title: Pregnancy-associated mortality in Taiwan, 2004-2011.
abstract: OBJECTIVE
  Pregnancy-associated death is defined by the American College of Obstetricians and Gynecologists as "a death of a woman while pregnant or within 1 year of termination of pregnancy, irrespective of the cause of death." We sought to determine pregnancy-associated mortality ratio (PAMR) in Taiwan and to compare the cause of death pattern with other countries to assess the national health status of Taiwanese women.
  
  
  METHODS
  We linked four nationwide population-based data sets (birth registration, birth notification, National Health Insurance claims, and cause of death mortality) from 2004 to 2011 to identify women aged 15-49 years that died from pregnancy-associated deaths. We then calculated the PAMR and cause of death distribution by maternal age.
  
  
  RESULTS
  A total of 559 pregnancy-associated deaths were identified with an overall PAMR of 36 (deaths per 100,000 live births). The J-shaped age-specific PAMR mortality pattern was noted, in which the PAMR was 32, 25, 24, 36, 71, 143, and 369 for women aged 15-19 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, and 45-49 years, respectively. The age-standardized PAMR decreased drastically from 45 in 2004-2005 to 36 in 2006-2007 and 30 in 2008-2009, but leveled off to 33 in 2010-2011. The proportion of indirect causes increased from 2004-2007 to 2008-2011 among women aged 15-29 years and 35-49 years.
  
  
  CONCLUSIONS
  Compared with previous studies, the PAMR of Taiwan is moderate. However, the proportion of external causes of pregnancy-associated deaths in Taiwan is the lowest compared with other regions. Further studies (such as death review) are needed to explore possible preventable factors.
authors.affiliation: Department of Obstetrics and Gynecology, Sin-Lau Christian Hospital, Tainan, Taiwan.
authors.forename: Li
authors.initials: L
authors.lastname: Sha
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: Research Center for Health Data, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Fu-Wen
authors.initials: FW
authors.lastname: Liang
authors.affiliation: Department of Statistics, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Lea-Hua
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Research Center for Health Data, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Tsung-Hsueh
authors.initials: TH
authors.lastname: Lu
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
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D005260:Female; D006801:Humans; D050498:Live Birth / Q000453:epidemiology; D008423:Maternal Age; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Taiwan; cause of death; data linkage; pregnancy-associated mortality