Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006-2015

BackgroundMaternal mortality is a sentinel indicator of health care quality. Our purpose was to analyze trends in Texas maternal mortality by demographic characteristics and cause of death, and to evaluate data quality. MethodsMaternal mortality data were initially analyzed by single years, but then were grouped into 5-year averages (2006-2010 and 2011-2015) for more detailed analyses. Rates were computed per 100000 live births. A two-proportion z test or Poisson regression for numerators <30 was used to evaluate differences. ResultsThe Texas maternal mortality rate increased from 18.6 in 2010 to 38.7 in 2012, and then declined nonsignificantly to 32.5 in 2015. The 2011-2015 rate (34.2) was 87% higher than the 2006-2010 rate (18.3). In 2011-2015, the maternal mortality rate for women 40years (558.8) was 27 times higher than for women <40years (20.7). From 2006-2010 to 2011-2015, the maternal mortality rate increased by 121% for women 40years and by 55% for women <40years. The rate increased by 132% for nonspecific causes of death, and by 54% for specific causes. Rates for women <40years for specific causes increased by 36%. ConclusionsThe observed increase in maternal mortality in Texas from 2006-2010 to 2011-2015 is likely a result of both a true increase in rates and increased overreporting of maternal deaths, as indicated by implausibly high and increasing rates for women aged 40years and among nonspecific causes of death. Efforts are needed to strengthen reporting of death certificate data, and to improve access to quality maternal health care services.