Maternal Mortality Rates Highlight Alarming Inequities by State, Race/Ethnicity

Laura Fleszar, MPH

Credit: LinkedIn

Breaking data were published from the first investigation to comprehensively analyze the state-by-state, maternal mortality rates among 5 racial and ethnic groups in the US. Laura Fleszar, MPH, led a team from The Institute for Health Metrics and Evaluation (IHME) and Mass General Brigham, aiming to address the dire need for understanding long-term trends in maternal mortality ratios with estimations across racial and ethnic groups in all states.¹

The observational study revealed significant variations in maternal mortality rates between racial/ethnic groups which suggested an urgent need for targeted interventions and policy reforms. Investigators used vital registration and census data from 1999 through 2019, which further illuminated the concerning state of maternal mortality in the US.

The significant rises have been evidenced to continue beyond the examined time range in the current study.²

In 2019, the ratios were highest among American Indian and Alaska Native and Black populations compared with Asian, Native Hawaiian, or Other Pacific Islander; Hispanic; and white populations. This stark inequality persisted over the 2-decade period analyzed.¹

Maternal Mortality Increases in all US Racial, Ethnic Populations

From 1999 to 2019, median state maternal mortality ratios increased across all racial and ethnic groups. The American Indian and Alaska Native population experienced the most substantial rise in median state ratios beginning at 14 (IQR, 5.7 - 23.9) to 49.2 (IQR, 14.4 - 88).

Notably, the Black population consistently had the highest median state ratios throughout the entire study period with an increase from 26.7 (IQR, 18.3 - 32.9) to 55.4 (IQR, 31.6 - 74.5).

• Asian, Native Hawaiian, or Other Pacific Islander population: 9.6 (IQR, 5.7 - 12.6) to 20.9 (IQR, 12.1 - 32.8).
• Hispanic population: 9.6 (IQR, 6.9 - 11.6) to 19.1 (IQR, 11.6 - 24.9).
• White population: 9.4 (IQR, 7.4 - 11.4) to 26.3 (IQR, 20.3 - 33.3).

Existing interventions have had limited impact in mitigating maternal mortality for these groups, according to the study. Investigators acknowledged even with the introduction of a pregnancy checkbox on death certificates, the median state maternal mortality ratios for the American Indian and Alaska Native and Asian, Native Hawaiian, or Other Pacific Islander populations continued to rise.

The comprehensive nature of this research provides critical evidence to guide intervention policies and benchmark progress in preventing maternal deaths, beginning with comprehensive mortality surveillance in all states through vital registration to identify areas and racial/ethnic groups most in need of improvement, investigators wrote.

Additionally, the study urged policymakers to prioritize initiatives that directly address the underlying causes of maternal mortality, particularly among these high-risk populations as evidence exhibited the persistence of the crisis and the exacerbation of disparities.

States with Steep Rise in Maternal Mortality:

• American Indian & Alaska Native > 162%
  •  FL, KS, IL, RI, WI
• White > 135%
  • IN, GA, TN, LA, MO
• Hispanic > 105%
  • IN, MN, GA, TN, IL
• Asian Pacific Islander > 83%
  • KS, IL, MO, MI, GA
• Black > 93%
  • LA, NJ, GA, AR, TX

References:

1. Fleszar LG, Bryant AS, Johnson CO, et al. Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States. JAMA. 2023;330(1):52–61. doi:10.1001/jama.2023.9043
2. Grossi G. Black and Hispanic Women had Significant Rise in Maternal Mortality in 2020. HCPLive. March 8, 2023. https://www.hcplive.com/view/black-hispanic-women-significant-rise-maternal-mortality-2020