Living in deprived urban districts increases perinatal health inequalities

Abstract

Objective: Analyses of the effects of place of residence, socioeconomic status and ethnicity on perinatal mortality and morbidity in the Netherlands. Methods: Epidemiological analysis of all singleton deliveries > 22 gestational weeks (871,889 live born and 5927 stillborn) from the Dutch National Perinatal Registry 2002–2006. Multiple logistic regression analysis was used to determine whether place of residence (deprived neighborhood, or not) contributed to the adverse perinatal outcome (defined as perinatal mortality, preterm birth, small for gestational age, congenital abnormalities or Apgar score <7, 5 min after birth), additional to individual pregnancy characteristics, demographic characteristics, ethnic background and socioeconomic class. Results: Incidence of adverse perinatal outcome was 16.7%. After adjustment the excess risk for perinatal mortality in deprived districts was 21%, for preterm birth 16%, for small-for-gestational age 11%, and for Apgar score <7 after 5 min 11%. Conclusions: Perinatal inequalities appear impressive in both urban and nonurban areas, with a significant additive risk of living in a deprived neighborhood. Excess risk for perinatal mortality generally outranges that for morbidity, suggesting both an etiological and prognostic pathway for neighborhood effects. A distinct pattern exists for congenital anomalies, for which first trimester adverse selection effects may be responsible.

Keywords::

• Deprived neighborhood
• ethnicity
• perinatal inequalities
• perinatal morbidity
• perinatal mortality
• place of residence
• socioeconomic status

Acknowledgments

The national data on perinatal outcome were kindly provided by the Netherlands Perinatal Registry. (Request number: 0866). All authors approved the final version of the manuscript. Guarantor: Erasmus MC. Contributors of the paper are Johanna P de Graaf participated in the study design, interpretation of results and manuscript writing. Anita C. J. Ravelli participated in the study design, performed the primary data analysis, and participated in the interpretations of the results and revision of the draft version. Marij A. M. de Haan participated in the interpretation of results and the manuscript writing. Eric A. P. Steegers codeveloped the core idea and participated in the study design, analyses and interpretation of results and manuscript writing. Gouke J. Bonsel developed the core idea, developed the study design and participated in data analysis, interpretation of results, and manuscript writing.

Declaration of Interest: The authors report no conflicts of interest.

Appendix

Perinatal outcome per 1000 births to C4 and ethnic origin (Western [W] and non-Western [NW]).

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