1. CONCLUSIONS / PUBLIC HEALTH IMPLICATIONS
Health and Social Disparities Among Pregnancy-Related Deaths in California
Christy McCain, MPH1, Elizabeth Lawton, MHS2, Connie Mitchell, MD, MPH2, Sue Holtby, MPH1, Elliott Main, MD3, 4, Debra Bingham, DrPH, RN5, Christine Morton, PhD3
1Public Health Institute, Santa Cruz, CA, 2California Department of Public Health, Maternal Child and Adolescent Health, 3California Maternal Quality Care Collaborative (CMQCC),
Stanford University, CA; 4California Pacific Medical Center, San Francisco, CA; 5Perinatal Consultant, Belmont, CA and formerly CMQCC ( )
CA-PAMR is supported by Title V funds from the California Department of Public Health; Maternal, Child and Adolescent Health Division
BACKGROUND
FINDINGS
Disparities by Expected Payer Source at Time of Delivery, PAMR Pregnancy-Related Cohort (N=98)
Race/Ethnicity of California Birth Cohort (N=1,075,073) and PAMR Pregnancy-Related Cohort (n=98)
California’s maternal mortality rate has nearly tripled in the last decade, from 5.6 per 100,000 live births in 1996 to16.9 per 100,000 live births in 2006.
The maternal mortality rate among African Americans continues to increase and is disproportionately high compared to other racial/ethnic groups. In California, from , African-American women were roughly four times more likely to suffer a maternal death than other racial/ethnic groups.
RESEARCH QUESTIONS
Select Characteristics of the PAMR Pregnancy-Related Cohort, by Race/Ethnicity (n=98)
*At least one of the following was identified: Delay/failure to seek care, noncompliance, Lack of knowledge re: importance of event, Non-English Speaker, Domestic Violence, Lack of Social Support, Substance Abuse, Obesity or Multiplicity of Medical Conditions
Are there disparities among demographic characteristics of the women who died of pregnancy-related causes?
Do the women who died differ from the general population of women giving birth in California?
Medi-Cal was the payer source for 44% of women who gave birth in California in (n=1,076,073) and 57% of the pregnancy-related deaths (n=98) indicating that women who died from pregnancy-related causes were likely poorer than the average California woman giving birth.
Compared with privately-insured women, publicly-funded women were significantly…
Less likely to have graduated from high school
More likely to be unmarried
More likely to smoke or use other drugs during their pregnancy
More likely to die more than 42 days after the delivery
More likely to have had patient factors identified as contributing to their death
METHODS
The California Pregnancy-Associated Mortality Review (CA-PAMR) is a systematic review of pregnancy-related deaths in California used to identify causes of death, contributing factors, and opportunities for improvement.
Coroner reports, death and birth certificates, hospital discharge data and medical records are abstracted and compiled into case summaries for all California deaths that appear to be pregnancy-related within one year of being pregnant.
A multidisciplinary panel of experts reviews the case summaries and identifies whether the death was pregnancy-related, causation, each woman’s risk level, preventability and opportunities for improvement.
CONCLUSIONS / PUBLIC HEALTH IMPLICATIONS
African-American women had a higher average body mass index than all other racial groups combined, and cardiomyopathy was the leading cause of death. Public health efforts should address these risk factors with education and behavior change strategies. Quality improvements in obstetric management, such as better screening and appropriate referrals, should be implemented.
• Medi-Cal recipients are at higher risk for maternal death than privately-insured women. Since poverty will likely increase with the economic downturn, strong public health messages should continue among low-income groups to ensure a healthy pregnancy and access to affordable and quality care.
Among the women who died, there were many social factors that were difficult to quantify. Qualitative methods, such as surrogate interviews, may be helpful in teasing out the context of the racial/ethnic and other social disparities.
KEY DEFINITIONS
Maternal Mortality: The death of a woman while pregnant or within
42 days of end of pregnancy, from pregnancy-related causes.
Pregnancy-Related Death: The death of a woman from cause(s) directly related to the physiologic changes of pregnancy or from causes that were aggravated by pregnancy or its management, up to one year postpartum.
*p<.05