Despite advances in maternal care, approximately 1 in 5000 women die in childbirth in the United States each year. African-American women are nearly 4 times more likely to die in childbirth than Caucasian women. Dr. Michael Froelich, Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, and colleagues noted that at the University of Alabama Hospital, the number of African American and Caucasian women who deliver was about equal. They examined death rates between January 1990 and December 2010 to determine whether death rates were higher among African American women. The results of their study are published in this month’s issue of Anesthesia & Analgesia in the article titled “Why Do Pregnant Women Die? A Review of Maternal Deaths from 1990 to 2010 at the University of Alabama at Birmingham.”
The authors first identified all women who died who were between 11 and 50 years of age, and then looked for ICD-9 codes that indicated whether the death was related to pregnancy, childbirth, or the postpartum state. Patients who died were matched 2:1 to patients who delivered the same week.
There were 77 women in the maternal death group. There was insufficient evidence to suggest racial disparity in the incidence of death. The proportion of African American women in the maternal death group was 57% (42 of 77) vs. 61% (94 of 154) in the matched control group. In addition, there was no association between mortality status and insurance status, income, BMI, marital status, or parity. Longer distance between the patient’s home and the hospital was associated with greater mortality. African American women tended to live closer to the hospital, perhaps accounting for their better outcome at the University of Alabama than suggested by national statistics. Gestational age, fetal survival, duration of hospital stay, lack of prenatal care, and cesarean delivery rate were also factors associated with greater mortality. Obesity was not a factor in this study, although obesity has been implicated as a risk factor in other studies.
We do not know if the results at the University of Alabama are representative of outcomes at all tertiary teaching hospitals. If this is a representative outcome, then our major teaching hospitals appear to provide equally excellent care to all patients, regardless of race. It follows that we need to look elsewhere to understand the racial differences in maternal mortality evident in US national statistics