{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:09:36Z","timestamp":1779170976343,"version":"3.51.4"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Differences in health resources between rural and urban areas were identified as an important factor hindering the further reduction of maternal mortality ratio (MMR). However, few studies were conducted to analyze the trends and causes between them. Jinan in eastern China was selected as the research site, and differences and trends in maternal deaths from 1991 to 2025 were analyzed to provide suggestions for government departments to formulate targeted measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data such as the number of live births, maternal deaths, and causes of deaths were collected from paper files, electronic sheets, and web-based information platforms in Jinan. The study period was divided into seven stages with 5-year as a cycle, and Joinpoint Regression Model was used to analyze the trends of maternal deaths in urban and rural areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2,115,657 live births and 370 maternal deaths were included from 1991 to 2025 in Jinan. The overall MMR was 17.49 per 100,000 live births, of which the rural MMR was 21.15 per 100,000 live births and the urban MMR was 10.68 per 100,000 live births. The MMR showed an overall downward trend, with average annual percent change (AAPC) of \u22124.72% (95% CI: \u22125.32, \u22124.11), \u22124.03% (95% CI: \u22124.64, \u22123.41), and \u22125.49% (95% CI: \u22126.22, \u22124.75) in the total population, rural areas, and urban areas, respectively. The main causes of maternal deaths were obstetric hemorrhage (OH), hypertensive disorders of pregnancy (HDP), amniotic fluid embolism (AFE), heart disease (HD), venous thrombosis and pulmonary embolism (VTE), hepatopathy (Hep), and puerperal infection (PI). A total of 129 avoidable maternal deaths were recorded from 1991 to 2025, with a higher proportion in rural areas than in urban areas (85.27 vs. 14.73%). The main causes of avoidable deaths were Individual, Family and Community (46.51%) and Health Facility (43.41%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Some achievements had been made in Jinan in reducing MMR. Pregnant women in rural areas still faced challenges in controlling MMR. Efforts to reduce MMR, the government should take comprehensive measures to improve health awareness in rural areas and address the weak rescue capacity of rural hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1830524","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:44:41Z","timestamp":1779169481000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Urban-rural disparities in the trends and causes of maternal deaths in Jinan, 1991\u20132025: a longitudinal trend analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiaoxia","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Gynecology, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University","place":["Jinan, 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