Long-term dynamic burden and attributable risk analysis of indirect maternal mortality over the past 30 years: an observational study and insights for perioperative management in the next decade.

OBJECTIVE

Reducing indirect maternal mortality (IMM) and promoting maternal health remain complex global challenges. This study evaluates 30-year trends in IMM burden and provides evidence for policy formulation.

MATERIALS AND METHODS

Data on IMM disease burden in 195 countries/regions were extracted from the Global Burden of Disease (GBD) database. Trends in age-standardized death rate (ASDR) and disability-adjusted life year rate (AS-DALY) were analyzed, with subgroup analyses by age, region, and socioeconomic demographic index (SDI). Risk factor associations with IMM were also explored.

RESULTS

Over 30 years, ASDR and AS-DALY showed downward trends with estimated annual percentage changes (EAPCs) of -0.64 (95% CI: -0.87 to -0.41) and -3.04 (95% CI: -3.33 to -2.74), respectively. However, high-SDI regions exhibited a significant upward trend in ASDR (EAPC = 3.88, 95% CI: 3.31-4.45), while middle-SDI regions showed the steepest decline (EAPC = -3.04). Iron deficiency was an independent risk factor for IMM-related DALYs, with marked regional heterogeneity.

CONCLUSION

Despite the reduction in the burden of IMM, low- and middle-income regions, as well as women of childbearing age between 25 and 34, still face high risks. Iron supplementation interventions and systematic optimization of medical resources are key focuses for improvement.