Maternal mortality in the U.S. more than doubled between 1999 and 2019


Date:
July 3, 2023
Source:
Mass General Brigham
Summary:
A new study has found that maternal mortality rates have worsened
from 1999 to 2019, hitting some racial and ethnic groups and
states harder than others. The study found rates highest for Black
populations and the largest increase was seen in American Indian
and Alaskan Native populations. By region, high rates of maternal
mortality were found in northern Mountain states and the Midwest
in addition to the South, a region traditionally known to have
high rates.


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FULL STORY ==========================================================================
A new study by investigators from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and Mass General Brigham found that maternal mortality rates have worsened from 1999 to 2019,
hitting some racial and ethnic groups and states harder than others. Their results are published in the Journal of the American Medical Association (JAMA).

"Maternal mortality is a crisis in the United States. These rates have
been increasing over the past several decades and were exacerbated by
the pandemic," said co-first author Allison Bryant, MD, MPH, senior
medical director for health equity at Mass General Brigham. "Our study
sheds light on the wide disparities within maternal mortality rates --
the specter of maternal death differentially burdens some ethnic and
racial populations." Maternal mortality, or maternal death, is a death
during or up to one year after the end of pregnancy. According to the
Centers for Disease Control and Prevention, common causes of maternal
death include mental health conditions - - including death by suicide,
and overdose related to substance use disorder - - excessive bleeding (hemorrhage), cardiac and coronary conditions, infection, thromboembolism (blood clot), cardiomyopathy (a disease of the heart muscle) and
hypertensive disorders of pregnancy (relating to high blood pressure).

Previous research has found that rates of different causes of maternal mortality vary by race and ethnicity.

Bryant and co-authors used the National Vital Statistics System 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 over those periods. This modeling estimated maternal mortality
for each state and each race and ethnicity out of every 100,000 live
births without potentially breaching any person's privacy.

"These disparities in maternal mortality are just the tip of the iceberg
and tell us a lot about the health risks facing people in the states
where these deaths are most likely to occur, " said Greg Roth, associate professor in the Division of Cardiology and Director of the Program in Cardiovascular Health Metrics at IHME. "In the U.S., maternal deaths
are often caused by vascular diseases like severe high blood pressure
or blood clots. So maternal deaths share many of the same drivers as
heart attacks, strokes, and heart failure.

Our state-by-state research emphasizes where we need to focus our
prevention efforts and which groups are suffering the most." For all
ethnic and racial groups, maternal mortality more than doubled over
this time period. These rates have been rising most substantially
for American Indian and Alaskan Native people. The maternal mortality
rates for Black women were the highest of any group, but the average of state-level rates had started to plateau around 2015 (pre-COVID) for
Black women. Factors like structural racism and interpersonal racism
play into these disparities, Bryant said.

Substantial prevention and awareness efforts around maternal mortality
may have had an impact for some populations, but not all.

Maternal mortality rates and disparities varied widely across states. The
South had high maternal mortality across all race and ethnicity groups,
but especially for Black individuals. Black individuals had the highest maternal mortality rates in some states in the Northeast, which tripled
over the time of the study. Maternal mortality rates in the Midwest and
the Great Plains states were where highest rates were found for American
Indian and Alaskan Native women.

"Often, states in the South are called out as having the worst maternal mortality rates in the nation, whereas California and Massachusetts have
the best. But that doesn't tell the whole story," Bryant said. "It's
essential to look at the disparities between populations that exist
even in the 'best' states." The study had several limitations. The
researchers didn't always have access to information about the causes
of maternal death. And the way maternal deaths are recorded on death certificates has changed in the U.S. over the time of this study.

The data used in the study stopped prior to the pandemic in 2019. National
data show maternal mortality increased in 2020 and 2021 when it was
harder to access health care. The pandemic also hindered some prevention efforts to decrease the deaths of Black women. The pandemic may have
widened the disparities seen in this study, Bryant said.

"Our findings provide important insights on maternal mortality rates
leading up to the pandemic, and it's likely that we'll see a continued
increase in the risk of maternal mortality across all populations if we
analyze data from subsequent years," Bryant said. "Black individuals would likely still have the highest rate, but there may be a higher uptick
in some of the other groups in the last few years. As we emerge from
the pandemic, we must renew our focus on addressing maternal mortality."
This study was supported in part by grants from the National Heart, Lung,
and Blood Institute (R01HL136868), the National Institutes of Health (75N94019C00016), and Gates Ventures LLC.

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========================================================================== Journal Reference:
1. Laura G. Fleszar, Allison S. Bryant, Catherine O. Johnson,
Brigette F.

Blacker, Aleksandr Aravkin, Mathew Baumann, Laura Dwyer-Lindgren,
Yekaterina O. Kelly, Kelsey Maass, Peng Zheng, Gregory
A. Roth. Trends in State-Level Maternal Mortality by Racial and
Ethnic Group in the United States. JAMA, 2023; 330 (1): 52 DOI:
10.1001/jama.2023.9043 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2023/07/230703133100.htm

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