A national population-based cohort study to investigate inequalities in maternal mortality in the United Kingdom, 2009-17

Marian Knight, Kathryn Bunch, Sara Kenyon, Derek Tuffnell, Jennifer J Kurinczuk

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Abstract

BACKGROUND: Disparities have been documented in maternal mortality rates between women from different ethnic, age and socio-economic groups in the UK. It is unclear whether there are differential changes in these rates amongst women from different groups over time. The objectives of this analysis were to describe UK maternal mortality rates in different age, ethnic and socio-economic groups between 2009 and 2017, and to identify whether there were changes in the observed inequalities, or different trends amongst population subgroups.

METHODS: Maternal mortality rates with 95% confidence intervals (CI) in specific age, deprivation and ethnic groups were calculated using numbers of maternal deaths as numerator and total maternities as denominator. Relative risks (RR) with 95% CI were calculated and compared using ratios of relative risk. Change over time was investigated using non-parametric tests for trend across ordered groups.

RESULTS: Women from black and Asian groups had a higher mortality rate than white women in most time periods, as did women aged 35 and over and women from the most deprived quintile areas of residence. There was evidence of an increasing trend in maternal mortality amongst black women and a decrease in mortality amongst women from the least deprived areas, but no trends over time in any of the other ethnic, age or IMD groups were seen. There was a widening of the disparity between black and white women (RR 2.59 in 2009-11 compared with 5.27 in 2015-17, ratio of the relative risks 2.03, 95% CI 1.11, 3.72).

CONCLUSIONS: The clear differences in the patterns of maternal mortality amongst different ethnic, age and socio-economic groups emphasise the importance of research and policies focussed specifically on women from black and minority ethnic groups, together with other disadvantaged groups, to begin to reduce maternal mortality in the UK.

Original languageEnglish
Pages (from-to)392-398
Number of pages7
JournalPaediatric and Perinatal Epidemiology
Volume34
Issue number4
Early online date3 Feb 2020
DOIs
Publication statusPublished - Jul 2020

Bibliographical note

Funding Information:
The Maternal Newborn and Infant Clinical Outcome Review Programme delivered by MBRRACE-UK is commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England, NHS Wales, the Health and Social Care division of the Scottish government, the Northern Ireland Department of Health, the States of Jersey, Guernsey, and the Isle of Man. We would particularly like to thanks all MBRRACE-UK Lead Reporters and other staff in NHS Trusts, Health Boards and Health and Social Care Trusts across the UK and those from the Crown Dependencies, whose contribution made it possible to collect the MBRRACE-UK data.

Publisher Copyright:
© 2020 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd

Keywords

  • Maternal mortality
  • ethnic groups
  • socioeconomic factors
  • maternal age
  • cohort analysis
  • maternal mortality
  • socio-economic factors

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health

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