Ethnic differences in stillbirth and early neonatal mortality in The Netherlands

• Published in: Journal of epidemiology and community health (1979) 2011-08, Vol.65 (8), p.696-701
• Main Authors: Ravelli, A C J, Tromp, M, Eskes, M, Droog, J C, van der Post, J A M, Jager, K J, Mol, B W, Reitsma, J B
• Format: Article
• Language: English
• Subjects: access to health care; Adult; Age; Biological and medical sciences; Birth weight; Cohort Studies; Cultural differences; demography; Epidemiology; Ethnic groups; ethnic minorities SI; Ethnicity; Female; General aspects; Health Behavior; Health risks; Humans; Infant Mortality - ethnology; Infant, Newborn; late in care; Life tables; Logistic Models; Medical sciences; Minority & ethnic groups; Miscellaneous; Mortality; Mortality - ethnology; Mortality - trends; Mortality risk; mortality SI; Neonatal mortality; Neonates; Netherlands - epidemiology; perinatal epidemiology; Perinatal mortality; Predisposing factors; Pregnancy; Pregnancy Complications; Premature birth; prenatal experience; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registries; Research Report; Risk Factors; Social Class; social differences; Socioeconomic status; Socioeconomics; stillbirth; Stillbirth - ethnology; Womens health; Young Adult
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2009.095406

BackgroundEthnic disparities in perinatal mortality are well known. This study aimed to explore the contribution of demographic, socioeconomic, health behavioural and pre-existent medical risk factors among different ethnic groups on fetal and early neonatal mortality.MethodsWe assessed perinatal mortality from 24.0 weeks' gestation onwards in 554 234 singleton pregnancies of nulliparous women in the linked Netherlands Perinatal Registry over the period 2000–2006. Logistic regression modelling was used.ResultsConsiderable ethnic differences in perinatal mortality exist especially in fetal mortality. Maternal age, socioeconomic status and pre-existent diseases could not explain these ethnic differences. Late booking visit could explain some differences. Compared with the Dutch, African women had an increased fetal mortality risk of OR 1.7 (95% CI 1.4 to 2.1); South Asian women, 1.8 (1.4 to 2.3); other non-Western women, 1.3 (1.1 to 1.6) and Turkish/Moroccan women, 1.3 (1.1 to 1.4). The risk on early neonatal mortality was only increased in other non-Western women, OR 1.3 (1.0 to 1.8). Ethnic differences were even present in the women without risk factors including preterm births. Mortality risk for East Asian and other Western women was lower or comparable with the Dutch.ConclusionImportant ethnic differences in fetal mortality exist, especially among women of African and South Asian origin. Ethnic minorities should be more acquainted with the significance of early start of prenatal care. Tailored prenatal care for women with African and South Asian origin seems necessary. More research on underlying cause of deaths is needed by ethnic group.