Introduction
High and increasing levels of pregnancy-related mortality and morbidity in the U.S.
indicate that the underlying health status of reproductive-aged women may be far from
optimal, yet few studies have examined mortality trends and disparities exclusively
among this population.
Methods
All-cause and cause-specific mortality data for 1999–2019 were obtained from the Centers
for Disease Control and Prevention WONDER Underlying Cause of Death database. Levels
and trends in mortality between 1999 and 2019 for women aged 15–44 years stratified
by age, race/ethnicity, and state were examined. Given the urgent need to address
pregnancy-related health disparities, the correlation between all-cause and pregnancy-related
mortality rates across states for the years 2015–2019 was also examined.
Results
Age-adjusted, all-cause mortality rates among women aged 15–44 years improved between
2003 and 2011 but worsened between 2011 and 2019. The recent increase in mortality
among this age group was not driven solely by increases in external causes of death.
Patterns differed by age, race/ethnicity, and geography, with non-Hispanic American
Indian and Alaskan Native women having 2.3 and non-Hispanic Black women having 1.4
times the risk of all-cause mortality in 2019 compared with that of non-Hispanic White
women. Age-adjusted all-cause mortality rates and pregnancy-related mortality rates
were strongly correlated at the state level (r=0.75).
Conclusions
Increasing mortality among reproductive-aged women has substantial implications for
maternal, women's, and children's health. Given the high correlation between pregnancy-related
mortality and all-cause mortality at the state level, addressing the structural factors
that shape mortality risks may have the greatest likelihood of improving women's health
outcomes across the life course.
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Article Info
Publication History
Published online: February 09, 2022
Identification
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
