Preventive Medicine

Meta-analysis quantifies large, persistent Black–White disparities in maternal mortality

Across 30 observational studies including nearly 70 million Black and 259 million White patients, Black patients had markedly higher maternal mortality risk. Compared with White patients, Black patients had greater odds of any maternal death (adjusted OR 2.82, 95% CI 1.70–4.69). Disparities persisted for deaths within 42 days (adjusted OR 1.90, 95% CI 1.18–3.07) and up to 1 year postpartum (adjusted OR 4.40, 95% CI 3.07–6.31). Black patients also had higher odds of death from direct obstetric causes, particularly hypertensive disorders, and from indirect causes. Authors argue the pervasive disparities require structural, system-level interventions beyond individual clinical risk management. 1

WHO Safe Childbirth Checklist boosts practices and can lower stillbirths with strong implementation

This meta-analysis pooled three cluster randomized trials of the WHO Safe Childbirth Checklist across India, Indonesia, and Pakistan, totaling 169,511 births. Across full study periods, perinatal and early neonatal mortality did not differ between intervention and control facilities. During months with direct observation of practices, intervention facilities had lower stillbirth rates by 9.8 per 1,000 births versus controls. Adherence to 15 evidence-based practices was higher in intervention facilities by 3.6 practices in intention-to-treat analyses. Findings suggest checklists can reduce stillbirth when paired with effective coaching and monitoring that meaningfully improves bedside practice. 2

Behavioral–mental health score powerfully stratifies mortality and life expectancy

Investigators created a behavioral and mental health score incorporating diet, physical activity, alcohol, smoking, sleep, and depression. Among 413,180 adults in UK Biobank and US NHANES, higher scores were strongly associated with lower all-cause mortality over 13.3 years’ mean follow-up. Compared with the lowest quintile, the highest quintile had an all-cause mortality HR 0.56 (95% CI 0.47–0.67). Higher scores were also linked to lower cardiovascular and cancer mortality and about 5.6 years longer life expectancy. Relative benefits were greater among adults younger than 65 years and those with BMI below 25 kg/m². 3

Instagram support groups increase e-cigarette abstinence among adolescents and young adults

This randomized trial assigned 500 youth aged 13–21 who used e-cigarettes at least weekly to Instagram support groups or quitline referral. The 5-week Instagram intervention delivered motivational interviewing, peer support, skills training, and group quit attempts via direct messages. Intention-to-treat analysis, counting missing as vaping, showed higher 7-day abstinence with Instagram groups (18.2% vs 11.8%; OR 2.15, 95% CI 1.1–4.2). Complete-case analysis also favored Instagram groups over 6 months (53.9% vs 40.4%; OR 2.07, 95% CI 1.21–3.52). Despite low retention, social media–based cessation was acceptable to diverse youth and outperformed quitline referral. 4