Underreporting of maternal mortality in Taiwan: A data linkage study

Abstract

Objective: This study examined the extent to which maternal mortality in Taiwan is underreported in officially published mortality statistics.

Materials and methods: We used National Health Insurance claims data collected from two million samples, which were linked with the officially published mortality data, to identify women aged 15-49 years, who were admitted to a hospital with pregnancy-related diagnoses during 2000-2009 and died during the pregnancy or within 42 days after the termination of pregnancy.

Results: Based on these linked data, we identified 26 maternal deaths, only nine of which were reported in the original officially published mortality data; thus, the rate of underreporting was 65% [(26 - 9)/26]. The revised maternal mortality ratio was 14.1 deaths per 100,000 live births (95% confidence interval: 8.7-19.5), which was approximately three times higher than the official reported ratio of 4.9 (95% confidence interval: 1.7-8.1). The most common cause of maternal deaths was amniotic fluid embolism (n = 10), followed by eclampsia and preeclampsia (n = 4).

Conclusion: Approximately two-thirds of the maternal deaths in Taiwan were unreported in the officially published mortality data. Hence, routine nationwide data linkage is essential to monitor maternal mortality in Taiwan accurately.

Keywords: Taiwan; cause of death; data linkage; maternal mortality; pregnancy mortality.