Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996

Razum O, Jahn A, Blettner M, Reitmaier P (1999)
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 28(5): 919-924.

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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.
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Razum O, Jahn A, Blettner M, Reitmaier P. Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. 1999;28(5):919-924.
Razum, O., Jahn, A., Blettner, M., & Reitmaier, P. (1999). Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 28(5), 919-924.
Razum, O., Jahn, A., Blettner, M., and Reitmaier, P. (1999). Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 28, 919-924.
Razum, O., et al., 1999. Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 28(5), p 919-924.
O. Razum, et al., “Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996”, INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, vol. 28, 1999, pp. 919-924.
Razum, O., Jahn, A., Blettner, M., Reitmaier, P.: Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. 28, 919-924 (1999).
Razum, Oliver, Jahn, A, Blettner, M, and Reitmaier, P. “Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996”. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 28.5 (1999): 919-924.
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