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

Background: Maternal 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.

Methods: Maternal 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 100 000 live births. A two-proportion z test or Poisson regression for numerators <30 was used to evaluate differences.

Results: The 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 ≥40 years (558.8) was 27 times higher than for women <40 years (20.7). From 2006-2010 to 2011-2015, the maternal mortality rate increased by 121% for women ≥40 years and by 55% for women <40 years. The rate increased by 132% for nonspecific causes of death, and by 54% for specific causes. Rates for women <40 years for specific causes increased by 36%.

Conclusions: The 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 ≥40 years 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.