Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993-2006.

OBJECTIVE

To compare trends in and causes of pregnancy-related mortality by race, ethnicity, and nativity from 1993 to 2006.

METHODS

We used data from the Pregnancy Mortality Surveillance System. For each race, ethnicity, and nativity group, we calculated pregnancy-related mortality ratios and assessed causes of pregnancy-related death and the time between the end of pregnancy and death.

RESULTS

Race, ethnicity, and nativity-related minority women contributed 40.7% of all U.S. live births but 61.8% of the 7,487 pregnancy-related deaths during 1993-2006. Pregnancy-related mortality ratios were 9.1 and 7.5 deaths per 100,000 live births among U.S.- and foreign-born white women, respectively, and slightly higher at 9.6 and 11.6 deaths per 100,000 live births for U.S.- and foreign-born Hispanic women, respectively. Relative to U.S.-born white women, age-standardized pregnancy-related mortality ratios were 5.2 and 3.6 times higher among U.S.- and foreign-born black women, respectively. However, causes and timing of death within 42 days postpartum were similar for U.S.-born white and black women with cardiovascular disease, cardiomyopathy, and other pre-existing medical conditions emerging as chief contributors to mortality. Hypertensive disorders, hemorrhage, and embolism were the most important causes of pregnancy-related death for all other groups of women.

CONCLUSION

Except for foreign-born white women, all other race, ethnicity, and nativity groups were at higher risk of dying from pregnancy-related causes than U.S.-born white women after adjusting for age differences. Integration of quality-of-care aspects into hospital- and state-based maternal death reviews may help identify race, ethnicity, and nativity-specific factors for pregnancy-related mortality.

LEVEL OF EVIDENCE: III.