摘要：Objectives. We sought to determine whether differences in the prevalences of 5 specific pregnancy complications or differences in case fatality rates for those complications explained the disproportionate risk of pregnancy-related mortality for Black women compared with White women in the United States. Methods. We used national data sets to calculate prevalence and case-fatality rates among Black and White women for preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage for the years 1988 to 1999. Results. Black women did not have significantly greater prevalence rates than White women. However, Black women with these conditions were 2 to 3 times more likely to die from them than were White women. Conclusions. Higher pregnancy-related mortality among Black women from preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage is largely attributable to higher case-fatality rates. Reductions in case-fatality rates may be made by defining more precisely the mechanisms that affect complication severity and risk of death, including complex interactions of biology and health services, and then applying this knowledge in designing interventions that improve pregnancy-related outcomes. For the past 5 decades, Black women have consistently experienced an almost 4-times greater risk of death from pregnancy complications than have White women. This increased risk of pregnancy-related death among Black women is independent of age, parity, or education. 1 , 2 An increased risk of death from other conditions, such as breast and gynecological cancer, has also been reported for Black Women. 3 – 5 Black women are also more likely to die from complications of pregnancy, including hemorrhage, 6 hypertensive disorders of pregnancy, 7 and cardiomyopathy. 8 However, the reasons for this excess mortality remain unclear. Our lack of knowledge about what factors cause the disparity in pregnancy-related mortality between Black and White women impedes our ability to formulate appropriate research and to design interventions to eliminate this disparity. Excess mortality from a condition can be caused by a higher prevalence of the condition, a higher case-fatality rate, or a combination of these factors. To better understand the reasons for the higher pregnancy-related mortality rate among Black women, we calculated prevalence and case-fatality rates for 5 selected complications of pregnancy among Black and White women to determine the contribution of each factor to the difference in pregnancy-related mortality ratios. These 5 conditions—preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage—account for 26% of all pregnancy-related deaths. We partitioned the Black–White gap in the pregnancy-related mortality ratio into 2 parts: 1 attributable to differences in prevalence and the other attributable to differences in case-fatality rates.
