Background. A national study in Finland showed significantly higher death rates associated with abortion than with childbirth. Our objective was to examine this association using an American population over a longer period.
Methods. California Medicaid records for 173,279 women who had an induced abortion or a delivery in 1989 were linked to death certificates for 1989 to 1997.
Results. Compared with women who delivered, those who aborted had a significantly higher age-adjusted risk of death from all causes (1.62), from suicide (2.54), and from accidents (1.82), as well as a higher relative risk of death from natural causes (1.44), including the acquired immunodeficiency syndrome (AIDS) (2.18), circulatory diseases (2.87), and cerebrovascular disease (5.46). Results are stratified by age and time.
Conclusions. Higher death rates associated with abortion persist over time and across socioeconomic boundaries. This may be explained by self-destructive tendencies, depression, and other unhealthy behavior aggravated by the abortion experience.
THE REDUCTION of maternal mortality rates is a major goal of national health care initiatives. The accuracy of maternal mortality figures has been questioned, however, because of inadequate reporting mechanisms and confusion about when a woman's pregnancy actually contributes to the cause of death. It is difficult, for example, to reliably determine whether pregnancy has contributed to death resulting from tumor, stroke, or suicide.
To overcome the difficulties involved when using an a priori definition of "pregnancy-related" deaths, researchers at Stakes, the National Research and Development Centre for Welfare and Health in Finland, undertook two important record linkage studies. (1,2) They identified all death certificates from 1987 to 1994 for all women aged 15 to 49, linked them to Finland's centralized Birth, Abortion, and Hospital Discharge Registers, and examined death rates relative to all pregnancy events among these women during the year before their deaths.
The Stakes studies revealed remarkable variations in death rates relative to pregnancy outcome. Women who had given birth had half the death rate of women who had not been pregnant in the year before death. By contrast, women who had had an induced abortion were 76% more likely to die than women who had not been pregnant, 102% more likely to die than women who miscarried, and 252% more likely to die than women who had carried to term. Compared with women who delivered, the age-adjusted odds ratio of dying during the year after an induced abortion was 1.6 for death from nonviolent causes, 4.2 for death from injuries related to accidents, 6.5 for suicide, and 14.0 for homicide.
If the findings reported by Stakes identify a true association between mortality rates and previous pregnancy outcomes, one would expect them to be replicable elsewhere. In addition, the Stakes findings raise the question of how long the effects of previous pregnancy outcomes on mortality rates may persist. The goals of our study were to investigate whether the Stakes findings would be observed in a homogeneous socioeconomic population and to examine any associations between pregnancy history and subsequent mortality over a longer period.
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