International Journal of Epidemiology, Vol 28, 919-924, Copyright © 1999 by International Epidemiological Association
O Razum, A Jahn, M Blettner and P Reitmaier
BACKGROUND: Maternal mortality is a sensitive indicator for inequity in
health. We describe recent trends in overall and cause-specific maternal
mortality ratio among women of German and non-German nationality residing
in West Germany. METHODS: Using birth and death register data for 1980-1996
we related 1067 cases of maternal death (ICD 9: 630-676) to 11.2 million
live births. We assessed the effects of nationality and of marital status,
a proxy for socioeconomic status, controlling for year of death and age of
the mother in a Poisson regression model. RESULTS: Maternal mortality ratio
in West Germany decreased from 13 per 100000 live births in 1980-1988 to
6.1 in 1989- 1996. The crude relative risk for non-German nationality
decreased from 1.9 (95% CI: 1.6-2.3) to 1.3 (1.0-1.7); after adjusting for
age, year of death and marital status it was 1.7 (95% CI: 1.4-2.1) and 1.6
(95% CI: 1.2-2.1). Unmarried women incurred an adjusted relative risk of
1.8 (95% CI: 1.5-2.3). Non-German women experienced an excess mortality
from abortions which largely disappeared in 1989-1996; concurrently, being
unmarried no longer conveyed an additional risk to them. The risk status of
German mothers developed unfavourably: increasing proportions are
unmarried, which continues to be a marker of elevated relative risk in this
group. CONCLUSIONS: Our findings suggest continuously improving
accessibility and quality of obstetric services, in particular for women of
non-German nationality. Still, inequity in maternal risk continues to
exist. Maternal risk, however, is not determined by the simple distinction
'German' versus 'non-German'; its association with socioeconomic status
extends beyond nationality.
ARTICLES
Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996
Department of Tropical Hygiene and Public Health, Heidelberg, Germany. oliver.razum@urz.uni-heidelberg.de
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