LATEBREAKER
Women’s Health
Incidence of Maternal Hemorrhage: A Systematic Analysis for the Global Burden of Disease Study Jennifer Faith* Jennifer Faith Ira Martopullo Nicholas Kassebaum Mae Dirac
Results of the Global Burden of Disease (GBD) Study 2021 are anticipated to be released in spring of 2024. As part of this study, we quantified incidence of obstetric complications, including maternal hemorrhage, for 204 countries and territories, from 1990 to 2021, and for five-year age groups from 10-54 years. We used 497 data sources to estimate incidence of maternal hemorrhage, including data from a systematic review of peer-reviewed and gray literature and from claims and hospital discharges, altogether encompassing 524 country-years from 106 countries and territories. Data included known heterogeneity in case definition, case ascertainment, denominator, and demographics, so we used Meta-Regression, Bayesian, Regularized, Trimmed (MR-BRT) to adjust sources with non-reference case definitions. Sources with aggregate age groups were disaggregated by imposing age patterns from preliminary age-specific models. We modeled maternal hemorrhage as incidence ratio, or incident cases per live birth, using a meta-regression model in DisMod-MR 2.1. Modeled estimates were multiplied by GBD-estimated age-specific fertility rates to estimate incidence rates. In 2021, we estimated 14.0 million incident cases of maternal hemorrhage, a small (1.5%) and nonsignificant decrease from the 14.2 million estimated for 1990. Incidence ratios were stable between 1990 and 2021, but incident rates decreased by 32.4%, suggesting that population increase might be a notable contributor to stable case counts over time. In 2021, incidence rates were highest in Sub-Saharan Africa, and incident cases were highest in India followed by China. We will discuss enhancements to nonfatal estimation for the upcoming round of GBD, including adding new data, enhancing adjustment of non-reference data by expanding alternative definitions and by using alternative ICD mappings of clinical data, and improving incidence ratio estimation by incorporating mortality-to-incidence ratios in the modeling process.