459: Trends in stroke-related maternal mortality in the United States

Abstract

We conducted a retrospective analysis of maternal mortality data in the United States from 1979-2017 in order to evaluate trends in stroke- related deaths. A retrospective cohort study was performed of all maternal live births and deaths as reported by the Center for Disease Control and Prevention from 1979-2017. Maternal mortality was defined as any death occurring in a pregnancy or within 42 days of the end of a pregnancy (including termination, miscarriage, and birth). Stroke-related causes of death were determined by ICD-9 codes from 1979-1998 and ICD-10 codes from 1999-2017. Maternal mortality ratios (MMR) per 100,000 live births were calculated for each year for the overall population as well as by race. There was a total of 270 maternal deaths due to stroke-related disease from 1979-2017, accounting for 1.1% of total deaths. Forty percent of these deaths were attributed to non-traumatic intracranial hemorrhage followed by 29% due to a stroke cause- not otherwise classified. Over this time period, there was an overall 91% decrease in mortality due to stroke-related disease with a decrease in the MMR from 0.57 per 100,000 live births in 1979 to 0.03 in 2017 (Adjusted rate ratio 2016-2017 versus 1979-1980 0.09, 95% CI 0.04-0.21). As shown in Table 1, when evaluated by race, the proportion of deaths due to stroke-related disease mimicked overall mortality data with 63.3% of stroke-related deaths occurring in whites as compared to 33.0% in blacks. Figure 1 displays how this trend is consistent across all subtypes of stroke-related death evaluated. Despite lower numbers, overall higher MMRs were noted in the black population which accounted for all stroke-related mortality in 2017. Despite fluctuations over time, the maternal mortality rate due to stroke-related disease has decreased significantly over time. Non-traumatic intracranial hemorrhage is the major contributing etiology of these cases. The distribution of stroke-related deaths by race is similar to overall mortality data with lower absolute numbers, but higher MMRs in black as compared to white patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)