Perinatal & Pediatric
State patterns in maternal deaths due to disparity, 2018-2021 Lauren Rossen* Lauren Rossen Ashley Hirai Amy Branum Sarah Forrest
Maternal mortality is a major public health concern in the US. Given small numbers of events (generally <1000/year nationally), it is difficult to assess variation in maternal mortality and related disparities by state, as rates for many subgroups are unreliable. Spatial models can be used to produce more stable estimates for small geographic areas. A recent paper used spatiotemporal models to estimate state-level patterns in maternal mortality by race/ethnicity, but the focus was on trends over time from 1999-2019 and many single-year estimates were still unreliable.
Data on maternal deaths (while pregnant or within 42 days) and corresponding denominators (numbers of live births) were drawn from mortality and birth data from 2018-2021, tabulated by state of residence and race/ethnicity (Hispanic, and the following non-Hispanic [NH] groups: American Indian or Alaska Native [AIAN], Asian, Black, Native Hawaiian or Other Pacific Islander [NHOPI], and White). Log-binomial hierarchical Bayesian models with spatial random effects were used to estimate the number of maternal deaths per 100,000 live births by race/ethnicity, borrowing strength across states and racial/ethnic groups to produce more stable estimates of maternal mortality rates (MMRs). Deaths due to disparity were defined as the number of maternal deaths that could be avoided if all groups had the same rate as non-Hispanic White in each state.
The states with the largest annual number of maternal deaths due to disparities overall and for non-Hispanic Black women were Florida (15), Texas (14), Georgia (14), and New York (13). States with the highest percentages of maternal deaths due to disparity for NH Black women were New York, New Jersey, Colorado, and Mississippi (~66-71%). For NH AIAN women, Washington, Colorado, and Minnesota had the highest percentages.
More granular estimates of maternal mortality disparities at the state level could inform efforts to prevent maternal deaths and reduce inequities.
