title: Near miss maternal mortality in a multiethnic population.
abstract: OBJECTIVE
  To determine the impact of ethnicity on "near miss"/severe obstetric morbidity in a multi-ethnic, tertiary care population.
  
  
  METHODS
  We carried out a cross-sectional analysis using birth data for 12,774 women with Medicaid who gave birth between January 1994 and January 2005 at Duke University. Univariate and multivariate analyses were carried out to compare ethnic groups and risk factors for severe obstetric morbidity and mortality using codes for conditions corresponding to the WHO definitions of near miss maternal morbidities.
  
  
  RESULTS
  African-American women experienced significantly more pregnancy complications (25.4%) compared to White (21.7%) and Hispanic (18.8%) women. The presence of medical comorbidities was highest among African-Americans (9.1%) compared to Whites (8.1%) and Hispanics (2.6%). Near miss mortality, however, was significantly higher in Hispanic women (5.9%) compared to African-Americans (4.6%), and Whites (4.1%). Hispanic women had 45% greater risk of near miss mortality compared to Whites (relative risk [RR] = 1.45, 95% confidence interval [CI]: 1.14-1.84) whereas differences were non-significant for African-American women. In multivariate regression, near misses remained highest for Hispanic women (RR = 1.66; 95% CI: 1.27-2.17).
  
  
  CONCLUSIONS
  The increase in near miss maternal mortality for Hispanic women suggests a more complex interaction between ethnicity, socioeconomic status and health than traditional birth outcome measures capture.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27110, USA.
authors.forename: Haywood L
authors.initials: HL
authors.lastname: Brown
authors.forename: Maria
authors.initials: M
authors.lastname: Small
authors.forename: Yhenneko J
authors.initials: YJ
authors.lastname: Taylor
authors.forename: Monique
authors.initials: M
authors.lastname: Chireau
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008428:Maternal Mortality / Q000208:ethnology*; D008484:Medicaid / Q000706:statistics & numerical data; D009017:Morbidity; D009657:North Carolina / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D012923:Social Class; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult