Maternal Disorders Mortality: A County-Level Analysis of 24 North-Central Texas Counties, 2013–2019
Data Source: Institute for Health Metrics and Evaluation (IHME), U.S. County-Level Estimates by Ethnicity
Executive Summary
This report summarizes county-level maternal disorders mortality estimates produced by the Institute for Health Metrics and Evaluation (IHME) for 24 counties in north-central Texas, spanning the Dallas–Fort Worth metropolitan area and its surrounding rural counties, over the period 2013–2019. The dataset comprises 21,168 modeled estimates of female death rates from maternal disorders, disaggregated by county, ethnicity, age group, and year, with accompanying upper and lower uncertainty bounds.
Three findings stand out. First, maternal mortality across the region declined over the study period: the mean age-standardized death rate rose from 1.27 per 100,000 females in 2013 to a peak of 1.42 in 2016, then fell to 1.14 by 2019, with 22 of 24 counties recording lower rates in 2019 than in 2013. Second, a pronounced rural–urban gradient exists: small rural counties such as Eastland (1.81), Palo Pinto (1.79), and Stephens (1.67) carry rates roughly three times those of affluent suburban counties such as Collin (0.52), Denton (0.58), and Rockwall (0.67). Third, a persistent racial disparity is evident: Black women experienced an average age-standardized rate of 2.20 per 100,000 — approximately 2.2 times the rate among White women (1.05) in county-years where both estimates are available — mirroring the well-documented national Black–White maternal mortality gap.
1. Data and Demographic Structure
Scope and dimensions. The merged analytic table contains 21,168 rows and 20 fields, each carrying a point estimate with upper and lower uncertainty bounds. Geography covers 24 Texas counties identified by name and FIPS code — the DFW urban core (Dallas, Tarrant, Collin, Denton) plus surrounding suburban and rural counties (Ellis, Johnson, Parker, Kaufman, Hunt, Hood, Wise, Rockwall, Somervell, Erath, Hill, Navarro, Bosque, Brown, Comanche, Eastland, Hamilton, Jack, Palo Pinto, Stephens). The time period is 2013–2019 (seven annual estimates). The population is female only; the cause of death is Maternal disorders (GBD cause ID 366). The measure is Deaths expressed as rates; values are stored as per-person rates and are scaled to deaths per 100,000 females throughout this report. Ethnicity comprises six groups — Total, White, Black, Latino, Asian, and American Indian/Alaska Native (AIAN). Age spans 21 bands from under 1 year through 85+, plus All Ages and Age-standardized aggregates; age-standardized rates are used for all cross-county and cross-group comparisons.
Data completeness. Approximately 6,909 of 21,168 records (32.6%) carry no estimate, reflecting IHME suppression where county-level populations are too small to support stable modeled estimates. Completeness varies sharply by group: Total and White estimates are 100% complete, Latino 95.8%, Black 54.2%, Asian 37.5%, and AIAN 16.7%. Findings for the smaller groups should be interpreted with corresponding caution, and missing values should be treated as suppressed, not zero.
2. Key Findings
2.1 Temporal trend: a 2016 peak, then decline. The mean age-standardized maternal mortality rate across the 24 counties held near 1.3 per 100,000 females from 2013 through 2015, peaked at 1.42 in 2016, and declined thereafter to 1.09 in 2018 and 1.14 in 2019. Between 2013 and 2019, rates fell in 22 of the 24 counties; only Eastland County registered a meaningful increase (+0.05). The largest improvements occurred in Hill (−0.32), Erath (−0.27), and Navarro and Comanche (−0.24 each).
2.2 Geographic pattern: a rural–urban gradient. County-level burden follows a clear socioeconomic and geographic gradient. The highest average rates over 2013–2019 are concentrated in small rural counties west and south of the DFW metroplex, while the lowest rates appear in the high-income northern suburbs. The spread — from 0.52 in Collin County to 1.81 in Eastland County — represents nearly a 3.5-fold difference across a contiguous region.
County mean age-standardized rates per 100,000 (2013–2019), highest to lowest: Eastland 1.81, Palo Pinto 1.79, Stephens 1.67, Navarro 1.63, Brown 1.57, Jack 1.55, Comanche 1.55, Bosque 1.45, Hunt 1.44, Hill 1.41, Hamilton 1.38, Erath 1.34, Hood 1.28, Johnson 1.19, Wise 1.19, Somervell 1.17, Dallas 1.15, Tarrant 1.08, Parker 1.07, Kaufman 1.07, Ellis 1.02, Rockwall 0.67, Denton 0.58, Collin 0.52.
2.3 Racial and ethnic disparities. Black women bear the highest burden in every year of the series, with an average age-standardized rate of 2.20 per 100,000 (2.10 in 2013, peaking at 2.41 in 2016, 2.15 in 2019) — roughly 2.2 times the White rate (1.05) in county-years where both groups are estimated. This ratio is consistent with the national Black–White maternal mortality disparity documented by the CDC and in the IHME literature. Average rates among Latino (0.94), AIAN (0.84), and Asian (0.53) women are lower, though sparse coverage for AIAN and Asian populations limits the precision of those comparisons.
2.4 Age pattern: risk concentrated at 25–39. Mortality follows the expected maternal-age risk curve. Mean rates per 100,000 by band are: 15–19 at 0.34, 20–24 at 1.53, 25–29 at 2.85, 30–34 at 3.65, 35–39 at 3.87, 40–44 at 2.77, and 45–49 at 1.92. Rates are lowest among adolescents, rise steeply through the twenties, and peak at 35–39 — a pattern consistent with elevated risk at advanced maternal age. Rates decline after age 40 as births become less frequent, though per-birth risk in that group remains clinically significant.
3. Interpretation and Public Health Implications
Taken together, the estimates describe a region in which overall maternal mortality improved modestly over 2013–2019, but where the benefits of that improvement were unevenly distributed. Rural counties — which typically face obstetric unit closures, longer travel times to delivery hospitals, and higher uninsured rates — consistently carry the region’s heaviest burden. The persistence of a two-fold Black–White disparity across the entire period indicates that the overall decline did not close the racial gap.
These patterns suggest three priorities for regional public health attention: sustaining access to obstetric and prenatal care in rural counties west of the metroplex; targeted interventions addressing the drivers of excess mortality among Black women, including access, quality of care, and chronic-condition management; and continued surveillance of the 25–39 age group, where absolute risk is highest.
4. Limitations
IHME values are small-area model outputs, not raw vital-statistics counts; uncertainty intervals (included in the source data) should accompany any published figure. Roughly one-third of records — concentrated among AIAN, Asian, and Black populations in small counties — carry no estimate and should be treated as suppressed rather than zero. Rates are per 100,000 female population, not per live birth, and are therefore not directly comparable to the CDC’s maternal mortality ratio (deaths per 100,000 live births). Finally, age-specific rates must not be summed or averaged across bands to produce a summary figure; the age-standardized series provided in the data is the appropriate comparison measure.
Appendix: Data Provenance
Source files follow the IHME naming convention IHME_USA_MATERNAL_COUNTY_RACE_ETHN_2000_2019, with one file per estimation year (2013–2019), merged into a single analytic table of 21,168 rows and 20 fields. Fields include measure, location (name and FIPS), ethnicity, male or female, age group, cause, year, metric, point estimate, and 95% uncertainty bounds. All figures in this report are computed from the age-standardized, rate-metric series unless otherwise noted, scaled to deaths per 100,000 females.