Pregnancy-Associated Mortality During the Pandemic: Disparities by Rurality.

Autor: Margerison CE; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan. Electronic address: margeris@msu.edu., Wang X; Department of Economics, Michigan State University, East Lansing, Michigan., Gemmill A; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Goldman-Mellor S; Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, California.
Jazyk: angličtina
Zdroj: American journal of preventive medicine [Am J Prev Med] 2025 Jan; Vol. 68 (1), pp. 176-181. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1016/j.amepre.2024.09.004
Abstrakt: Introduction: In the U.S., rural areas experience higher rates of adverse maternal health outcomes, but little data exists on rural/urban differences in pregnancy-associated deaths (PAD, all deaths during pregnancy and postpartum) or rural/urban differences in those deaths during the COVID-19 pandemic.
Methods: Cross-sectional U.S. vital statistics mortality data from 2018 to 2021 was used to identify PAD (analyzed in 2024). PAD ratios (deaths per 100,000 live births) and 95% confidence intervals (CIs) were calculated by year, cause, and rurality (urban, suburban, rural). The percent change in PAD ratios between the prepandemic (2018 and 2019) and pandemic (2020 and 2021) time periods was calculated by rurality.
Results: During the pandemic, rural-compared to suburban and urban-areas had the highest pregnancy-associated death ratios due to obstetric causes (53.9 deaths/100,000 live births, 95% CI: 48.8, 59.4), drug-related causes (19.0, 95% CI: 16.0, 22.4), suicide (4.4., 95% CI: 3.0, 6.2), and other causes (the majority of which are motor vehicle accidents, 16.4, 95% CI: 14.0, 19.6). Rural areas experienced increases in all causes of pregnancy-associated death from prepandemic (2018 and 2019) to pandemic (2020 and 2021) with increases of 48.1% in obstetric deaths, 115.9% in drug-related deaths, 17.8% in homicide, 25.7% in suicide, and 11.6% in other causes. Rural areas experienced the largest (compared to urban and suburban) increase in drug-related deaths, and only rural areas experienced an increase in suicide during the pandemic.
Conclusions: Rural areas experience a high burden of pregnancy-associated death, and this inequity was exacerbated during the COVID-19 pandemic.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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