The Effect of Socioeconomic Status on All-Cause Maternal Mortality: A Nationwide Population-Based Cohort Study

Improving maternal health is one of the 13 targets of Sustainable Development Goal 3; consequently, preventing maternal death, which usually occurs in women's prime productive years, is an important issue that needs to be addressed immediately. This study examines the association between socioeconomic status and all-cause maternal mortality in South Korea and provides evidence of preventable risk factors for maternal death. For this population-based retrospective cohort study, data on 3,334,663 nulliparous women were extracted from the Korean National Health Insurance Service database between 2003 and 2018. The outcome variables were all-cause maternal mortality within six weeks and a year after childbirth. A log-binomial regression model determined the association between maternal mortality and income-level adjusted covariates. Women with lower income levels had higher risk of maternal death within six weeks (risk ratio (RR) = 2.42, 95% confidence interval (CI) = 1.65-3.53) and within one year (RR = 1.83, 95% CI = 1.47-2.28), especially those who were aged 35-39 years, lived in rural areas, delivered via cesarean section, and had maternal comorbidities. The study identifies a significant relationship between South Korean primiparas' socioeconomic status and maternal death within six weeks or one year after childbirth, suggesting interventions to alleviate the risk of maternal death.