ArticleAmerican journal of epidemiology2022
Rural-Urban Differences in Maternal Mortality Trends in the United States, 1999-2017: Accounting for the Impact of the Pregnancy Status Checkbox.
Article in American journal of epidemiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed.
- Machine Learning Analysis of Maternal Mortality Determinants in Nigeria: An Exploratory Study.The International journal of health planning and management · 2026Article
- Multilevel modelling of determinants of perinatal mortality in East Africa: a pooled analysis of National health survey data.BMC public health · 2025Article
- Obstetric care in rural critical access hospitals: A domestic application of the World Health Organization Emergency Obstetric Care framework in rural communities.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Unveiling the Challenges and Solutions: A Scoping Review of Maternal Healthcare Access in Rural Georgia.Cureus · 2025Review
- Pregnancy-Associated Mortality During the Pandemic: Disparities by Rurality.American journal of preventive medicine · 2025Article
- Rural maternal health interventions: A scoping review and implications for best practices.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Quantifying the Association between Pump Use and Breastfeeding Duration.The Journal of pediatrics · 2024Article
- Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study.Lancet regional health. Americas · 2024Article
- Excess deaths associated with COVID-19 by rurality and demographic factors in the United States.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- Nationwide study of in-hospital maternal mortality in Ecuador, 2015-2022.Revista panamericana de salud publica = Pan American journal of public health · 2024Article
- Rural-urban residence and sequelae of hypertensive disorders of pregnancy in the first year postpartum, 2007 - 2019.Pregnancy hypertension · 2023Article
- Need for Improved Collection and Harmonization of Rural Maternal Healthcare Data.Clinical obstetrics and gynecology · 2022Review
- Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents.Children (Basel, Switzerland) · 2022Article
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5 authors.
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Abstract
It has been difficult to measure rural-urban differences in maternal mortality ratios (MMRs) in the United States in recent years because of the incremental adoption of a pregnancy status checkbox on the standard US death certificate. Using 1999-2017 mortality and birth data, we examined the impact of the pregnancy checkbox on MMRs according to urbanicity of residence (large urban area, medium/small urban area, or rural area), using log-binomial regression models to predict trends that would have been observed if all states had adopted the checkbox as of 1999. Implementation of the checkbox resulted in an average estimated increase of 7.5 maternal deaths per 100,000 live births (95% confidence interval (CI): 6.3, 8.8) in large urban areas (a 76% increase), 11.6 (95% CI: 9.6, 13.6) in medium/small urban areas (a 113% increase), and 16.6 (95% CI: 12.9, 20.3) in rural areas (a 107% increase), compared with MMRs prior to the checkbox. Assuming that all states had the checkbox as of 1999, demographic-factor-adjusted predicted MMRs increased in rural areas, declined in large urban areas, and did not change in medium/small urban areas. However, trends and urban-rural differences were substantially attenuated when analyses were limited to direct/specific causes of maternal death, which are probably subject to less misclassification. Accurate ascertainment of maternal deaths, particularly in rural areas, is important for reducing disparities in maternal mortality.
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