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Temporal trends in maternal mortality in Canada I: estimates based on vital statistics data
Sarka Lisonkova1, Sharon Bartholomew2, Jocelyn Rouleau2
1Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver BC.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|October 22, 2011
Summary
Canadian maternal mortality rates appear to be increasing, but this trend is likely due to changes in data collection, not a true rise in deaths. Further investigation into data ascertainment is needed.
Area of Science:
- Public Health
- Epidemiology
- Demography
Background:
- Vital Statistics and World Health Organization reports indicate a rise in maternal mortality in Canada.
- Understanding temporal trends and causes of maternal death is crucial for public health interventions.
Purpose of the Study:
- To analyze temporal trends, regional variations, and causes of maternal mortality in Canada.
- To compare maternal mortality data from Vital Statistics and hospitalization records.
Main Methods:
- Utilized Vital Statistics death registrations (1981-2007) and Canadian Institute for Health Information hospitalization data (1996-2007).
- Estimated maternal mortality rates, risk ratios, and confidence intervals.
- Employed Cochran-Armitage test for temporal trend analysis and compared data sources.
Main Results:
- Maternal mortality rates per 100,000 live births significantly increased from 4.5 (1981-1983) to 7.2 (2005-2007).
- Leading causes included circulatory diseases, obstetric embolism, and hypertension; deaths from circulatory diseases and puerperal infection rose.
- Hospitalization data showed stable maternal mortality trends, contrasting with Vital Statistics data, and revealed under-ascertainment in provincial/territorial data (12%-70%).
Conclusions:
- The observed increase in maternal mortality in Canadian Vital Statistics data is likely an artifact of changes in coding and ascertainment.
- Temporal trends in Vital Statistics data do not align with stable trends in hospitalization data.
- Accurate ascertainment and coding are critical for reliable maternal mortality surveillance.
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