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Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018
Summary
The National Center for Health Statistics (NCHS) updated its maternal mortality coding method in 2018 to improve data accuracy. This new method led to a 2018 maternal mortality rate of 17.4 per 100,000 live births, with significant disparities among racial and ethnic groups.
Area of Science:
- Public Health
- Epidemiology
- Vital Statistics
Background:
- The National Center for Health Statistics (NCHS) previously ceased publishing official maternal mortality estimates in 2007 due to challenges with the U.S. Standard Certificate of Death implementation.
- The full implementation of the revised death certificate, including a pregnancy status checkbox, enabled the resumption of maternal mortality data publication starting in 2018.
- Data quality evaluations revealed potential overreporting of maternal deaths, particularly among older women, following the adoption of the pregnancy checkbox.
Purpose of the Study:
- To describe methodological changes in coding, publishing, and releasing maternal mortality data by the NCHS.
- To present official 2018 maternal mortality estimates utilizing a refined coding approach.
- To provide updated maternal mortality rates and highlight disparities using a new, more accurate coding system.
Main Methods:
- Adoption of a new NCHS coding method (the 2018 method) for maternal deaths to address data quality issues.
- Restriction of the pregnancy checkbox application to decedents aged 10-44 years (previously 10-54).
- Specific criteria for assigning maternal codes when the pregnancy checkbox is the sole indicator of pregnancy on the death certificate, limited to ages 10-44.
Main Results:
- In 2018, 658 maternal deaths were identified using the new method.
- The 2018 maternal mortality rate was 17.4 deaths per 100,000 live births.
- Significant racial and ethnic disparities were observed: the rate for non-Hispanic black women (37.1) was 2.5 to 3.1 times higher than for non-Hispanic white (14.7) and Hispanic (11.8) women. Rates increased with age.
Conclusions:
- The revised 2018 coding method enhances the accuracy of maternal mortality data collection and reporting.
- The findings underscore persistent and significant racial, ethnic, and age-related disparities in maternal mortality in the U.S.
- Continued monitoring and analysis of maternal mortality trends are crucial for informing public health interventions.
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