Racial inequities in severe maternal morbidity among Black and White people in Canada: a population-based cohort study, 2012 to 2023.
Abstract
Background
Internationally, rates of severe maternal morbidity (SMM) are consistently higher among Black people than White people; however, in Canada, such disparities remain poorly understood. We sought to assess racial inequities in SMM among Black and White people in Canada.Methods
We conducted a population-based cohort study of in-hospital live births in Canada (excluding Quebec) from 2012 to 2023 using a Statistics Canada data set linking hospitalization and Census data. We included people who self-identified their race as Black or White. We defined SMM as a composite of diagnoses and procedures associated with high case fatality and prolonged hospitalization. We assessed frequencies of SMM overall and by SMM type, province or territory, year, and household income. We used logistic regression to estimate the association between race (as a social construct) and SMM, adjusted for maternal sociodemographic and clinical characteristics. All analyses used person-based weights for national representativeness.Results
We included 108 365 in-hospital deliveries to Black people and 1 385 810 in-hospital deliveries to White people that occurred between 2012 and 2023. Overall, SMM occurred in 47.8 and 27.7 per 1000 live births among Black and White people, respectively. The most common SMM type in both groups was severe preeclampsia (Black: 11.1, White: 6.7 per 1000 births). Rates of SMM were stable across years but varied by province or territory, with the largest disparity by race in New Brunswick (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.46 to 5.43). Additionally, rates of SMM declined with increasing income among White people but increased with increasing income among Black people. After multivariable adjustment, Black people remained at higher risk of SMM (adjusted OR 1.66, 95% CI 1.53 to 1.80).Interpretation
In Canada, Black people have a higher risk of SMM than White people after adjustment for sociodemographic and clinical factors. Equity-driven policies and care models centring Black communities are urgently needed.
Related
- Trends in the Frequency of Severe Maternal Morbidity Among American Indian and Alaska Native Individuals at Two Major Hospitals in the East Valley, Arizona
- Disparities in hypertensive disorders of pregnancy and severe maternal morbidity: Evidence from a statewide birth cohort.
- Ectopic pregnancy-related severe maternal morbidity in Shenzhen: a sentinel indicator for gaps in early pregnancy care systems.
- Weight Gain During Pregnancy and Severe Maternal Morbidity
- National Trends in Severe Maternal Morbidity by Insurance and Race and Ethnicity
BibTeX
@article{rajasingham2026racial,
title = {{Racial inequities in severe maternal morbidity among Black and White people in Canada: a population-based cohort study, 2012 to 2023.}},
author = {Maya Rajasingham and Cynthia Maxwell and Modupe Tunde-Byass and Karline Wilson-Mitchell and Aderemi Ejiwunmi and Elsie Amoako and Feben Aseffa and Gabrielle Griffith and Janelle Griffith and Jordyn Ledgister and Lara Gotha and Marjorie Dixon and Shani Robertson and Stacia Stewart and Abirami Kirubarajan and Susie Dzakpasu and Giulia M Muraca and for CanHEAL},
journal = {CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne},
year = {2026},
month = oct,
doi = {10.1503/cmaj.252020},
url = {https://europepmc.org/article/MED/42833691},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Racial inequities in severe maternal morbidity among Black and White people in Canada: a population-based cohort study, 2012 to 2023.
AU - Maya Rajasingham
AU - Cynthia Maxwell
AU - Modupe Tunde-Byass
AU - Karline Wilson-Mitchell
AU - Aderemi Ejiwunmi
AU - Elsie Amoako
AU - Feben Aseffa
AU - Gabrielle Griffith
AU - Janelle Griffith
AU - Jordyn Ledgister
AU - Lara Gotha
AU - Marjorie Dixon
AU - Shani Robertson
AU - Stacia Stewart
AU - Abirami Kirubarajan
AU - Susie Dzakpasu
AU - Giulia M Muraca
AU - for CanHEAL
PY - 2026
DA - 2026/10/04
JO - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
DO - 10.1503/cmaj.252020
UR - https://europepmc.org/article/MED/42833691
AB - Background Internationally, rates of severe maternal morbidity (SMM) are consistently higher among Black people than White people; however, in Canada, such disparities remain poorly understood. We sought to assess racial inequities in SMM among Black and White people in Canada.Methods We conducted a population-based cohort study of in-hospital live births in Canada (excluding Quebec) from 2012 to 2023 using a Statistics Canada data set linking hospitalization and Census data. We included people who self-identified their race as Black or White. We defined SMM as a composite of diagnoses and procedures associated with high case fatality and prolonged hospitalization. We assessed frequencies of SMM overall and by SMM type, province or territory, year, and household income. We used logistic regression to estimate the association between race (as a social construct) and SMM, adjusted for maternal sociodemographic and clinical characteristics. All analyses used person-based weights for national representativeness.Results We included 108 365 in-hospital deliveries to Black people and 1 385 810 in-hospital deliveries to White people that occurred between 2012 and 2023. Overall, SMM occurred in 47.8 and 27.7 per 1000 live births among Black and White people, respectively. The most common SMM type in both groups was severe preeclampsia (Black: 11.1, White: 6.7 per 1000 births). Rates of SMM were stable across years but varied by province or territory, with the largest disparity by race in New Brunswick (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.46 to 5.43). Additionally, rates of SMM declined with increasing income among White people but increased with increasing income among Black people. After multivariable adjustment, Black people remained at higher risk of SMM (adjusted OR 1.66, 95% CI 1.53 to 1.80).Interpretation In Canada, Black people have a higher risk of SMM than White people after adjustment for sociodemographic and clinical factors. Equity-driven policies and care models centring Black communities are urgently needed.
SN - 0820-3946
SN - 1488-2329
ER -