title: Underreporting of maternal mortality in Taiwan: A data linkage study.
abstract: OBJECTIVE
  This study examined the extent to which maternal mortality in Taiwan is underreported in officially published mortality statistics.
  
  
  METHODS
  We used National Health Insurance claims data collected from two million samples, which were linked with the officially published mortality data, to identify women aged 15-49 years, who were admitted to a hospital with pregnancy-related diagnoses during 2000-2009 and died during the pregnancy or within 42 days after the termination of pregnancy.
  
  
  RESULTS
  Based on these linked data, we identified 26 maternal deaths, only nine of which were reported in the original officially published mortality data; thus, the rate of underreporting was 65% [(26 - 9)/26]. The revised maternal mortality ratio was 14.1 deaths per 100,000 live births (95% confidence interval: 8.7-19.5), which was approximately three times higher than the official reported ratio of 4.9 (95% confidence interval: 1.7-8.1). The most common cause of maternal deaths was amniotic fluid embolism (n = 10), followed by eclampsia and preeclampsia (n = 4).
  
  
  CONCLUSIONS
  Approximately two-thirds of the maternal deaths in Taiwan were unreported in the officially published mortality data. Hence, routine nationwide data linkage is essential to monitor maternal mortality in Taiwan accurately.
authors.affiliation: Department of Obstetrics and Gynecology, Sin-Lau Christian Hospital, Tainan, Taiwan.
authors.forename: Tung-Pi
authors.initials: TP
authors.lastname: Wu
authors.affiliation: Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: ylhuang@tmu.edu.tw.
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Huang
authors.affiliation: NCKU Research Center for Health Data, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Fu-Wen
authors.initials: FW
authors.lastname: Liang
authors.affiliation: NCKU Research Center for Health Data, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Tsung-Hsueh
authors.initials: TH
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D004461:Eclampsia / Q000401:mortality; D004619:Embolism, Amniotic Fluid / Q000401:mortality; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D007344:Insurance Claim Reporting; D008428:Maternal Mortality; D008875:Middle Aged; D006473:Postpartum Hemorrhage / Q000401:mortality; D011225:Pre-Eclampsia / Q000401:mortality; D011247:Pregnancy; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Taiwan; cause of death; data linkage; maternal mortality; pregnancy mortality