Pregnancy-Related Mortality in CA
Pregnancy-related mortality in California from 2011 to 2019 is explored in this informative data set. The data includes pregnancy-related mortality ratio, associated deaths, and causes of pregnancy-related deaths, providing valuable insights into maternal health trends in the state. Analysis of pregnancy-associated deaths reveals various contributing factors, highlighting the importance of understanding and addressing maternal health issues to improve outcomes for expectant mothers.
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Presentation Transcript
Pregnancy-Related Mortality in CA CA-PMSS, 2011-2019
Instructions Instructions You are welcome to use any of the slides provided for educational purposes. Suggested citation: CA-PMSS: Pregnancy-Related Mortality in California, 2011-2019. California Department of Public Health; Maternal, Child and Adolescent Health Division. 2022. www.cdph.ca.gov/ca-pmss Questions? Contact us at MCAHDataHelp@cdph.ca.gov
Pregnancy Pregnancy- -Related Mortality Ratio in U.S. and California Related Mortality Ratio in U.S. and California 2011 2011- -2019 2019 Deaths per 100,000 live births United States PRMR California PRMR 23.0 20.0 17.8 17.3 16.9 15.9 17.0 18.0 17.3 17.2 16.1 14.0 14.1 13.4 13.1 12.9 12.8 11.0 11.5 10.7 8.0 9.5 5.0 2011 2012 2013 2014 2015 2016 2017 2018 2019 Pregnancy-related mortality ratio (PRMR) = Number of pregnancy-related deaths per 100,000 live births, up to one year after the end of pregnancy. Pregnancy-relatedness determinations were made through a structured expert committee case review process. Data on U.S. PRMR are published by CDC Pregnancy Mortality Surveillance System (accessed at Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC on January 19, 2022).
Pregnancy Pregnancy- -Associated Deaths Associated Deaths California 2011 California 2011- -2019 2019 Undetermined 1% Suicide 7% Homicide 8% Pregnancy- related 50% (29% of all P-A deaths) Drug overdose 11% Medical/Obstetric 58% Not pregnancy- related 50% Other injury 15% Unable to determine <1% Pregnancy-associated (P-A) deaths include deaths from any cause while pregnant or within one year of the end of pregnancy. P-A deaths were identified by linking the California vital records, patient discharge data, emergency department data, and ambulatory surgery center data (2011- 2019). These linked data were supplemented with information from coroner and autopsy reports and medical records to verify the decedent s pregnancy status and grouped cause-of-death classifications from ICD-10 codes in the California death certificate data. Pregnancy-relatedness determinations were made through a structured expert committee case review process.
Pregnancy Pregnancy- -Related Deaths by Cause Related Deaths by Cause California 2011 California 2011- -2019 2019 CVD (n=162) Cardiomyopathy 16% Other Cardiovascular 13% 29% Hem (n=82) 15% Sepsis (n=75) 14% HDP (n=55) 10% TPE (n=45) 8% AFE (n=43) 8% CVA (n=22) 4% Anes (n=5) 1% Other (n=60) 11% Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review. Abbreviations: CVD = Cardiovascular disease; Sepsis = Sepsis or infection; Hem = Hemorrhage; HDP = Hypertensive disorders of pregnancy; AFE = Amniotic fluid embolism; TPE = Thrombotic pulmonary embolism; CVA = Cerebrovascular accident; Anes = Anesthesia complications; Other = Other medical condition(s). Note: Deaths with undetermined cause were excluded from analysis (n=2).
Pregnancy Pregnancy- -Related Deaths by Timing to Death Related Deaths by Timing to Death California 2011 California 2011- -2019 2019 < 20 wks 9% 20 wks 8% Pregnant (n=96) 17% 0-6 days (n=263) 48% Day of delivery 23% 1-6 days 25% 7-42 days (n=113) 21% 43-365 days (n=79) 14% Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review.
Pregnancy Pregnancy- -Related Deaths by Cause and Timing to Death Related Deaths by Cause and Timing to Death California 2011 California 2011- -2019 2019 CVD (n=162) 16% 30% 22% 32% Hem (n=88) 20% 72% 7% 1% Sepsis (n=75) 13% 49% 32% 5% HDP (n=55) 62% 27% 4% 7% 36% TPE (n=45) 38% 16% 11% Pregnant 0-6 days 7-42 days 43-365 days AFE (n=43) 91% 2% 7% Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review. Abbreviations: CVD = Cardiovascular disease; Sepsis = Sepsis or infection; Hem = Hemorrhage; HDP = Hypertensive disorders of pregnancy; TPE = Thrombotic pulmonary embolism; ; AFE = Amniotic fluid embolism. Note: Deaths not shown in the above figure were from cerebrovascular accidents (22), anesthesia (5), other medical causes (60) and undetermined (2).
Pregnancy Pregnancy- -Related Mortality Ratio by Cause Related Mortality Ratio by Cause California 2011 California 2011- -2019 2019 Deaths per 100,000 live births CVD HEM SEP HDP TPE AFE 5.0 4.5 4.4 4.0 4.0 (n=60) 3.5 (n=60) 3.0 2.5 2.8 (n=42) 2.0 2.0 2.0 2.0 2.0 1.5 1.7 1.7 (n=30) 0.7 1.6 (n=27) (n=27) (n=29)) 1.4 (n=25) 1.0 (n=25) 1.3 (n=10) 1.2 (n=24) 1.1 (n=19) 0.4* 0.9 0.8 (n=19) (n=17) 0.5 (n=16) (n=14) (n=12) 0.0 2011-2013 2014-2016 2017-2019 Pregnancy-related mortality ratio (PRMR) = Number of pregnancy-related deaths per 100,000 live births, up to one year after the end of pregnancy. Pregnancy- relatedness determinations were made through a structured expert committee case review process. Abbreviations: CVD = Cardiovascular disease; Hem = Hemorrhage; Sepsis = Sepsis or infection; HDP = Hypertensive disorders of pregnancy; TPE = Thrombotic pulmonary embolism; AFE = Amniotic fluid embolism. * Significant decline in PRMR for deaths due to hypertensive disorders of pregnancy
Pregnancy Pregnancy- -Related Mortality Ratio by Age Related Mortality Ratio by Age California 2011 California 2011- -2019 2019 Deaths per 100,000 live births <25 25-29 30-34 35-39 40+ 45.0 40.0 41.6 (n=27) 35.0 34.1 (n=23) 30.0 25.0 25.6 (n=16) 20.0 22.2 (n=55) 19.7 (n=51) 15.0 17.3 (n=39) 10.0 11.9 (n=50) 11.7 (n=48) 10.9 (n=29) 10.9 (n=39) 10.3 (n=45) 9.0 9.4 8.7 6.7 5.0 (n=36) (n=32) (n=34) (n=27) 0.0 2011-2013 2014-2016 2017-2019 Pregnancy-related mortality ratio (PRMR) = Number of pregnancy-related deaths per 100,000 live births. Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review.
Pregnancy Pregnancy- -Related Mortality Ratio by Body Mass Index Related Mortality Ratio by Body Mass Index California 2011 California 2011- -2019 2019 Deaths per 100,000 live births <25 25.0-29.9 30-39.9 40+ 45.0 40.0 42.0 (n=23) 40.9 (n=19) 35.0 30.0 29.8 (n=15) 25.0 20.0 21.0 (n=60) 15.0 18.0 (n=47) 16.4 (n=45) 10.0 13.1 (n=49) 12.6 (n=46) 6.2 9.2 9.2 8.6 5.0 (n=46) (n=34) (n=67) (n=55) 0.0 2011-2013 2014-2016 2017-2019 Pregnancy-related mortality ratio (PRMR) = Number of pregnancy-related deaths per 100,000 live births. Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review. Body Mass Index (BMI) = A person s weight in kilograms divided by the square of height in meters. BMI may overestimate or underestimate body fatness in some individuals since it does not take into consideration an individual s muscle or bone mass. The clinical correlation of BMI has not been validated in some subpopulations, therefore BMI should not be used as the sole criteria for making health recommendations
Pregnancy Pregnancy- -Related Mortality Ratio by Payer Source Related Mortality Ratio by Payer Source California 2011 California 2011- -2019 2019 Deaths per 100,000 live births Private insurance Medi-Cal/Other public 20.0 18.0 17.5 (n=106) 16.0 15.5 (n=106) 14.0 12.0 10.0 10.9 (n=80) 8.0 9.1 8.4 8.2 6.0 (n=63) (n=61) (n=58) 4.0 2.0 0.0 2011-2013 2014-2016 2017-2019 Pregnancy-related mortality ratio (PRMR) = Number of pregnancy-related deaths per 100,000 live births. Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review.
Pregnancy Pregnancy- -Related Mortality Ratio by Community Conditions Related Mortality Ratio by Community Conditions California 2011 California 2011- -2019 2019 Deaths per 100,000 live births Q1-Most advantaged Q2 Q3 Q4-Least advantaged 18.0 16.0 16.2 (n=65) 15.7 (n=72) 15.6 (n=69) 14.0 15.2 (n=53) 12.0 13.2 (n=41) 12.6 (n=48) 12.5 (n=47) 11.5 (n=38) 10.0 9.6 8.0 9.4 8.7 (n=31) (n=26) 6.0 (n=23) 4.0 4.8 2.0 (n=13) 0.0 2011-2013 2014-2016 2017-2019 Pregnancy-related mortality ratio (PRMR) = Number of pregnancy-related deaths per 100,000 live births. Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review. Community conditions were measured using the California Healthy Places Index (HPI). Higher HPI percentiles indicate healthier community conditions relative to other California census tracts. Quartile 1 (Q1) is the highest quarter of percentiles indicating most advantaged community conditions, and Quartile 4 (Q4) is the lowest quarter of percentiles indicating the least advantaged community conditions.
Pregnancy Pregnancy- -Related Mortality Ratio by Race/Ethnicity Related Mortality Ratio by Race/Ethnicity California 2011 California 2011- -2019 2019 Deaths per 100,000 live births Hispanic/Latina Asian/Pacific Islander White Black 60.0 57.6 (n=42) 4-6x 50.0 Disparity: 4-6x higher for Black vs. other groups 47.3 (n=32) 40.0 44.1 (n=35) 3-4x 30.0 20.0 7.5 15.1 (n=32) (n=55) 10.0 12.9 (n=29) 12.6 (n=80) 11.2 (n=23) 12.3 (n=51) 11.0 (n=77) 9.6 11.1 (n=41) (n=39) 0.0 2011-2013 2014-2016 2017-2019 Pregnancy-related mortality ratio (PRMR) = Number of pregnancy-related deaths per 100,000 live births. Pregnancy-related deaths include deaths within a year of pregnancy from causes related to or aggravated by the pregnancy or its management, as determined by expert committee review.
