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Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study
OBJECTIVES: To investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk. DESIGN: Population-based perinatal mortality surveillance linked to national birth and death registration (Mothers and Babies: Reducing Risk through Audi...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968514/ https://www.ncbi.nlm.nih.gov/pubmed/35264402 http://dx.doi.org/10.1136/bmjopen-2021-057412 |
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author | Matthews, Ruth J Draper, Elizabeth S Manktelow, Bradley N Kurinczuk, Jennifer J Fenton, Alan C Dunkley-Bent, Jacqueline Gallimore, Ian Smith, Lucy K |
author_facet | Matthews, Ruth J Draper, Elizabeth S Manktelow, Bradley N Kurinczuk, Jennifer J Fenton, Alan C Dunkley-Bent, Jacqueline Gallimore, Ian Smith, Lucy K |
author_sort | Matthews, Ruth J |
collection | PubMed |
description | OBJECTIVES: To investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk. DESIGN: Population-based perinatal mortality surveillance linked to national birth and death registration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). SETTING: UK. PARTICIPANTS: 4 391 569 singleton births at ≥24(+0) weeks gestation between 2014 and 2019. MAIN OUTCOME MEASURES: Stillbirth rate difference per 1000 total births by ethnicity. RESULTS: Adjusted absolute differences in stillbirth rates were higher for babies of black African (3.83, 95% CI 3.35 to 4.32), black Caribbean (3.60, 95% CI 2.65 to 4.55) and Pakistani (2.99, 95% CI 2.58 to 3.40) ethnicities compared with white ethnicities. Higher proportions of babies of Bangladeshi (42%), black African (39%), other black (39%) and black Caribbean (37%) ethnicities were from most deprived areas, which were associated with an additional risk of 1.50 stillbirths per 1000 births (95% CI 1.32 to 1.67). Exploring primary cause of death, higher stillbirth rates due to congenital anomalies were observed in babies of Pakistani, Bangladeshi and black African ethnicities (range 0.63–1.05 per 1000 births) and more placental causes in black ethnicities (range 1.97 to 2.24 per 1000 births). For the whole population, over 40% of stillbirths were of unknown cause; however, this was particularly high for babies of other Asian (60%), Bangladeshi (58%) and Indian (52%) ethnicities. CONCLUSIONS: Stillbirth rates declined in the UK, but substantial excess risk of stillbirth persists among babies of black and Asian ethnicities. The combined disadvantage for black, Pakistani and Bangladeshi ethnicities who are more likely to live in most deprived areas is associated with considerably higher rates. Key causes of death were congenital anomalies and placental causes. Improved strategies for investigation of stillbirth causes are needed to reduce unexplained deaths so that interventions can be targeted to reduce stillbirths. |
format | Online Article Text |
id | pubmed-8968514 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-89685142022-04-20 Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study Matthews, Ruth J Draper, Elizabeth S Manktelow, Bradley N Kurinczuk, Jennifer J Fenton, Alan C Dunkley-Bent, Jacqueline Gallimore, Ian Smith, Lucy K BMJ Open Obstetrics and Gynaecology OBJECTIVES: To investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk. DESIGN: Population-based perinatal mortality surveillance linked to national birth and death registration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). SETTING: UK. PARTICIPANTS: 4 391 569 singleton births at ≥24(+0) weeks gestation between 2014 and 2019. MAIN OUTCOME MEASURES: Stillbirth rate difference per 1000 total births by ethnicity. RESULTS: Adjusted absolute differences in stillbirth rates were higher for babies of black African (3.83, 95% CI 3.35 to 4.32), black Caribbean (3.60, 95% CI 2.65 to 4.55) and Pakistani (2.99, 95% CI 2.58 to 3.40) ethnicities compared with white ethnicities. Higher proportions of babies of Bangladeshi (42%), black African (39%), other black (39%) and black Caribbean (37%) ethnicities were from most deprived areas, which were associated with an additional risk of 1.50 stillbirths per 1000 births (95% CI 1.32 to 1.67). Exploring primary cause of death, higher stillbirth rates due to congenital anomalies were observed in babies of Pakistani, Bangladeshi and black African ethnicities (range 0.63–1.05 per 1000 births) and more placental causes in black ethnicities (range 1.97 to 2.24 per 1000 births). For the whole population, over 40% of stillbirths were of unknown cause; however, this was particularly high for babies of other Asian (60%), Bangladeshi (58%) and Indian (52%) ethnicities. CONCLUSIONS: Stillbirth rates declined in the UK, but substantial excess risk of stillbirth persists among babies of black and Asian ethnicities. The combined disadvantage for black, Pakistani and Bangladeshi ethnicities who are more likely to live in most deprived areas is associated with considerably higher rates. Key causes of death were congenital anomalies and placental causes. Improved strategies for investigation of stillbirth causes are needed to reduce unexplained deaths so that interventions can be targeted to reduce stillbirths. BMJ Publishing Group 2022-01-24 /pmc/articles/PMC8968514/ /pubmed/35264402 http://dx.doi.org/10.1136/bmjopen-2021-057412 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Obstetrics and Gynaecology Matthews, Ruth J Draper, Elizabeth S Manktelow, Bradley N Kurinczuk, Jennifer J Fenton, Alan C Dunkley-Bent, Jacqueline Gallimore, Ian Smith, Lucy K Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study |
title | Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study |
title_full | Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study |
title_fullStr | Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study |
title_full_unstemmed | Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study |
title_short | Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study |
title_sort | understanding ethnic inequalities in stillbirth rates: a uk population-based cohort study |
topic | Obstetrics and Gynaecology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968514/ https://www.ncbi.nlm.nih.gov/pubmed/35264402 http://dx.doi.org/10.1136/bmjopen-2021-057412 |
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