US maternal deaths more than doubled between 1999-2019: JAMA

Maternal deaths more than doubled across America over the course of two decades, and the tragedy unfolded disproportionately.

Black mothers died at the highest rates in the nation, while the largest increases in deaths were found among American Indian and Alaska Native mothers. And some states – and racial or ethnic groups within them – fared worse than others.

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These were the findings of a new study published Monday in the Journal of the American Medical Association. The researchers looked at maternal deaths between 1999 and 2019 for every state and five racial and ethnic groups — but not the increase in the epidemic.

“This is a call to action for all of us to understand the root causes — to understand that some of it is about health care and access to health care, but a lot of it is about structural racism and the policies and procedures and things we have in place that can prevent people from getting healthy, “Doctor. said Allison Bryant, one of the study’s authors and a senior medical director for Health Equity Mass General Brigham,

Among wealthy countries, the US has the highest maternal mortality rate, defined as death during or up to one year after pregnancy. Common causes include excessive bleeding, infection, heart disease, suicide, and drug overdose.

Bryant and his colleagues at Mass General Brigham and the Institute for Health Metrics and Evaluation University of Washington Beginning with the National Vital Statistics data on deaths and live births. They then used a modeling procedure to estimate the maternal mortality rate out of every 100,000 live births.

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Overall, they found massive, growing inequalities. The study showed that high rates of maternal mortality are not limited to the South, but also extend to regions such as the Midwest and states such as Wyoming and Montana, which had higher rates for several racial and ethnic groups in 2019.

When the researchers compared maternal mortality rates in the first decade of the study to those in the second, they found dramatic jumps and identified five states with the largest increases between those decades. Those hikes exceeded:

  • 162% for American Indian and Alaska Native mothers in Florida, Illinois, Kansas, Rhode Island, and Wisconsin;
  • 135% for white mothers in Georgia, Indiana, Louisiana, Missouri, and Tennessee;
  • 105% for Hispanic mothers in Georgia, Illinois, Indiana, Minnesota, and Tennessee;
  • 93% for black mothers in Arkansas, Georgia, Louisiana, New Jersey, and Texas;
  • 83% for Asian and Pacific Islander moms in Georgia, Illinois, Kansas, Michigan, and Missouri.

“I hate to say it, but I was not surprised by the findings. We’ve seen enough evidence to suggest that maternal mortality is on the rise.” Try to find ways to do something.”

Maddox pointed out how, compared to other wealthier countries, the US invests less in things like social services, primary care and mental health. They also said that Missouri did not adequately fund public health and did not expand Medicaid during the years of the study. He has since expanded Medicaid — and lawmakers passed a bill giving new moms a full year of Medicaid health coverage. Last week, Missouri Governor Mike Parson signed a budget bill that included $4.4 million for a maternal mortality prevention plan.

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In neighboring Arkansas, black women are twice as likely to die from pregnancy-related deaths as white women, according to a 2021 state report.

Dr. William Greenfield, medical director of family health at the Arkansas Department of Health, said the disparity is significant and “has persisted over time,” and it’s difficult to pinpoint exactly why the state’s maternal mortality rate has increased among black mothers. .

Black women have long had the worst rates in the country, and the problem affects people of all socioeconomic backgrounds. For example, US Olympic champion sprinter Torrie Bowie, 32, died in May of complications from childbirth.

The pandemic has likely exacerbated all demographic and geographic trends, Bryant said, and “this is absolutely an area for future study.” Maternal death rates are set to decline in 2022 after hitting a six-decade high in 2021, according to preliminary federal data – a spike experts attributed primarily to COVID-19. Officials said the final 2022 rate is on track to approach pre-pandemic levels, which are still the highest in decades.

Bryant said it’s important to understand more about these disparities to help focus community-based solutions and understand what resources are needed to tackle the problem.

Arkansas is already using telemedicine and working on several other ways to increase access to care, said Greenfield, who is also a professor of obstetrics and gynecology. University of Arkansas Medical Center in Little Rock and was not involved in the study.

The state also has a “perinatal quality collaborative” network, which helps healthcare providers share best practices for things like reducing cesarean sections, managing complications with hypertensive disorders, and preventing childbirth-related injuries or serious complications. helps to understand.

Greenfield said, “Most of the deaths that we reviewed and those reviewed in other places … were preventable.”

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