Mortality Rate - Women in Maryland

Maryland

U.S. women have a higher rate of preventable deaths than women living in other high-income countries. After a period of improvement between 2003 and 2011, the death rate among women of reproductive age in the United States increased between 2011 and 2019. Unemployment, poverty, food insecurity, lack of private health insurance, having less than a high school education and living alone are all risk factors for premature death. In 2022, the leading causes of death for women ages 20-44 were unintentional injuries (led by poisoning and motor vehicle accidents), cancer, heart disease, suicide and chronic liver disease/cirrhosis. 

Pregnancy-related death, or maternal mortality, is another contributor to premature mortality rates among women of reproductive age. The maternal mortality rate in the U.S. has been rising steadily since 1990, and the U.S. consistently has the highest maternal mortality rate among high-income countries. A substantial increase in maternal deaths was reported after March 2020, coinciding with the beginning of the COVID-19 pandemic. 

The death of a woman adversely impacts her family and community. The early death of a mother or parent can lead to depression, anxiety and other long-term emotional problems in children, and is associated with decreased academic performance.

According to America’s Health Rankings analysis, the mortality rate is higher among:

• American Indian/Alaska Native women compared with all other racial/ethnic groups. Hawaiian/Pacific Islander and Black women also have an elevated mortality rate. The lowest mortality rates are observed among Asian, multiracial, Hispanic and white women.

Studies have also found that the mortality rate is higher among:

• Women living in rural areas compared with women in urban areas.
• Less-wealthy women compared with wealthier women.
• Women with less than a high school education compared with women with a college degree; the mortality rate was lower with each increase in education level.

Many deaths among women of reproductive age are preventable. Strategies to reduce premature death within this population can target the leading causes of death, including:

• Promoting the use of seat belts can reduce motor vehicle fatalities.
• Funding projects to prevent opioid misuse in women and girls may help decrease overdose deaths in the long run.
• Encouraging healthy lifestyle changes — such as eating healthily, getting regular physical activity, limiting alcohol and quitting smoking — may reduce the risk of heart disease, liver diseases and certain cancers.
• Implementing universal suicide screening and Safety Planning Interventions in emergency rooms can reduce suicide deaths by providing evidence-based coping strategies and supporting high-risk patients.
• Ensuring patients get the recommended routine cancer screenings for their age and risk profile — cancer screening can lead to earlier detection when cancers are easier to treat. 

Intimate partner violence (IPV) lethality risk assessments may prevent violence by identifying at-risk women and connecting them with life-saving safety planning and services. Other IPV prevention measures include teaching safe and healthy relationship skills and recognizing risky situations and behaviors in young people.

Deaths related to or aggravated by pregnancy also contribute uniquely to mortality rates among women of reproductive age. At the state level, age-adjusted all-cause mortality among women ages 15-44 is highly correlated with pregnancy-related mortality. The Alliance for Innovation on Maternal Health offers toolkits, patient safety bundles and other resources to support and guide quality improvement efforts in health care facilities to prevent pregnancy-related deaths. The Centers for Disease Control and Prevention recently established the Hear Her campaign to increase awareness of urgent warning signs that may help prevent pregnancy-related deaths. Expanding safe access to maternal care and facilities during pregnancy could also reduce mortality.

The Substance Abuse and Mental Health Services Administration has published an opioid overdose prevention toolkit for providers, communities, local governments and the general populace. The National Institute on Drug Abuse offers resources and advice about what to do if someone you know is struggling with drug misuse.

Healthy People 2030 has several goals related to reducing premature mortality among women, including:

• Reducing breast cancer deaths.
• Reducing maternal deaths.
• Reducing drug overdose deaths. 

Bundy, Joshua D., Katherine T. Mills, Hua He, Thomas A. LaVeist, Keith C. Ferdinand, Jing Chen, and Jiang He. “Social Determinants of Health and Premature Death among Adults in the USA from 1999 to 2018: A National Cohort Study.” Lancet Public Health 8, no. 6 (July 15, 2023): E422–31. https://doi.org/10.1016/S2468-2667(23)00081-6.

Curtin, Sally, and Merianne Rose Spencer. “Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019.” NCHS Data Brief No. 417. Hyattsville, MD: National Center for Health Statistics, September 21, 2021. https://doi.org/10.15620/cdc:109049.

Dunlap, Laura J., Stephen Orme, Gary A. Zarkin, Sarah A. Arias, Ivan W. Miller, Carlos A. Camargo, Ashley F. Sullivan, et al. “Screening and Intervention for Suicide Prevention: A Cost-Effectiveness Analysis of the ED-SAFE Interventions.” Psychiatric Services 70, no. 12 (August 27, 2019): 1082–87. https://doi.org/10.1176/appi.ps.201800445.

Gemmill, Alison, Blair O. Berger, Matthew A. Crane, and Claire E. Margerison. “Mortality Rates Among U.S. Women of Reproductive Age, 1999–2019.” American Journal of Preventive Medicine 62, no. 4 (April 2022): 548–57. https://doi.org/10.1016/j.amepre.2021.10.009.

Gunja, Munira Z., Shanoor Seervai, Laurie C. Zephyrin, and Reginald D. II Williams. “Health and Health Care for Women of Reproductive Age: How the United States Compares with Other High-Income Countries.” Issue Brief. The Commonwealth Fund, April 5, 2022. https://doi.org/10.26099/4pph-j894.

Hajat, Anjum, Jay S. Kaufman, Kathryn M. Rose, Arjumand Siddiqi, and James C. Thomas. “Long-Term Effects of Wealth on Mortality and Self-Rated Health Status.” American Journal of Epidemiology 173, no. 2 (January 15, 2011): 192–200. https://doi.org/10.1093/aje/kwq348.

Hummer, Robert A., and Elaine M. Hernandez. “The Effect of Educational Attainment on Adult Mortality in the United States.” Population Bulletin 68, no. 1 (June 2013): 1–16.

Kassebaum, Nicholas J., Caitlyn Steiner, Christopher J. L. Murray, Alan D. Lopez, and Rafael Lozano. “Global, Regional, and National Levels of Maternal Mortality, 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015.” The Lancet 388, no. 10053 (October 2016): 1775–1812. https://doi.org/10.1016/S0140-6736(16)31470-2.

Petrosky, Emiko, Janet M. Blair, Carter J. Betz, Katherine A. Fowler, Shane P. D. Jack, and Bridget H. Lyons. “Racial and Ethnic Differences in Homicides of Adult Women and the Role of Intimate Partner Violence — United States, 2003–2014.” Morbidity and Mortality Weekly Report 66, no. 28 (July 21, 2017): 741–46. https://doi.org/10.15585/mmwr.mm6628a1.

Stanley, Barbara, Gregory K. Brown, Lisa A. Brenner, Hanga C. Galfalvy, Glenn W. Currier, Kerry L. Knox, Sadia R. Chaudhury, Ashley L. Bush, and Kelly L. Green. “Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department.” JAMA Psychiatry 75, no. 9 (September 1, 2018): 894–900. https://doi.org/10.1001/jamapsychiatry.2018.1776.

Substance Abuse and Mental Health Services Administration. “SAMHSA Overdose Prevention and Response Toolkit.” Rockville, MD: Substance Abuse and Mental Health Services Administration, 2023. https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf.

Thoma, Marie E., and Eugene R. Declercq. “All-Cause Maternal Mortality in the US Before vs During the COVID-19 Pandemic.” JAMA Network Open 5, no. 6 (June 28, 2022): e2219133. https://doi.org/10.1001/jamanetworkopen.2022.19133.