Mortality rate is reported as the number of deaths in a population in a unit of time, and the data typically comes from vital statistics records, primarily death certificates. However, when that information is collected inconsistently it could lead to interpretations that are unintentionally misleading.
An issue that is prominent in the headlines, maternal mortality, relies on death certificates as the primary source of data. Maternal mortality, defined as “pregnancy-related death of a woman while pregnant or within 1 year of the end of the pregnancy,” has been on the rise in recent years. According to recent reports, Texas in particular has had a dramatic increase in pregnancy related deaths. According to vital statistics records, Texas’ maternal mortality rate has jumped 87 percent, from 18.3 for the five years from 2006 to 2010, to 34.2 for 2011 to 2015. News regarding this issue has caused many, including legislators, to take notice and ultimately propose new action. Texas Gov. Greg Abbott signed a bill which would allow the Task Force on Maternal Mortality and Morbidity more time to look closer and try to determine the cause of the increase.
But is the problem as bad as it appears? A study published in Birth earlier this year revealed that while there was an increase in maternal mortality, it appears that increase may not have been as dramatic as reported. The problem? Inaccurate and/or over-reporting the cause of death on death certificates.
Information can be recorded on a death certificate by a medical examiner or, as is the case in many rural areas, by a Justice of the Peace. The required training for these two positions varies greatly and may lead to divergent perspectives and interpretations as to the cause of death.
Changes to the death certification process have been made as recently as 2006 by adding a check box asking if the person who died was pregnant or had been pregnant within the last year. Although this change is an improvement, there is the still the possibility of inaccurate reporting.
A recent joint report published by the Maternal Mortality Review Committees in Colorado, Delaware, Georgia and Ohio said it best: “There is a clear need for ongoing technical assistance as we continue to build the analytical capacity required to address the myriad of maternal and child health problems that plague our nation. Without strong, accurate data we cannot effectively measure the problem nor work toward effective policy change and program development that improves birth outcomes.”
Successful policies and effective practice depend on the availability of good information. Therefore, the accuracy of our health data is critical. We can do better, but only if we make it a top priority.