Underreporting of Maternal Deaths on Death Certificates and the Magnitude of the Problem of Maternal Mortality

Horon, Isabelle L.

doi:10.2105/ajph.2004.040063

Cited by 114 publications

(84 citation statements)

References 15 publications

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“…Several reports have shown that vital statistics data alone under-report maternal deaths as much as 30 to 60% compared to enhanced surveillance. [18][19][20][21] Furthermore, our institution is a regional perinatal center, which accepts referral of women at high risk of morbidity and death.…”

Section: Discussionmentioning

confidence: 99%

Predictors of maternal mortality and near-miss maternal morbidity

et al. 2007

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Objective: To identify risk factors for life-threatening maternal outcomes.Study Design: Hospital charts were reviewed for cases of maternal mortality or near-miss and for controls overmatched 1:3. Significant risk factors were identified through simple and best subsets multiple logistic regression.Result: Eight cases of mortality and 69 near-miss cases were found. Significant risk factors with their odds ratios and 95% confidence intervals are: age 35 to 39 years (2.3, 1.2 to 4.4) and >39 years (5.1, 1.8 to 14.4); African-American race (7.4, 2.5 to 22.0) and Hispanic ethnicity (4.2, 1.3 to 13.2); chronic medical condition (2.7, 1.5 to 4.8); obesity (3.0, 1.7 to 5.3); prior cesarean (5.2, 2.8 to 9.8) and gravidity (1.2, 1.1 to 1.5 per pregnancy). In multivariable logistic regression, race remained significant while controlling for other significant factors and markers of socioeconomic status.Conclusion: Some risk factors can be modified through medical care, education or social support systems. Racial disparity in outcome is confirmed and is unexplained by traditional risk factors.

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Section: Discussionmentioning

confidence: 99%

Predictors of maternal mortality and near-miss maternal morbidity

et al. 2007

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“…Data from Europe suggest that underreporting of perinatal suicide on death certificates is in the range of 26% to 56%, 10,11 given that the presence of a child, or perhaps a birth, does not always emerge during the investigation of a death. 1,4,9,12,13 Despite high-profile media attention and calls to increase knowledge, with the goal of encouraging policy change, little is known about the true extent of the problem in Canada or the steps that can be taken to prevent it. 14,15 Greater knowledge about the suicide rate during pregnancy and the postpartum period, as well as the characteristics and patterns of health service use of women who die by suicide, is critical to inform suicide prevention strategies for perinatal women, and ultimately to reduce maternal mortality.…”

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confidence: 99%

Perinatal suicide in Ontario, Canada: a 15-year population-based study

Grigoriadis

Wilton

Kurdyak

et al. 2017

CMAJ

145

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BACKGROUND:Death by suicide during the perinatal period has been understudied in Canada. We examined the epidemiology of and health service use related to suicides during pregnancy and the first postpartum year. METHODS:In this retrospective, population-based cohort study, we linked health administrative databases with coroner death records (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) for Ontario, Canada. We compared sociodemographic characteristics, clinical features and health service use in the 30 days and 1 year before death between women who died by suicide perinatally, women who died by suicide outside of the perinatal period and living perinatal women.

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“…Maryland DHMH also identifies pregnancy-associated deaths from other sources, including linkage of death records with birth and fetal death records and review of medical examiner records. 5,7 The availability of comprehensive data collected from multiple sources provided the opportunity to study the effectiveness of check boxes on death certificates in identifying pregnancy-associated deaths. The few previous studies that have assessed the effectiveness of pregnancy check boxes did not use comprehensive, enhanced surveillance to identify all pregnancy-associated deaths, including deaths due to nonmedical causes, such as accidents, homicide, and suicide.…”

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confidence: 99%

Effectiveness of Pregnancy Check Boxes on Death Certificates in Identifying Pregnancy-Associated Mortality

Horon

Cheng

2011

Public Health Rep

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SYNOPSISObjectives. Information that would allow the identification of women who were pregnant at the time of death or within the year preceding death has historically been underreported on death certificates. As a result, the magnitude of the problem of pregnancy-associated mortality is underestimated. To improve the identification of these deaths, check boxes for reporting pregnancy status have been added to death certificates in a number of states. We used multiple external data sources to determine whether check boxes have been effective in identifying pregnancy-associated deaths.Methods. We collected data on deaths occurring among pregnant or recently pregnant women residing in Maryland during the years 2001-2008 using multiple data sources. We determined the percentage of these deaths that could be identified through check boxes placed on death certificates.Results. Overall, 64.5% of pregnancy-associated deaths were identified through pregnancy check boxes on death certificates, including 98.1% of maternal deaths-defined as deaths occurring during pregnancy or within 42 days of delivery from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes-and 46.7% of deaths from nonmaternal causes, such as homicide, suicide, accidents, and substance abuse.Conclusions. Check boxes on death certificates are effective in identifying pregnancy-associated deaths resulting from maternal causes. However, they are far less effective in identifying deaths resulting from nonmaternal causes, such as homicide, accidental death, and substance abuse, which represent three of the four leading causes of pregnancy-associated death in Maryland.

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Underreporting of Maternal Deaths on Death Certificates and the Magnitude of the Problem of Maternal Mortality

Cited by 114 publications

References 15 publications

Predictors of maternal mortality and near-miss maternal morbidity

Predictors of maternal mortality and near-miss maternal morbidity

Perinatal suicide in Ontario, Canada: a 15-year population-based study

Effectiveness of Pregnancy Check Boxes on Death Certificates in Identifying Pregnancy-Associated Mortality

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