Socio-Economic Inequalities in Stillbirth and Preterm Birth Rates Across Europe: A Population-Based Study

Lucy Smith; Marianne Philibert; Sonya Scott; Maria Jose Vidal Benede; Liili Abuladze; Adela Recio Alcaide; Marina Cuttini; Maria Fernandez Elorriaga; Alex Farr; Alison Macfarlane; Ewa Mierzejewska; Jan Nijhuis; Judith Racape; Jennifer Zeitlin

doi:10.1111/1471-0528.18274

Socio-Economic Inequalities in Stillbirth and Preterm Birth Rates Across Europe: A Population-Based Study

BJOG. 2025 Jul 10. doi: 10.1111/1471-0528.18274. Online ahead of print.

Authors

Affiliations

¹ Department of Population Health Sciences, College of Life Sciences, University of Leicester, UK.
² Obstetrical Perinatal and Pediatric Epidemiology, Université Paris Cité, Inserm, Paris, France.
³ Public Health Scotland, Glasgow, Scotland, UK.
⁴ Department of Health, Public Health Agency of Catalonia, Catalonia, Spain.
⁵ Estonian Institute for Population Studies, School of Governance, Law and Society, Tallinn University, Estonia.
⁶ Instituto de Estudios Fiscales, Madrid, Spain.
⁷ La Nostra Famiglia Association, Eugenio Medea Pediatric Research Hospital, Lecco, Bosisio Parini, Italy.
⁸ Faculty of Nursing, Physiotherapy, and Podiatry, Universidad Complutense de Madrid, Spain.
⁹ Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
¹⁰ Centre for Maternal and Child Health Research, School of Medical and Health Sciences, City St George's, University of London, London, UK.
¹¹ Institute of Mother and Child, Warsaw, Poland.
¹² Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, MUMC+, Maastricht, the Netherlands.
¹³ School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.

PMID: 40637057
DOI: 10.1111/1471-0528.18274

Abstract

Objective: To estimate socio-economic (SES) inequalities in stillbirth and preterm birth rates across European countries using population-based routine data.

Design: Cross-sectional study of national-level perinatal health and SES indicators (mother's education/occupation or area-level deprivation).

Setting: Twenty-four countries in the Euro-Peristat network.

Population: Seventeen million births in 2015-2019.

Methods: Rates of stillbirth, singleton very preterm birth (VPB) and singleton moderate/late preterm birth (MLPB) were derived from routine national birth data collected with a common protocol.

Main outcome measure: Percentage of excess adverse outcomes associated with SES and concentration indices.

Results: Median rates of adverse outcomes were higher in the lowest versus highest SES groups [Stillbirth: 4.9 (interquartile range (IQR):4.30-5.80)] versus 2.7 (IQR:2.25-3.14) per 1000 births; VPB: 1.0 (IQR: 0.87-1.12) versus 0.6 (IQR: 0.59-0.66) per 100 live births; MLPB: 5.8 (IQR: 5.27-6.40) versus 4.4 (IQR:4.13-4.65) per 100 live births. Excess adverse outcomes associated with lower SES varied greatly, particularly for stillbirth (range-3%, 51%) versus VPB (7%, 27%) and MLPB (5%, 20%). Concentration indices further highlighted varying socio-economic inequalities across countries. Median concentration indices were similar for countries with both lower and higher levels of adverse events, with median CIs of -0.12 for countries with both high and low levels of stillbirth.

Conclusion: We identified widespread but varying inequalities between countries. These seemed to be unrelated to the rate of adverse outcomes. This suggests the need for policy strategies directly targeted to the prevention of stillbirth and preterm birth in low SES populations. Our findings demonstrate the feasibility of monitoring inequalities internationally using routine data to identify effective action.

Keywords: preterm birth; socioeconomic inequalities; stillbirth.

Abstract

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