(Press-News.org) IHME/Mass General Brigham study finds rates highest for Black population; largest increase seen in American Indian and Alaskan Native populations
High rates of maternal mortality found in northern Mountain states and the Midwest in addition to the South, a region traditionally known to have high rates
Study is the first such analysis for every state, showing differences in each by racial and ethnic groups
A new study by investigators from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and Mass General Brigham found that maternal mortality rates have worsened from 1999 to 2019, hitting some racial and ethnic groups and states harder than others. Their results are published in the Journal of the American Medical Association (JAMA).
"Maternal mortality is a crisis in the United States. These rates have been increasing over the past several decades and were exacerbated by the pandemic," said co-first author Allison Bryant, MD, MPH, senior medical director for health equity at Mass General Brigham. "Our study sheds light on the wide disparities within maternal mortality rates — the specter of maternal death differentially burdens some ethnic and racial populations."
Maternal mortality, or maternal death, is a death during or up to one year after the end of pregnancy. According to the Centers for Disease Control and Prevention, common causes of maternal death include mental health conditions — including death by suicide, and overdose related to substance use disorder — excessive bleeding (hemorrhage), cardiac and coronary conditions, infection, thromboembolism (blood clot), cardiomyopathy (a disease of the heart muscle) and hypertensive disorders of pregnancy (relating to high blood pressure). Previous research has found that rates of different causes of maternal mortality vary by race and ethnicity.
Bryant and co-authors used the National Vital Statistics System data on deaths and live births in each state and racial/ethnic group between 1999 and 2019. They then used a modeling process to create estimates of maternal deaths over those periods. This modeling estimated maternal mortality for each state and each race and ethnicity out of every 100,000 live births without potentially breaching any person's privacy.
"These disparities in maternal mortality are just the tip of the iceberg and tell us a lot about the health risks facing people in the states where these deaths are most likely to occur, " said Greg Roth, associate professor in the Division of Cardiology and Director of the Program in Cardiovascular Health Metrics at IHME. "In the U.S., maternal deaths are often caused by vascular diseases like severe high blood pressure or blood clots. So maternal deaths share many of the same drivers as heart attacks, strokes, and heart failure. Our state-by-state research emphasizes where we need to focus our prevention efforts and which groups are suffering the most."
For all ethnic and racial groups, maternal mortality more than doubled over this time period. These rates have been rising most substantially for American Indian and Alaskan Native people. The maternal mortality rates for Black women were the highest of any group, but the average of state-level rates had started to plateau around 2015 (pre-COVID) for Black women. Factors like structural racism and interpersonal racism play into these disparities, Bryant said. Substantial prevention and awareness efforts around maternal mortality may have had an impact for some populations, but not all.
Maternal mortality rates and disparities varied widely across states. The South had high maternal mortality across all race and ethnicity groups, but especially for Black individuals. Black individuals had the highest maternal mortality rates in some states in the Northeast, which tripled over the time of the study. Maternal mortality rates in the Midwest and the Great Plains states were where highest rates were found for American Indian and Alaskan Native women.
"Often, states in the South are called out as having the worst maternal mortality rates in the nation, whereas California and Massachusetts have the best. But that doesn't tell the whole story," Bryant said. "It's essential to look at the disparities between populations that exist even in the 'best' states."
The study had several limitations. The researchers didn't always have access to information about the causes of maternal death. And the way maternal deaths are recorded on death certificates has changed in the U.S. over the time of this study.
The data used in the study stopped prior to the pandemic in 2019. National data show maternal mortality increased in 2020 and 2021 when it was harder to access health care. The pandemic also hindered some prevention efforts to decrease the deaths of Black women. The pandemic may have widened the disparities seen in this study, Bryant said.
“Our findings provide important insights on maternal mortality rates leading up to the pandemic, and it’s likely that we’ll see a continued increase in the risk of maternal mortality across all populations if we analyze data from subsequent years,” Bryant said. “Black individuals would likely still have the highest rate, but there may be a higher uptick in some of the other groups in the last few years. As we emerge from the pandemic, we must renew our focus on addressing maternal mortality.”
Funding: This study was supported in part by grants from the National Heart, Lung, and Blood Institute (R01HL136868), the National Institutes of Health (75N94019C00016), and Gates Ventures LLC.
Paper cited: Fleszar LG et al. " Trends in state-level maternal mortality by race/ethnicity group in the United States, 1999-2019" JAMA DOI: 10.1001/jama.2023.9043
###
About Mass General Brigham
Mass General Brigham is an integrated academic health care system, uniting great minds in medicine to make life-changing impact for patients in our communities and people around the world.
Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services.
Mass General Brigham is a non-profit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org.
About the Institute for Health Metrics and Evaluation
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME is committed to transparency and makes this information widely available so that policymakers have the evidence they need to make informed decisions on allocating resources to improve population health.
For more information, please visit healthdata.org.
END
Brigham researchers mapped lesions related to epilepsy to a common brain circuit
This study points to a novel role of deep brain circuits in the cause and control of epilepsy
New findings highlight the possibility of using this brain circuit to guide brain stimulation treatments for epilepsy
Focal epilepsy affects over 30 million patients worldwide and is commonly caused by brain lesions, such as stroke. However, it is unclear why some lesion locations cause epilepsy while others do not. A new study by investigators from the Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, found ...
About The Study: Food insecurity was associated with slightly faster memory decline among middle to older–age individuals, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.
Authors: Adina Zeki Al Hazzouri, Ph.D., of Columbia University in New York, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2023.21474)
Editor’s ...
About The Study: While maternal mortality remains unacceptably high among all racial and ethnic groups in the U.S., American Indian and Alaska Native and Black individuals are at increased risk, particularly in several states where these inequities had not been previously highlighted. Maternal mortality persists as a source of worsening disparities in many U.S. states and prevention efforts during this study period (1999 to 2019) appear to have had a limited impact in addressing this health crisis.
Authors: Gregory A. ...
About The Study: Childhood diabetes is an increasing global health challenge with rising incidence. Results of this study suggest that despite the global decline in deaths and disability-adjusted life-years (DALYs), the number of deaths and DALYs remains high among children with diabetes, especially in low Sociodemographic Index regions. Improved understanding of the epidemiology of diabetes in children may facilitate prevention and control.
Authors: Xiaodong Sun, M.D., Ph.D., and Ningning Hou, M.D., of the Affiliated Hospital of Weifang Medical ...
About The Study: The results of this study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the U.S. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.
Authors: Wayne R. Lawrence, Dr.P.H., of the National Institutes of Health in Bethesda, Maryland, is the corresponding author.
To ...
· Use of successful medications to break up blood clots rose from 4% to 14% due to new approach
Suspected stroke victims now bypass emergency room for CT scanner and nurse stroke experts, who support patient care team
Community educators went to beauty and barber shops, churches and water distribution centers to deliver stroke-awareness talks
Approach can be duplicated by other communities to improve treatment
CHICAGO --- The use of thrombolysis, medications to break up blood clots, for acute ischemic stroke reduces post-stroke disability, but it is underutilized. This particularly affects Black individuals, who experience ...
Our body’s fat metabolism plays a vital role in energy production in our body. A research team at the University of Basel, Switzerland, has discovered a molecular switch that regulates lipid metabolism in our cells. This switch controls the storage or conversion of lipids into energy.
All organisms need energy to live. We get energy from various components of our food. Our body uses a part of this energy directly and stores the rest. While glucose serves as an immediately available energy source, fats are stored as energy reserve in form of lipid droplets within our cells.
When the body needs energy from these fat stores, lipids are transported ...
Artificial intelligence can predict on- and off-target activity of CRISPR tools that target RNA instead of DNA, according to new research published in Nature Biotechnology.
The study by researchers at New York University, Columbia Engineering, and the New York Genome Center, combines a deep learning model with CRISPR screens to control the expression of human genes in different ways—such as flicking a light switch to shut them off completely or by using a dimmer knob to partially turn down their activity. These precise gene controls could be used to develop new CRISPR-based therapies.
CRISPR is a gene ...
It’s estimated that around 25% of patients who have a cardiac arrest and receive cardiopulmonary resuscitation (CPR) in a normal hospital setting will survive. Those odds shoot up to 50% for patients who receive CPR during or in the immediate period following surgery, where they are closely monitored by specialists who know their medical history and can intervene without delay. But it’s unclear whether that trend applies to frail patients, who are often older and at a higher risk of experiencing CPR-related trauma and complications. Such uncertainty has led some doctors ...
Induced pluripotent stem (iPS) cells have a great impact on biology and medicine, and they are expected to improve regenerative medicine. Since 2014 when a sheet of retinal pigment epithelial cells derived from iPS cells was transplanted into patients with age-related macular degeneration, clinical trials have been conducted with various cell types derived from iPS cells. While iPS cells derived from healthy individuals have been used so far, it is expected that transplantation therapy using iPS cells can be enhanced through genetic modification in the future.
Therefore, we addressed this possibility by utilizing a Fabry disease mouse model, ...
