B104-23 Inequities in Postpartum Hemorrhage Mortality Among Women in the United States: A Retrospective Study (1999-2023)

Abstract Introduction Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide. However, national long-term trends in the United States have not been comprehensively assessed across demographic and geographic strata. Methods We extracted US mortality data from the CDC WONDER database, including deaths from 1999 to 2023 in which PPH (ICD-10 codes O72.0-O72.3) was listed as a multiple cause. Inclusions were restricted to female decedents of reproductive age (15-49 years). Annual death counts were extracted, and results stratified by race, Hispanic origin, census region, and place of death. Proportional analyses compared each subgroup’s share of deaths in PPH cohort to its share of the national female population. Results From 1999-2023, 694 PPH-related deaths were identified. Annual death counts were generally stable at 20-35 deaths per year, with modest increase in 2003 (n = 43). Racial disparities were pronounced as Black women accounted for 27.2% of total deaths while making up only 15.1% of the total female population in the US; Asian women had 10.6% of PPH deaths while accounting for 6.6% of total population; American Indian/Alaska Native (AI/AN) women 1.9% vs 1.3%. In contrast, White women accounted for 60.4% of deaths while making up 77.0% of the female population. By Hispanic origin, Hispanic women represented 25.0% of deaths vs representing 17.9% of the female population, while non-Hispanic women accounted for 75.0% vs. 82.1%. Regional disparities were evident as the South contributed 44.5% of deaths vs. accounting for only 37.2% of the population, while Northeast (14.6% vs. 17.7%) and Midwest (16.9% vs. 21.2%) were underrepresented. 83.2% of PPH deaths occurred in inpatient facilities, 8.6% in outpatient/ER settings, 6.8% at home, and 1.5% in other locations. Across all death certificates, there were 710 multiple-cause mentions of PPH codes, most frequently O72.1 (other immediate PPH, 53.8%), followed by O72.3 (postpartum coagulation defects, 23.9%), O72.0 (third-stage hemorrhage, 19.0%), and O72.2 (delayed/secondary hemorrhage, 3.2%). By urbanization, 669 deaths were classifiable. The largest share occurred in large central metro areas (36.8%), followed by large fringe metro (23.6%) and medium metro (18.1%), with smaller proportions in small metro (6.1%), micropolitan (7.6%), and noncore rural counties (7.8%). Conclusions Despite relatively low national counts, PPH mortality in the US demonstrates striking regional, racial, and ethnic inequities, with disproportionate burden among Black, Hispanic, and residents of the South. These findings highlight persistent disparities and point to the need for targeted prevention and system-level quality improvement in high-risk populations and regions. This abstract is funded by: None