International Journal of Epidemiology, Vol 28, 64-69, Copyright © 1999 by International Epidemiological Association
B Salanave, MH Bouvier-Colle, N Varnoux, S Alexander and A Macfarlane
OBJECTIVES: To compare the ways maternal deaths are classified in national
statistical offices in Europe and to evaluate the ways classification
affects published rates. METHODS: Data on pregnancy- associated deaths were
collected in 13 European countries. Cases were classified by a European
panel of experts into obstetric or non- obstetric causes. An ICD-9 code
(International Classification of Diseases) was attributed to each case.
These were compared to the codes given in each country. Correction indices
were calculated, giving new estimates of maternal mortality rates.
SUBJECTS: There were sufficient data to complete reclassification of 359 or
82% of the 437 cases for which data were collected. RESULTS: Compared with
the statistical offices, the European panel attributed more deaths to
obstetric causes. The overall number of deaths attributed to obstetric
causes increased from 229 to 260. This change was substantial in three
countries (P < 0.05) where statistical offices appeared to attribute
fewer deaths to obstetric causes. In the other countries, no differences
were detected. According to official published data, the aggregated
maternal mortality rate for participating countries was 7.7 per 100,000
live births, but it increased to 8.7 after classification by the European
panel (P < 0.001). CONCLUSION: The classification of
pregnancy-associated deaths differs between European countries. These
differences in coding contribute to variations in the reported numbers of
maternal deaths and consequently affect maternal mortality rates.
Differences in classification of death must be taken into account when
comparing maternal mortality rates, as well as differences in obstetric
care, underreporting of maternal deaths and other factors such as the age
distribution of mothers.
ARTICLES
Classification differences and maternal mortality: a European study. MOMS Group. MOthers' Mortality and Severe morbidity
INSERM-U149, Paris, France.
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