Primary Submission Category: Health equity
Changes in pregnancy-associated mortality in the United States during the COVID-19 pandemic: differences by race and ethnicity
Authors: Claire Margerison Xueshi Wang Alison Gemmill Sidra Goldman-Mellor
Presenting Author: Claire Margerison*
Mortality during pregnancy and the first year postpartum (i.e., pregnancy associated deaths) increased 35% from 2019 to 2020, with increases of 55.3% in drug-related deaths, 41.2% in homicides, and 28.4% in obstetric deaths. Here, we examine how changes in cause-specific pregnancy-associated deaths differed by race and ethnicity. We used US death certificate records from 2018-2020, restricted to female US resident decedents ages 15 to 44. We restricted our analysis to deaths occurring between April and December to isolate the COVID-19 pandemic period of 2020. We obtained the count of live births for the same population and time frame from the Centers for Disease Control and Prevention WONDER database. We used the standardized pregnancy checkbox to classify deaths as ‘pregnancy-associated’. We classified obstetric causes, drug-related causes, suicide, homicide, and other causes using ICD-10 codes. Race and ethnicity were assigned based on the death certificate as Hispanic and non-Hispanic White, Black, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, or Multiple Races. We calculated the pregnancy-associated death ratio (# deaths/100,000 live births) by race or ethnicity and year and generated 95% confidence intervals assuming a chi-squared distribution. Black pregnant and postpartum people experienced the largest increase (79%) in drug-related death during the pandemic period. Hispanic, white, American Indian and Alaska Native people and those reporting multiple races all experienced increases in drug-related deaths (58%, 50%, 36%, and 168%, respectively). Black pregnant and postpartum people also experienced a 71% increase in homicide from 2019 to 2020, and White, American Indian and Alaska Native, and Asian people experienced increases in homicide of 46%, 111%, and 11%, respectively. White and Black pregnant and postpartum people experienced declines in suicide death from 2019 to 2020, but all other groups experienced increases. All racial or ethnic groups except American Indian and Alaska Native people experienced increases in pregnancy and postpartum deaths due to obstetric causes.