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Analysis

Minority Women More Likely to Die from Pregnancy-Related Complications

By John Commins  
   September 06, 2019

Pregnancy-related deaths per 100,000 live births for black, American Indian and Alaska Native women older than 30 were four to five times as high as they were for white women.

Minority women are as much as three times more likely to die from pregnancy-related causes than white women, and most of these deaths are preventable, according to research published this week from the Centers for Disease Control and Prevention.

The disparity worsens as the women age, CDC found. Pregnancy-related deaths per 100,000 live births were four to five times higher for black and American Indian / Alaska Native women age 30 or older than for white women of the same age.

The disparity exists even in states with the lowest pregnancy-related mortality ratios and among women with higher levels of education, suggesting that the factors surrounding pregnancy-related death for black and AI/AN women "is a complex national problem," CDC said.

About 700 women die every year in the United States from pregnancy-related complications, according to CDC estimates.

The findings were published this week in Morbidity and Mortality Weekly Report (MMWR), and suggest that the disparity observed in pregnancy-related death for black and AI/AN women is a complex national problem, said study lead author Emily Petersen, MD, medical officer at CDC's Division of Reproductive Health.

"These disparities are devastating for families and communities and we must work to eliminate them," Petersen said. "There is an urgent need to identify and evaluate the complex factors contributing to these disparities and to design interventions that will reduce preventable pregnancy-related deaths."

CDC's Pregnancy-Related Mortality Surveillance System (PMSS) defines a pregnancy-related death as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication.

An earlier CDC report in May looked at data from 13 state Maternal Mortality Review Committees (MMRCs), which estimated that 60% of pregnancy-related deaths are preventable, mostly through access to better care.

That study also found that each pregnancy-related death saw contributing factors, including access to appropriate care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs.

This week's CDC study, based on analysis of national data on pregnancy-related mortality from 2007-2016, found that:

  • Overall PRMRs increased from 15 to 17 pregnancy-related deaths per 100,000 births.
     
  • Non-Hispanic black and non-Hispanic AI/AN women experienced higher PRMRs (40.8 and 29.7, respectively) than all other racial/ethnic populations.  This was 3.2 and 2.3 times higher than the PRMR for white women – and the gap widened among older age groups.
     
  • For women over the age of 30, PRMR for black and AI/AN women was four to five times higher than it was for white women.
     
  • The PRMR for black women with at least a college degree was 5.2 times that of their white counterparts.
     
  • Cardiomyopathy, thrombotic pulmonary embolism, and hypertensive disorders of pregnancy contributed more to pregnancy-related deaths among black women than among white women.
     
  • Hemorrhage and hypertensive disorders of pregnancy contributed more to pregnancy-related deaths among AI/AN women than white women.
     
  • Disparities were persistent and did not change significantly between 2007-2008 and 2015-2016.

CDC said hospitals and health systems can help to reduce these disparities by implementing standardized protocols in quality improvement initiative, especially at hospitals that disproportionately serve these minority women.

CDC also called for hospitals to identify "implicit bias" in their healthcare delivery to improve patient-provider relationships, and communication, and ultimately outcomes.

CDC said it will award more than $45 million over five years to support the work of MMRCs in 25 states through the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) program. 

“These disparities are devastating for families and communities and we must work to eliminate them.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

About 700 women die every year in the United States from pregnancy-related complications.

CDC estimates that 60% or more of the deaths could be prevented by improving access to quality healthcare.

The disparity in mortality exists even in states with the lowest pregnancy-related mortality ratios and among women with higher levels of education.


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