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clinmed/2001030003v1 (April 25, 2001)
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Suicide Deaths Associated with Pregnancy Outcome: A Record Linkage Study of 173,279 Low Income American Women

David C Reardon, Philip G Ney, Fritz J Scheuren, Jesse R Cougle, Priscilla K Coleman, and Thomas W Strahan

Design: Record linkage study. State funded medical insurance records identifying all paid claims for abortion or delivery in 1989 were linked to the state death certificate registry. Subjects: A population of 173,279 low income women eligible for state-funded medical insurance in California, United States, who had either an induced abortion or delivery in 1989. Results: Aborting women who had no known live births were significantly more likely to die than women with no known history of abortion, and women with a history of both abortion and childbirth. The relative risk was highest when comparing low income women with only one known pregnancy outcome. Compared to women who delivered, those who aborted had a significantly higher age adjusted risk of dying from all causes (1.62), from suicide (2.54), and accidents (1.82), as well as a higher risk of dying from nonviolent causes (1.44), including AIDS (2.18), circulatory diseases (2.87) and cerebrovascular disease (5.46). The higher death rates were significant across an eight year period and over four of the six age groups examined. After controlling for history of prior psychiatric care, the results remained significant and in many cases the relative risk increased. Conclusions: The pattern of death rates associated with prior pregnancy outcomes among low income women of California are similar to the pattern previously observed among the general population of women in Finland. Moreover, the apparent beneficial effects of childbirth and/or the detrimental effects of pregnancy loss persist over many years. The results are discussed in context of related literature.