Pregnancy checkbox classification and place of death among late maternal deaths in the United States in 2024
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Late maternal deaths occur 43–365 days after delivery, when obstetric follow-up has typically ended. The U.S. pregnancy checkbox improves death-certificate capture of recent pregnancy but may classify deaths with uncertain pregnancy-relatedness. Weathering and social ecological frameworks guided this analysis of causes, disparities, checkbox sensitivity, and place of death. Methods Using 2024 National Center for Health Statistics mortality and natality files, this descriptive cross-sectional analysis defined late maternal deaths as deaths 43–365 days postpartum. Death counts were from the mortality dataset, and the live-birth denominators were from the natality dataset. Estimates were recalculated after excluding checkbox-classified records. Results Among 971 maternal deaths, 322 (33.2%) occurred late postpartum. Cardiovascular disease was the leading late cause (145 deaths; 45.0%). Late maternal mortality was highest among Black women (21.1 per 100,000 live births); the highest stratified ratio was among Black women 35 years or older with a high school education or less (64.8 per 100,000). Among late substance use, overdose, or self-harm deaths, 57.1% occurred at home or in emergency, outpatient, or dead-on-arrival settings. Overall, 285 late deaths (88.5%) were checkbox-classified; excluding them reduced the late mortality ratio from 8.87 to 1.02 per 100,000. Conclusions Late maternal mortality reflected chronic and behavioral causes, disparities, deaths outside inpatient hospital settings, and high reliance on checkbox-classified records. These findings support consideration of one-year postpartum follow-up, integrated care, and vital-record quality improvement.
Source: Discover Public Health
Institution: Liberty University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7204578200