Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study

被引：2

作者：

Joseph, K. S. ^{[1
,2
,3
,4
]}

Lisonkova, Sarka ^{[1
,2
,3
,4
]}

Boutin, Amelie ^{[6
,7
]}

Muraca, Giulia M. ^{[1
,2
,3
,8
,9
]}

Razaz, Neda ^{[10
]}

John, Sid ^{[1
,2
,3
]}

Sabr, Yasser ^{[1
,2
,3
]}

Simon, Sophie ^{[1
,2
,3
]}

Koegl, Johanna ^{[1
,2
,3
,11
]}

Suarez, Elizabeth A. ^{[12
,13
]}

Chan, Wee-Shian ^{[2
,3
,5
]}

Mehrabadi, Azar ^{[14
,15
]}

Brandt, Justin S. ^{[16
]}

Schisterman, Enrique F. ^{[17
]}

Ananth, Cande, V ^{[13
,18
,19
,20
,21
]}

机构：

[1] Univ British Columbia, Dept Obstet & Gynaecol, Vancouver, BC, Canada

[2] Childrens & Womens Hosp, Vancouver, BC, Canada

[3] Hlth Ctr British Columbia, Vancouver, BC, Canada

[4] Univ British Columbia, Sch Populat & Publ Hlth, Vancouver, BC, Canada

[5] Univ British Columbia, Dept Med, Vancouver, BC, Canada

[6] Univ Laval, Fac Med, Dept Pediat, Quebec City, PQ, Canada

[7] Univ Laval, Res Ctr, CHU Quebec, Quebec City, PQ, Canada

[8] McMaster Univ, Dept Obstet & Gynecol, Hamilton, ON, Canada

[9] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[10] Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden

[11] Med Univ Innsbruck, Dept Obstet & Gynecol, Innsbruck, Austria

[12] Rutgers Inst Hlth Hlth Care Policy & Aging Res, Ctr Pharmacoepidemiol & Treatment Sci, New Brunswick, NJ USA

[13] Rutgers Robert Wood Johnson Med Sch, Dept Obstet Gynecol & Reprod Sci, Div Epidemiol & Biostat, New Brunswick, NJ USA

[14] Dalhousie Univ, Dept Obstet & Gynaecol, Perinatal Epidemiol Res Unit, Halifax, NS, Canada

[15] Dalhousie Univ, Dept Pediat, Perinatal Epidemiol Res Unit, Halifax, NS, Canada

[16] NYU Grossman Sch Med, Dept Obstet & Gynecol, Div Maternal Fetal Med, New York, NY USA

[17] Univ Penn, Perelman Sch Med, Dept Biostat Epidemiol & Informat, Philadelphia, PA USA

[18] Rutgers Sch Publ Hlth, Dept Biostat & Epidemiol, Piscataway, NJ USA

[19] Rutgers Robert Wood Johnson Med Sch, Cardiovasc Inst New Jersey, New Brunswick, NJ USA

[20] Rutgers Robert Wood Johnson Med Sch, Dept Med, New Brunswick, NJ USA

[21] Rutgers Robert Wood Johnson Med Sch, Environm & Occupat Hlth Sci Inst, Piscataway, NJ USA

来源：

LANCET REGIONAL HEALTH-AMERICAS | 2024年 / 39卷

基金：

加拿大健康研究院; 美国国家卫生研究院;

关键词：

Maternal mortality; United States; Cause of death; Epidemiology; Surveillance; Pregnancy complications; TRENDS; DEATHS;

D O I：

10.1016/j.lana.2024.100902

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background 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. Methods 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). Findings 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. Interpretation 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.

引用

页数：13

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