Adjustment of Maternal Mortality Rates for Misclassification
This visualization displays maternal mortality rates (MMRs) in the United States from 1999 through 2017 and illustrates the impact of potential over- and under-reporting of maternal deaths. Estimates shown in this visualization are based on an accompanying report that describes the impact of the staggered implementation of the 2003 U.S. Standard Certificate of Death from 2003 through 2017, which added a checkbox to determine pregnancy status at the time of death. That report evaluates the impact of the staggered implementation of the pregnancy checkbox and potential outcome misclassification on MMRs and related trends from 1999 through 2017. More detail about the data and methodology can be found in the following report:
Rossen LM, Womack LS, Hoyert DL, Anderson RN, Uddin SFG. The impact of the pregnancy checkbox and misclassification on maternal mortality trends in the United States, 1999–2017. National Center for Health Statistics. Vital Health Stat 3(44). 2020.pdf icon
In this visualization, users can examine observed MMRs over time, and predicted MMRs under two alternative hypothetical scenarios in which: 1) no states had implemented the pregnancy checkbox at any point, and 2) all states had the checkbox from 1999 through 2017. Additionally, users can examine how predicted MMRs vary assuming a certain fixed error rate associated with the pregnancy checkbox. These adjusted estimates were generated assuming that a certain percentage of death certificates had a pregnancy checkbox selected in error, ranging from 0.25% through 1.0%. Finally, users can explore the impact of outcome misclassification on predicted MMRs by selecting values for sensitivity (the proportion of true maternal deaths captured in death certificate data) and false positive rates (the proportion of maternal deaths determined using death certificate data that are not maternal deaths).
Rossen LM, Womack LS, Hoyert DL, Anderson RN, Uddin SFG. The Impact of the Pregnancy Checkbox and Misclassification on Maternal Mortality Trends in the US, 1999-2017. National Center for Health Statistics. Vital Health Stat 3(44). 2020.