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Black-White Disparity in Maternal Mortality: A Systematic Review and Meta-analysis
Vibooshine Ratnam1, Jessica Healy-Profitós, Shu Qin Wei
1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, the Institut national de santé publique du Québec, the University of Montreal Hospital Research Centre, the OriginElle Fertility Clinic & Women's Health Centre, the Department of Pediatrics, Sainte-Justine Hospital Research Centre, and the Department of Medicine, University of Montreal, Montreal, Quebec, the Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, and the Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada; and the School of Public Health, Imperial College London, London, United Kingdom.
Objective:
To perform a literature review and meta-analysis of Black-White disparity in maternal mortality.
Data Sources:
PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Global Health, Google Scholar, PsycINFO, Scopus, MEDLINE, and Web of Science were reviewed from database inception through October 31, 2024.
Methods Of Study Selection:
Studies were included if the design was observational, the population comprised pregnant patients followed up to 1 year postpartum, the exposure was Black race compared with White race, and the outcome was maternal mortality during pregnancy or up to 1 year later.
Tabulation, Integration, And Results:
We assessed study quality using the Newcastle-Ottawa Scale. We performed a meta-analysis using random-effects models with the generic inverse variance method to calculate pooled unadjusted odds ratios (ORs) and adjusted odds ratios (aORs) with 95% CIs for the association between race and maternal mortality. Thirty observational studies including 69,942,559 Black and 258,712,381 White patients met eligibility criteria. A total of 31,453 deaths occurred among Black patients and 36,717 among White patients. Compared with White patients, Black patients had greater odds of any maternal mortality (unadjusted OR 3.04, 95% CI, 2.75-3.37, 27 studies; aOR 2.82, 95% CI, 1.70-4.69, four studies), maternal mortality within 42 days (unadjusted OR 2.75, 95% CI, 2.22-3.42, nine studies; aOR 1.90, 95% CI, 1.18-3.07, two studies), and maternal mortality up to 1 year postpartum (unadjusted OR 3.06, 95% CI, 2.79-3.35, 20 studies; aOR 4.40, 95% CI, 3.07-6.31, two studies). Black patients had a greater likelihood of death resulting from direct obstetric causes (unadjusted OR 3.47, 95% CI, 3.05-3.94, six studies), particularly hypertensive disorders of pregnancy (unadjusted OR 4.43, 95% CI, 3.74-5.24, six studies), and from indirect causes (unadjusted OR 2.50, 95% CI, 1.46-4.29, six studies).
Conclusion:
Black-White disparity in maternal mortality is widespread, suggesting that structural interventions at a systemic level are needed.
Systematic Review Registration:
PROSPERO, CRD42024549477.
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