Racial disparity in pregnancy-related mortality following a live birth outcome.
OBJECTIVE
African-American women have a 2- to 4-fold increased risk of pregnancy-related death compared with Caucasian women. We conducted this study to determine if differences in a combination of socioeconomic and medical risk factors may explain this racial disparity in pregnancy-related death.


METHODS
Pregnancy-related deaths of African-American (N=60) and Caucasian (N=47) women were identified from review of pregnancy-associated deaths (N=400) ascertained through cause of death on death certificates, electronic linkage of birth and death files, and review of the hospital discharge database for the State of North Carolina, during the period between 1992 and 1998. Controls (N=3404) were randomly selected from all live births for the same 7-year period. Logistic regression was used to model the association between race and pregnancy-related death.


RESULTS
The unadjusted odds ratio (OR) for pregnancy-related death for African-Americans compared with Caucasians was 3.07 (95% confidence interval [CI], 2.08, 4.54). After controlling for gestational age at delivery, maternal age, income, hypertension, and receipt of prenatal care, African-American race remained a significant predictor variable (OR 2.65 [95% CI 1.73, 4.07]).


CONCLUSIONS
Our analysis confirms that there is a strong association between race and pregnancy-related death, even after adjusting for potential predictors and confounders.
Harper
Margaret A
MA
Department of Obstetrics and Gynecology (M.A.H.), Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. mharper@wfubmc.edu
Espeland
Mark A
MA
Dugan
Elizabeth
E
Meyer
Robert
R
Lane
Kathy
K
Williams
Sharon
S
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology; D016015:Logistic Models; D008428:Maternal Mortality; D008498:Medical Record Linkage; D009657:North Carolina / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology* / Q000401:mortality*; D012307:Risk Factors; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*