Pregnancy-Related Mortality in California 2012-2020
pregnancy-related mortality data in California from 2012 to 2020, including pregnancy-related mortality ratio trends, pregnancy-associated deaths, and pregnancy-related deaths by cause. Gain insights into risk factors, statistics, and expert committee reviews.
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Presentation Transcript
Pregnancy-Related Mortality in CA CA-PMSS, 2012-2020
Instructions Instructions You are welcome to use any of the slides provided for educational purposes. Suggested citation: CA-PMSS: Pregnancy-Related Mortality in California, 2012-2020. California Department of Public Health; Maternal, Child and Adolescent Health Division. 2023. 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 2012 2012- -2020 2020 Deaths per 100,000 live births United States PRMR California PRMR California PRMR, excl. Covid-19 deaths 24.0 21.0 17.6 17.3 17.3 16.9 18.0 18.6* 18.0 17.3 17.2 15.0 16.1 15.9 15.0 12.0 14.1 13.4 13.1 12.8 11.5 9.0 10.7 9.5 6.0 3.0 0.0 2012 2013 2014 2015 2016 2017 2018 2019 2020 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 was determined by expert committee case review process. Data on U.S. PRMR were accessed at Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC on April 6, 2023). * The CA 2020 PRMR was significantly higher than the PRMRs in 2012 and 2013
Pregnancy Pregnancy- -Associated Deaths Associated Deaths California 2012 California 2012- -2020 (N=2,039) 2020 (N=2,039) Undetermined <1% Suicide 7% Homicide 8% Pregnancy- related 49% Not Medical/Obstetric 57% pregnancy- related 50% Drug overdose 13% (28% of all P-A deaths) 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 (2012-2020). 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 was determined by expert committee review.
Pregnancy Pregnancy- -Related Deaths by Cause Related Deaths by Cause California 2012 California 2012- -2020 (N=564) 2020 (N=564) CVD (n=161) Cardiomyopathy 15% Other Cardiovascular 13% 29% Hem (n=89) 16% Inf (n=85) 15% Other infection 12% 3% Covid-19 HDP (n=53) 9% TPE (n=44) 8% AFE (n=44) 8% CVA (n=22) 4% Anes (n=6) 1% Other (n=58) 10% 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; Hem = Hemorrhage; Inf = Sepsis or infection; 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 Related Deaths by Timing to Death California 2012 California 2012- -2020 (N=564) 2020 (N=564) Timing to Death During pregnancy (n=94) 17% Day of delivery* (n=135) 24% After pregnancy: 1-6 days (n=139) 25% 7-42 days (n=114) 20% 43-365 days (n=82) 15% 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. * delivery refers to live births and other pregnancy outcomes resulting in fetal deaths.
Pregnancy Pregnancy- -Related Deaths by Cause and Timing to Death Related Deaths by Cause and Timing to Death California 2012 California 2012- -2020 (N=564) 2020 (N=564) After pregnancy: During pregnancy 0-6 days 7-42 days 43-365 days CVD (n=161) 17% 31% 19% 32% 1% Hem (n=89) 19% 72% 8% Inf (n=85) 14% 42% 35% 8% HDP (n=53) 64% 25% 4% 8% TPE (n=44) 30% 48% 11% 11% AFE (n=44) 89% 2% 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; Hem = Hemorrhage; Inf = Sepsis or infection; 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 (26), anesthesia (10), other medical causes (78) and undetermined (4).
Pregnancy Pregnancy- -Related Mortality Ratio by Cause Related Mortality Ratio by Cause California 2012 California 2012- -2020 (N=564) 2020 (N=564) Deaths per 100,000 live births CVD Hem Inf HDP TPE AFE 4.5 4.5 n=65 4.0 4.0 n=53 3.5 2.6 n=34 3.0 2.9 n=43 2.5 2.7 n=36 1.1 Covid-19 n=15 2.0 2.1 n=30 1.9 n=27 1.5 1.7 n=26 1.7 n=22 0.8* n=10 1.5 n=23 1.4 n=19 1.4 n=21 1.4 n=19 1.4 n=20 1.0 1.1 n=16 0.9 n=14 0.4** 0.8 n=11 0.5 0.0 2012-2014 2015-2017 2018-2020 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 was determined through expert committee review. Abbreviations: CVD = Cardiovascular disease; Hem = Hemorrhage; Inf = 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 ** Unstable ratio; n<10
Pregnancy Pregnancy- -Related Mortality Ratio by Age Related Mortality Ratio by Age California 2012 California 2012- -2020 (N=564) 2020 (N=564) Deaths per 100,000 live births <25 25-29 30-34 35-39 40+ 40.0 37.9 n=25 35.0 34.7 n=22 30.0 29.8 n=20 25.0 23.3 n=60 20.0 20.1 n=47 18.6 n=47 15.0 15.6 n=64 6.7 n=26 5.5 n=22 10.0 11.5 n=50 11.5 n=28 11.2 n=43 10.5 n=36 10.2 n=32 10.0 n=42 5.0 0.0 2012-2014 2015-2017 2018-2020 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 2012 California 2012- -2020 (N=564) 2020 (N=564) Deaths per 100,000 live births <25 25.0-29.9 30-39.9 40+ 60.0 54.2 n=30 50.0 40.0 43.8 n=21 30.0 30.9 n=16 24.1 n=69 20.0 10.4 n=73 8.4 n=31 8.1 n=48 6.2 n=46 15.5 n=41 15.4 n=55 15.1 n=42 14.2 n=53 10.0 0.0 2012-2014 2015-2017 2018-2020 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 Type Related Mortality Ratio by Payer Type California 2012 California 2012- -2020 (N=564) 2020 (N=564) Deaths per 100,000 live births Medi-Cal Private 25.0 20.0 21.5 n=115 15.0 16.3 n=103 10.0 10.2 n=69 9.4 n=66 8.5 n=60 7.8 n=53 5.0 0.0 2012-2014 2015-2017 2018-2020 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. PRMRs for payer types Self-pay and Other government programs are not shown due to small counts.
Pregnancy Pregnancy- -Related Mortality Ratio by Community Conditions Related Mortality Ratio by Community Conditions California 2012 California 2012- -2020 (N=564) 2020 (N=564) Deaths per 100,000 live births Q1 (Most advantaged) Q2 Q3 Q4 (Least advantaged) 20.0 18.0 18.9 n=68 18.8 n=52 16.0 16.9 n=73 16.9 n=53 14.0 14.2 n=64 12.0 12.7 n=47 12.4 n=47 11.7 n=38 10.0 9.8 n=27 9.5 n=31 8.0 9.2 n=22 6.0 4.0 4.4 n=12 2.0 0.0 2012-2014 2015-2017 2018-2020 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 2012 California 2012- -2020 (N=564) 2020 (N=564) Deaths per 100,000 live births Hispanic/Latina Asian White Black 60.0 57.7 n=41 50.0 Disparity: 4-5x higher for Black vs. other groups 45.8 n=30 3-4x 5-6x 40.0 42.5 n=33 30.0 20.0 9.9 n=41 9.6 n=38 7.8 n=56 15.0 n=29 14.8 n=90 10.0 12.7 n=87 10.9 n=23 11.6 n=25 12.6 n=45 0.0 2012-2014 2015-2017 2018-2020 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. PRMRs for American Indian/Alaska Native, Native Hawaiian/Pacific Islander, Multiple-race and other races are not shown due to small counts.
Pregnancy Pregnancy- -Related Mortality Ratio by Race/Ethnicity and Cause Related Mortality Ratio by Race/Ethnicity and Cause California 2012 California 2012- -2020 (N=564) 2020 (N=564) CVD Hem Inf HDP TPE AFE Other White 10.6 4.3 1.8 1.3 0.9 0.6* 0.9 0.9 Hispanic /Latina 11.6 2.7 2.3 2.0 1.3 0.5 0.6 2.1 Asian 12.4 2.3 2.3 1.4* 0.6* 1.1* 1.9 2.7 48.6 Black 14.5 2.3* 7.5 5.6 6.5 4.2 7.9 (Scale=1:3) All 13.2 3.8 2.1 2.0 1.2 1.0 1.0 2.1 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. Abbreviations: CVD = Cardiovascular disease; Hem = Hemorrhage; Inf = Sepsis or infection; HDP = Hypertensive disorders of pregnancy; TPE = Thrombotic pulmonary embolism; AFE = Amniotic fluid embolism. PRMRs of American Indian/Alaska Native, Native Hawaiian/Pacific Islander, Multiple-race and other races are not shown due to small counts * Unstable ratio; n<10
