Pregnancy-related death rates by county, race, and ethnicity in the US, 2000-2019

Rachel A Zajdel; Erik J Rodriquez; Paula D Strassle; George A Mensah; Gina S Wei; Laverne G Mensah; Parkes Kendrick; Kelly Compton; Yekaterina O Kelly; Mathew M Baumann; Zhuochen Li; Dillon O Sylte; M Ashworth Dirac; Christopher Jl Murray; Laura Dwyer-Lindgren; Ali Mokdad; Eliseo J Pérez-Stable

doi:10.1186/s13690-025-01688-z

Pregnancy-related death rates by county, race, and ethnicity in the US, 2000-2019

Arch Public Health. 2025 Nov 13;83(1):274. doi: 10.1186/s13690-025-01688-z.

Authors

Rachel A Zajdel^{1

2}, Erik J Rodriquez³, Paula D Strassle⁴, George A Mensah⁵, Gina S Wei⁶, Laverne G Mensah⁷, Parkes Kendrick⁸, Kelly Compton⁸, Yekaterina O Kelly⁸, Mathew M Baumann⁸, Zhuochen Li⁸, Dillon O Sylte⁸, M Ashworth Dirac^{8

9}, Christopher Jl Murray^{8

10}, Laura Dwyer-Lindgren^{8

10}, Ali Mokdad^{8

10}, Eliseo J Pérez-Stable³

Affiliations

¹ Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA. rachel.zajdel@nih.gov.
² Office of the Director, National Institute On Minority Health and Health Disparities, Bethesda, MD, USA. rachel.zajdel@nih.gov.
³ Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
⁴ Division of Intramural Research, National Institute On Minority Health and Health Disparities, Bethesda, MD, USA.
⁵ Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
⁶ Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
⁷ Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
⁸ Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
⁹ Department of Family Medicine, University of Washington, Seattle, Washington, USA.
¹⁰ Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA.

Abstract

Background: Substantial disparities across geographies and racial and/or ethnic populations contribute to increasing maternal mortality in the US. The present study adds to existing literature by examining pregnancy-related death rates by race and/or ethnicity at the county level and over time.

Methods: We used data from the US National Vital Statistics System and the US National Center for Health Statistics to estimate age-standardized pregnancy-related death rates as maternal deaths per 100,000 females aged 15 to 44 years from 2000 to 2019. We utilized validated small-area estimation methods and adjusted pregnancy-related death rates to account for misreporting of race and/or ethnicity on death certificates. Estimates were stratified by US county and racial and/or ethnic population (American Indian or Alaska Native [AIAN], Asian, Black, Latina, and White).

Results: Pregnancy-related death rates increased for all racial and/or ethnic populations from 2000 to 2019, and in 99.4% (3062 of 3079) of counties (87.4% statistically significant). White women experienced the greatest median percent increase in pregnancy-related death across counties (214.7%) from 2000-2019, although they did not experience the highest burden in absolute terms. In 2019, the highest pregnancy-related death rates were observed among AIAN and Black women (3.5 and 3.7 deaths per 100,000) and in counties in the Northern Great Plains and Southern regions. Asian and Latina women experienced relatively lower pregnancy-related death rates (1.0 and 1.3 deaths per 100,000), yet they also exhibited an increase in pregnancy-related death since 2000.

Conclusions: Pregnancy-related death rates continued to rise in the US through 2019 and disparities by race and/or ethnicity and geography remain stark. Clinical and public health interventions are urgently needed to address disparities and decrease maternal mortality.

Keywords: County-level; Health disparities; Maternal mortality; Pregnancy-related deaths; Race and ethnicity.