Traditional Versus Contemporary Models for Identifying Causes of Maternal Death: A Population-Based Study

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Epidemiology

Background:

• Accurate identification of maternal death causes is crucial for effective public health interventions.
• Current methods often rely on the underlying cause of death, potentially overlooking contributing factors.
• Understanding differences in cause assignment is vital for refining maternal mortality reduction strategies.

Purpose of the Study:

• To compare cause-of-maternal-death assignment using underlying cause versus multiple causes of death.
• To analyze the impact of different assignment methods on the ranking of leading maternal mortality causes.
• To evaluate the correlation between these two methods over time.

Main Methods:

• Cross-sectional, population-based study utilizing US data from 1999-2002 and 2018-2022.
• Analysis of 1633 maternal deaths (1999-2002) and 1929 maternal deaths (2018-2022).
• Quantification and ranking of six selected obstetrical causes of death based on underlying and multiple causes.

Main Results:

• In 2018-2022, pre-eclampsia was the leading cause by underlying cause, while hemorrhage led by multiple causes.
• Rankings differed significantly between the two methods in 2018-2022 (correlation coefficient 0.62, p=0.19).
• A significant correlation was observed in 1999-2002 (correlation coefficient 0.83, p=0.04), suggesting a shift in analysis impact.

Conclusions:

• The multiple causes-of-death approach provides a different perspective on maternal mortality patterns compared to the underlying cause method.
• Utilizing multiple causes may offer a more comprehensive understanding for prioritizing clinical and public health efforts.
• This approach could lead to more effective strategies for reducing maternal mortality.