BOSTON: A new study by researchers at the Institute for Health Metrics and Evaluation at the University of Washington and Brigham General Mass found that maternal mortality rates have worsened between 1999 and 2019, affecting some racial and ethnic groups and states more than others.
Maternal mortality, or maternal death, is a death during or up to one year after the end of pregnancy. The results of the study are published in Journal of the American Medical Association.
The study found that maternal mortality rates are highest among members of the black population, with the largest increases seen in American Indian and Alaska Native populations.
High rates of maternal mortality were found in northern mountain states and the Midwest, in addition to the South, a region traditionally known for having high rates, the study found.
The study is the first such analysis for each state, showing differences in each by racial and ethnic groups.
“Maternal mortality is a crisis in the United States. These rates have been rising over the past few decades and were exacerbated by the pandemic,” co-author Dr. Allison Bryant, senior medical director of health equity at Mass General Brigham, said in a statement Monday. “Our study il ·illuminates the wide disparities between maternal mortality rates: the specter of maternal death burdens some ethnic and racial populations differently.”
In accordance with the Centers for Disease Control and Preventioncommon causes of maternal death include mental health conditions, including death by suicide, overdose or substance use disorder, excessive bleeding (hemorrhage), heart and coronary conditions, infection, thromboembolism (blood clot), cardiomyopathy (a disease of the heart muscle). and hypertensive disorders of pregnancy (related to high blood pressure).
Previous research has found that rates of different causes of maternal mortality vary by race and ethnicity.
Bryant and her coauthors used National System of Vital Statistics data on deaths and live births in each state and racial/ethnic group between 1999 and 2019. They then used a modeling process to create estimates of maternal deaths during those periods . This model estimated maternal mortality for each state and each race and ethnicity per 100,000 live births without potentially violating anyone’s privacy.
“These disparities in maternal mortality are just the tip of the iceberg and tell us a lot about the health risks people face in states where these deaths are most likely to occur,” said Greg Roth , associate professor of the Division of Cardiology and director. from the Cardiovascular Health Metrics Program of the Institute for Health Metrics and Evaluation. “In the US, maternal deaths are often caused by vascular diseases such as severe high blood pressure or blood clots. So maternal deaths share many of the same factors as heart attacks, strokes and heart failure. Our research state by state emphasizes where we need to focus our prevention efforts and which groups suffer the most.”
For all ethnic and racial groups, maternal mortality doubled during this time period. According to the researchers, these rates have increased most substantially for American Indians and Alaska Natives.
Maternal mortality rates for black women were the highest of any group, but the average statewide rates had begun to decline around 2015 (pre-COVID) for black women. Factors such as structural racism and interpersonal racism play into these disparities, Bryant said. Substantial maternal mortality prevention and awareness efforts may have had an impact in some populations, but not all.
Maternal mortality rates and disparities varied widely across states. The South had high maternal mortality in all racial and ethnic groups, but especially for black individuals. Black individuals had the highest maternal mortality rates in some northeastern states, which tripled during the time of the study. Maternal mortality rates in the Midwest and Great Plains states were where the highest rates were found for American Indian and Alaska Native women.
“Southern states are often said to have the worst maternal mortality rates in the country, while California and Massachusetts have the best. But that doesn’t tell the whole story,” Bryant said. “It is essential to look at the disparities between populations that exist even in the ‘best’ states.”
The study had several limitations. Researchers did not always have access to information on the causes of maternal death. And the way maternal deaths are recorded on death certificates has changed in the US during the time of this study.
The data used in the study stopped before the pandemic in 2019. National data show that maternal mortality increased in 2020 and 2021, when access to health care was more difficult. The pandemic also hampered some prevention efforts to reduce the deaths of black women. The pandemic may have widened the disparities seen in this study, Bryant said.
“Our findings provide important information about maternal mortality rates leading up to the pandemic, and we are likely to see a continued increase in the risk of maternal mortality in all populations if we look at data from subsequent years,” Bryant said. “Black individuals would probably still have the highest rate, but there may be a higher increase in some of the other groups in recent years. As we emerge from the pandemic, we need to renew our focus on addressing mortality maternal”.
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