Historical and Recent Changes in Maternal Mortality Due to Hypertensive Disorders in the United States, 1979 to 2018

Abstract

[Figure: see text].

Keywords: continental population groups; eclampsia; live birth; maternal mortality; preeclampsia.

Figure 1.. Age-period-cohort trends in overall and race-specific maternal mortality with hypertensive conditions as the cause in the United States, 1979 to 2018.

Maternal mortality rate (MMR; per 100 000 live births) is shown in relation to maternal age on the y axis on the left. The MMR ratio is shown in relation to maternal birth cohort (with the 1960 maternal birth year as the reference) and period (with 1980 as the reference) on the right axis. The shaded bands denote 95% CI. The yearly change in MMR was −0.3% (95% CI, −0.6 to −0.0) for all women (solid line), −0.4% (95% CI, −0.9 to −0.1) for White women (dashed line), and 0.0% (95% CI, −0.5 to 0.5) for Black women (dotted line). Advancing maternal age was strongly associated with increasing MMR after age 25 y, and age-specific rates were substantially higher in Black compared with White women. Compared with 1980, the RRs for hypertension-related MMR showed that the MMR declined up to 1990 and stabilized thereafter. The MMR increased marginally and among White and Black women in the 1970 birth cohort and declined thereafter. RR indicates rate ratio.

Figure 2.. Age-period-cohort trends in overall and race-specific maternal mortality with preeclampsia/eclampsia as the cause in the United States, 1979 to 2018.

Maternal mortality rate (MMR; per 100 000 live births) is shown in relation to maternal age on the y axis on the left. The MMR ratio is shown in relation to maternal birth cohort (with the 1960 maternal birth year as the reference) and period (with 1980 as the reference) on the right axis. The shaded bands denote the 95% CI. The yearly change in MMR was −2.6% (95% CI, −2.9 to −2.2) for all women (solid line), −2.5% (95% CI, −2.9 to −2.0) for White women (dashed line), and −2.6% (95% CI, −3.2 to −2.0) for Black women (dotted line). The APC analysis shows a strong linear increase in preeclampsia/eclampsia-related MMR among Black women aged ≥30 y and among White women aged ≥35 y. Compared with MMR in 1980, RRs for mortality declined, on average, by 2.5% and 2.6% per year among White and Black women, respectively. No appreciable birth cohort effects were evident. RR indicates rate ratio.

Figure 3.. Age-period-cohort trends in overall and race-specific maternal mortality with chronic hypertension as the cause in the United States, 1979 to 2018.

Maternal mortality rate (MMR; per 100 000 live births) is shown in relation to maternal age on the y axis on the left. The MMR ratio is shown in relation to maternal birth cohort (with the 1960 maternal birth year as the reference) and period (with 1980 as the reference) on the right axis. The shaded bands denote 95% CI. The yearly change in MMR was 9.2% (95% CI, 7.9–10.6) for all women (solid line), 9.4% (95% CI, 7.4–11.4) for White women (dashed line), and 9.1% (95% CI, 7.1–11.1) for Black women (dotted line). Chronic hypertension–related MMR showed a sharp linear increase with advancing maternal age, with MMRs being higher among Black women compared with White women. Compared with 1980, MMR increased by 9.4% and 9.1% per year among White and Black women, respectively. These analyses showed no appreciable effects due to maternal birth cohorts. RR indicates rate ratio.