003 to 5.7 per 10 000 deliveries in 2007, P<0.001), while others increased (e.g., postpartum hemorrhage with blood transfusion rates increased from 36.6 in 2003 to 44.3 per 10 000 deliveries in 2007, P<0.001). Interprovincial/territorial contrasts showed several disparities with respect to specific maternal illnesses. CONCLUSION: The observed temporal trends and regional disparities in severe maternal morbidity may represent important population health phenomena, and further investigation is required to assess their importance.
Authors: Carmen B Young; Shiliang Liu; Giulia M Muraca; Yasser Sabr; Tracy Pressey; Robert M Liston; K S Joseph Journal: CMAJ Date: 2018-05-07 Impact factor: 8.262
Authors: Susitha Wanigaratne; Donald C Cole; Kate Bassil; Ilene Hyman; Rahim Moineddin; Marcelo L Urquia Journal: Am J Public Health Date: 2015-10-15 Impact factor: 9.308
Authors: Azar Mehrabadi; Jennifer A Hutcheon; Lily Lee; Robert M Liston; K S Joseph Journal: BMC Pregnancy Childbirth Date: 2012-10-11 Impact factor: 3.007
Authors: Azar Mehrabadi; Shiliang Liu; Sharon Bartholomew; Jennifer A Hutcheon; Laura A Magee; Michael S Kramer; Robert M Liston; K S Joseph Journal: BMJ Date: 2014-07-30