Marian F MacDorman1, Eugene Declercq2, Marie E Thoma3. 1. Research Professor, Maryland Population Research Center, University of Maryland, College Park, MD, USA. 2. Professor, Department of Community Health, Boston University School of Public Health, Boston, MA, USA. 3. Assistant Professor, Department of Family Science, University of Maryland, College Park, MD, USA.
Abstract
BACKGROUND: Maternal mortality is a sentinel indicator of health care quality. Our purpose was to analyze trends in Texas maternal mortality by demographic characteristics and cause of death, and to evaluate data quality. METHODS: Maternal mortality data were initially analyzed by single years, but then were grouped into 5-year averages (2006-2010 and 2011-2015) for more detailed analyses. Rates were computed per 100 000 live births. A two-proportion z test or Poisson regression for numerators <30 was used to evaluate differences. RESULTS: The Texas maternal mortality rate increased from 18.6 in 2010 to 38.7 in 2012, and then declined nonsignificantly to 32.5 in 2015. The 2011-2015 rate (34.2) was 87% higher than the 2006-2010 rate (18.3). In 2011-2015, the maternal mortality rate for women ≥40 years (558.8) was 27 times higher than for women <40 years (20.7). From 2006-2010 to 2011-2015, the maternal mortality rate increased by 121% for women ≥40 years and by 55% for women <40 years. The rate increased by 132% for nonspecific causes of death, and by 54% for specific causes. Rates for women <40 years for specific causes increased by 36%. CONCLUSIONS: The observed increase in maternal mortality in Texas from 2006-2010 to 2011-2015 is likely a result of both a true increase in rates and increased overreporting of maternal deaths, as indicated by implausibly high and increasing rates for women aged ≥40 years and among nonspecific causes of death. Efforts are needed to strengthen reporting of death certificate data, and to improve access to quality maternal health care services.
BACKGROUND: Maternal mortality is a sentinel indicator of health care quality. Our purpose was to analyze trends in Texas maternal mortality by demographic characteristics and cause of death, and to evaluate data quality. METHODS: Maternal mortality data were initially analyzed by single years, but then were grouped into 5-year averages (2006-2010 and 2011-2015) for more detailed analyses. Rates were computed per 100 000 live births. A two-proportion z test or Poisson regression for numerators <30 was used to evaluate differences. RESULTS: The Texas maternal mortality rate increased from 18.6 in 2010 to 38.7 in 2012, and then declined nonsignificantly to 32.5 in 2015. The 2011-2015 rate (34.2) was 87% higher than the 2006-2010 rate (18.3). In 2011-2015, the maternal mortality rate for women ≥40 years (558.8) was 27 times higher than for women <40 years (20.7). From 2006-2010 to 2011-2015, the maternal mortality rate increased by 121% for women ≥40 years and by 55% for women <40 years. The rate increased by 132% for nonspecific causes of death, and by 54% for specific causes. Rates for women <40 years for specific causes increased by 36%. CONCLUSIONS: The observed increase in maternal mortality in Texas from 2006-2010 to 2011-2015 is likely a result of both a true increase in rates and increased overreporting of maternal deaths, as indicated by implausibly high and increasing rates for women aged ≥40 years and among nonspecific causes of death. Efforts are needed to strengthen reporting of death certificate data, and to improve access to quality maternal health care services.
Authors: Andreea A Creanga; Cynthia J Berg; Carla Syverson; Kristi Seed; F Carol Bruce; William M Callaghan Journal: Obstet Gynecol Date: 2015-01 Impact factor: 7.661
Authors: Amanda J Stevenson; Imelda M Flores-Vazquez; Richard L Allgeyer; Pete Schenkkan; Joseph E Potter Journal: N Engl J Med Date: 2016-02-02 Impact factor: 91.245
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Bolajoko O Olusanya; Saad B Omer; John Nelson Opio; Orish Ebere Orisakwe; Jeyaraj D Pandian; Christina Papachristou; Jae-Hyun Park; Angel J Paternina Caicedo; Scott B Patten; Vinod K Paul; Boris Igor Pavlin; Neil Pearce; David M Pereira; Konrad Pesudovs; Max Petzold; Dan Poenaru; Guilherme V Polanczyk; Suzanne Polinder; Dan Pope; Farshad Pourmalek; Dima Qato; D Alex Quistberg; Anwar Rafay; Kazem Rahimi; Vafa Rahimi-Movaghar; Sajjad ur Rahman; Murugesan Raju; Saleem M Rana; Amany Refaat; Luca Ronfani; Nobhojit Roy; Tania Georgina Sánchez Pimienta; Mohammad Ali Sahraian; Joshua A Salomon; Uchechukwu Sampson; Itamar S Santos; Monika Sawhney; Felix Sayinzoga; Ione J C Schneider; Austin Schumacher; David C Schwebel; Soraya Seedat; Sadaf G Sepanlou; Edson E Servan-Mori; Marina Shakh-Nazarova; Sara Sheikhbahaei; Kenji Shibuya; Hwashin Hyun Shin; Ivy Shiue; Inga Dora Sigfusdottir; Donald H Silberberg; Andrea P Silva; Jasvinder A Singh; Vegard Skirbekk; Karen Sliwa; Sergey S Soshnikov; Luciano A Sposato; 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