Evidence map›Paper›PMID 39516003›Full record

SynthesisJournal of epidemiology and community health2025

Association between socioeconomic disadvantage and severe maternal morbidity and mortality in high-income countries: a systematic review.

Dorothea Geddes-Barton, Sofia Baldelli, Roshan Karthikappallil, Thomas Bentley, Blessing Omorodion, Lucy Thompson, Nia Wyn Roberts, Raph Goldacre, Marian Knight, Rema Ramakrishnan

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of epidemiology and community health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Observational
  4. Article
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Dorothea Geddes-BartonNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK shil5823@ox.ac.uk.ORCID http://orcid.org/0000-0003-0081-7670
Sofia BaldelliOxford Medical School, Medical Sciences Division, University of Oxford, Oxford, UK.
Roshan KarthikappallilOxford Medical School, Medical Sciences Division, University of Oxford, Oxford, UK.
Thomas BentleyOxford Medical School, Medical Sciences Division, University of Oxford, Oxford, UK.
Blessing OmorodionOxford Medical School, Medical Sciences Division, University of Oxford, Oxford, UK.
Lucy ThompsonOxford Medical School, Medical Sciences Division, University of Oxford, Oxford, UK.
Nia Wyn RobertsBodleian Health Care Libraries, University of Oxford, Oxford, Oxfordshire, UK.ORCID http://orcid.org/0000-0002-1142-6440
Raph GoldacreHealth Data Epidemiology Group, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Marian KnightNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.ORCID http://orcid.org/0000-0002-1984-4575
Rema RamakrishnanNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.ORCID http://orcid.org/0000-0002-6784-8319

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSocioeconomic position (SEP) is among the most important determinants of variations in health outcomes. This systematic review aimed to summarise the association between socioeconomic disadvantage and the risk of severe maternal morbidity (SMM) and maternal mortality (MM) across high-income countries.

methodsA comprehensive search was conducted in the MEDLINE, EMBASE, CINAHL and PsycInfo databases and Google Scholar from January 2000 to June 2023. Peer-reviewed papers from observational studies conducted in Organisation for Economic Co-operation and Development countries were included. Meta-analyses of comparable studies, a narrative summary and a harvest plot were undertaken.The risk of bias was assessed using a modified Newcastle-Ottawa tool.

resultsThe final review included 52 papers. In the meta-analyses, compared with the least amount of neighbourhood deprivation, neighbourhood income, neighbourhood poverty and years of education, the ORs for SMM in the highest group were 1.45 (95% CI 1.13 to 1.85), 1.48 (95% CI 1.34 to 1.63), 1.61 (95% CI 0.97 to 2.66) and 1.29 (95% CI 1.22 to 1.37), respectively. Similarly, the ORs for MM among least versus highest amount of neighbourhood deprivation, unemployed versus employed, lower versus higher occupational group and years of education were 2.10 (95% CI 1.57 to 2.81), 1.86 (95% CI 0.95 to 3.66), 1.61 (95% CI 1.03 to 2.51) and 1.90 (95% CI 1.29 to 2.79), respectively. DISCUSSION: In high-income countries across the different measures of SEP, socioeconomic disadvantage is associated with increased risk for SMM and MM. There is a need for interventions across multiple societal levels that will be effective in reducing these inequitable outcomes. PROSPERO REGISTRATION NUMBER: CRD42023399267.

Indexed as

Developed CountriesMaternal MortalityFemaleHumansPovertyPregnancyResidence CharacteristicsSocioeconomic Disparities in HealthSocioeconomic FactorsEPIDEMIOLOGYOBSTETRICSPUBLIC HEALTH

Identifiers

PMID39516003
PMCPMC11874458

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.