title: Excess of maternal mortality in foreign nationalities in Spain, 1999-2006.
abstract: OBJECTIVE
  This study aimed to compare maternal mortality by province, autonomous region and mother's country of birth in Spain during 1999-2006.
  
  
  METHODS
  A cross-sectional ecological study with all live births and maternal mortality cases occurring during 1999-2006 in Spain was done. Data were drawn from the National Statistics Institute (INE) and we used the Movement of Natural Persons (MNP) and death statistics broken down by cause of death. Maternal mortality rates by province, autonomous region and mother's country of birth were calculated. To compare maternal mortality by province, standardised mortality ratios were calculated using an indirect standardisation. The risk of maternal death by autonomous region, age and mother's country of birth was calculated by a Poisson regression.
  
  
  RESULTS
  Sub-Saharan nationalities present the highest maternal mortality rates. Adjusted by age and autonomous region, foreign nationalities had 67% higher risk of maternal mortality (RR=1.67; 95%CI=1.22-2.33). Adjusted by mother's country of birth and age, two autonomous regions had a significant mortality excess: Andalusia (RR=1.84; 95%CI=1.32-2.57) and Asturias (RR=2.78 95%CI=1.24-6.24).
  
  
  CONCLUSIONS
  This study shows inequalities in maternal mortality by province, autonomous region and mother's country of birth in Spain. It would be desirable to implement a maternal mortality active surveillance system and the use of confidential qualitative surveys for analysis of socio-economic and healthcare circumstances surrounding deaths. These measures would be invaluable for in-depth understanding and characterisation of a preventable phenomenon such as maternal death.
authors.affiliation: National Centre for Epidemiology (Centro Nacional de Epidemiología-CNE), Field Epidemiology Training Program (FETP), Carlos III Institute of Health, C/Sinesio Delgado 6, Pabellón 12, 28029 Madrid, Spain. fmiguelangel@isciii.es
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Luque Fernández
authors.forename: Aurora
authors.initials: A
authors.lastname: Bueno Cavanillas
authors.forename: Salvador
authors.initials: S
authors.lastname: de Mateo
mesh_terms: D002423:Cause of Death; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality / Q000208:ethnology*; D011247:Pregnancy; D012042:Registries; D012306:Risk; D012307:Risk Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000208:ethnology