Maternal Death: An Investigation of Disparities in Pregnancy Related Mortality based on Socioeconomic Factors
Abstract Number: T-13
Abstract Type: Original Research
Background: African-American women die from pregnancy-related causes at higher rates than women in other racial/ethnic groups. (Hogan 2010) The disparity in maternal mortality rates has been widening since the 1940s. (Hoyert 2007) To investigate race differences in the cause of maternal deaths at a tertiary care center in Alabama, we planned to examined maternal deaths recorded at the university of Alabama at Birmingham (UAB) Hospital from 1990 to 2011 by race, cause of death and pre-existing health conditions.
Methods: We have identified 99 maternal deaths at UAB from 1990 to 2011. At the current state of analysis we were able to include data from the first decade (1990 – 2000). Our first analysis step was design to determine whether the proportion of African American women who died in our cohort was the same as one would have predicted when taking into account race demographics of the counties of residence for each woman. We then categorized cases by race, insurance status, access to prenatal care and known co-morbid conditions at the time of hospital admission. Associations of categorical variables were tested with a Pearson Chi-square test.
Results: The proportion of African American women who died at UAB hospital from 1990 to 2000 was significantly than one would have expected based on the race demographics of their county of residence (χ2= 7.628, p=.0057). However, we did not observe a significant difference when comparing insurance status (no insurance, Medicaid, private insurance; χ2= 2.916,p=.572), health status (pre-existing conditions yes/no; χ2=.286 ,p=.592), and prenatal care (yes/no; χ2= 1.047,p=.306) (table 1).
Conclusions: The growing disparity in maternal deaths serve as a call to action: to investigate the deaths, understand the causes, recognize and comprehend racial/ethnic disparities, and develop strategies for prevention. As a first analysis step, we have confirmed the racial inequality of maternal death in our own institution. We plan to further investigate causes of deaths and comorbid conditions through an expanded analysis.
1. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ: Maternal mortality for 181 countries, 1980 –2008: A systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010; 375: 1609 –23
2. Hoyert DL. Maternal mortality and related concepts. National Center for Health Statistics. Vital Health Stat 3(33). 2007.