Socioeconomic disparities in changes to preterm birth and stillbirth rates during the first year of the COVID-19 pandemic: a study of 21 European countries
Author:
Zeitlin Jennifer1ORCID, Philibert Marianne1, Barros Henrique2ORCID, Broeders Lisa3, Cap Jan4, Draušnik Željka5ORCID, Engjom Hilde6, Farr Alex7, Fresson Jeanne8, Gatt Miriam9, Gissler Mika1011ORCID, Heller Günther12, Isakova Jelena13, Källén Karin14, Kyprianou Theopisti15, Loghi Marzia16, Monteath Kirsten1718, Mortensen Laust1920, Rihs Tonia21, Sakkeus Luule22, Sikora Izabela23, Szamotulska Katarzyna24, Velebil Petr2526, Verdenik Ivan27, Weber Guy28, Zile Irisa29, Zurriaga Oscar303132, Smith Lucy33, , Klimont Jeannette, Farr Alex, Alexander Sophie, Delnord Marie, Racapé Judith, Vandervelpen Gisèle, Zhang Wei-Hong, Kolarova Rumyana, Jordanova Evelin, Dimnjakovic Jelena, Draušnik Željka, Rodin Urelija, Kyprianou Theopisti, Scoutellas Vasos, Jirova Jitka, Velebil Petr, Hansen Anne Vinkel, Mortensen Laust Hvas, Abuladze Liili, Sakkeus Luule, Gissler Mika, Heino Anna, Amyx Melissa, Blondel Béatrice, Chantry Anne, Tharaux Catherine Deneux, Durox Mélanie, Fresson Jeanne, Hocquette Alice, Philibert Marianne, Vilain Annick, Zeitlin Jennifer, Bon Dimitra, Heller Günther, Misselwitz Björn, Antsaklis Aris, Sziller István, Eiríksdóttir Védís Helga, Gunnarsdóttir Jóhanna, Ólafsdóttir Helga Sól, Kearns Karen, Sikora Izabela, Boldrini Rosaria, Cuttini Marina, Donati Serena, Loghi Marzia, Pappagallo Marilena, Misins Janis, Zile-Velika Irisa, Gaidelyte Rita, Isakova Jelena, Billy Audrey, Lecomte Aline, Pastore Jessica, Weber Guy, Gatt Miriam, Achterberg Peter, Broeders Lisa, Hindori-Mohangoo Ashna, Nijhuis Jan, Akerkar Rupali, Engjom Hilde, Klungsøyr Kari, Mierzejewska Ewa, Szamotulska Katarzyna, Barros Henrique, Rodrigues Carina, Budianu Mihaela-Alexandra, Cucu Alexandra, Horga Mihai, Puscasiu Lucian, Sandu Petru, Tica Vlad, Cáp Ján, Lucovnik Miha, Verdenik Ivan, Alcaide Adela Recio, Fernández-Elorriaga María, Jané Mireia, Vidal Maria José, Zurriaga Óscar, Källén Karin, Nyman Anastasia, Rihs Tonia, Anderson Diane, Clarke Samantha, McConnell Hannah, Macfarlane Alison, Magill Sinead, Monteath Kirsten, Morgan Siobhán, Murphy Joanne, Piper Mark, Scott Sonya, Smith Lucy, Thomas Craig, Williams Martin, Habl Claudia, Pries Cara, Pentz Richard, Mathis-Edenhofer Stefan, Schmidt Andrea, Grabenhofer-Eggerth Alexander, Weiss Johannes, Sagerschnig Sophie, Gottlob Anita, Dolanski Lorenz, Degelsegger-Marquez Alexander, Gruber Beate, Habimana Katharana, Bogaert Petronille, Delnord Marie, Schutte Nienke, Vyncke Kim, Krzywania Tadek, Abboud Linda, Saso Miriam, Devleesschauwer Brecht, de Lizoreux Barthélémy Moreau, Derycke Pascal, Daubresse Pierre, Milbeck Sasha, De Ridder Karin, Van de Catsyne Charles-Andrew, Lagarija Sejla Cilovic, Chileva Anina, Dimnjakovic Jelena, Vukovic Jakov, Dankova Sarka, Májek Ondrej, Vorobjov Sigrid, Idavain Jane, Rätsep Merika, Tolonen Hanna, Mäkinen Mari, Gissler Mika, Zeitlin Jennifer, Philibert Marianne, Carcaillon-Bentata Laure, Haneef Romana, Makovski Tatjana, Thißen Martin, Seeling Stefanie, Fehr Angela, Ziese Thomas, Georgakopoulou Christina, Petelos Elena, Lionis Christog, Lingri Dimitra, Kornél Tóth, Töll Ágnes, Bezzegh Peter, Csizmadia István, Láng Róbert, Csaba Kiss, Cahill Alan, Courtney Michael, White Pauline, Ailish Kelly, Clarke Patricia, Kappala Sharon, Smyth Breda, Palmieri Luigi, Unim Brigid, Faragalli Andrea, Misins Janis, Zile Irisa, Zelviene Ausra, Astrauskiené Audronè, Weber Guy, Buttigieg Dorita, Calleja Neville, Lozan Oleg, Gramme Rodica, Tijhuis Mariken, Holz Daniela Moye, Hilderink Henk, Berger-Symons Linda, de Vries Marit, Haaheim Håkon, Forland Frode, Nordeng Zuzana, Larose Tricia, Strozyk Malgorzata, Maryniak Pawel, Drogon Krystyna, Węgrzyn Karolina, Wisniewski Tomasz, Paciorek Kinga, Nogueira Paulo, Bacelar-Nicolau Leonor, Santos Rodrigo Feteira, Lapão Luís, Peyroteo Mariana, Paulo Marília Silva, Montez Teresa, Dias Carlos, Gomez Veronica, Neves Lucinda Oliveira das, Peralta-Santos Andre, Sandu Petru, Gaftonie Elena Gabriela, Fekete Edit, Brinduse Lacramioara, Radulescu Silviu, Krstic Maja, Medaveric Aleksandar, Cap Jan, Zaletel Metka, Vinko Matej, Bric Tatjana Kofol, Gómez Inmaculada León, Rodriguez-Blazquez Carmen, Forjaz M João, Marin Marta, Larrauri Amparo, Ramis Rebeca, Diaz Asuncion, Angulo-Pueyo Ester, Garriga Cesar, Valero Teresa, Estupiñán Francisco, Garcia-Armesto Sandra, Bernal-Delgado Enrique, García Juan González, Azpiazu Javier Gómez-Arrue, Garces Ramon Launa, López-Cuadrado Teresa, Launag Ramón, Telleria Carlos, Seral Meriam, Angulo-Pueyo Ester, Syden Lovisa, Akbari Ashley, Lyons Ronan, Aldridge Sarag
Affiliation:
1. Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOpé), Centre for Research in Epidemiology and Statistics (CRESS), INSERM, INRAE, Paris Cité University , Paris, France 2. EPIUnit, University of Porto , Porto, Portugal 3. The Netherlands Perinatal Registry (Perined) , Utrecht, Netherlands 4. National Health Information Center , Bratislava, Slovakia 5. Division of Public Health, Croatian Institute of Public Health , Zagreb, Croatia 6. Division of Mental and Physical Health, Norwegian Institute of Public Health , Bergen, Norway 7. Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna , Vienna, Austria 8. Department for Research, Studies, Assessment and Statistics (DREES), French Ministry of Health , Paris, France 9. National Obstetric Information System, Directorate for Health Information and Research , Pieta, Malta 10. Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare , Helsinki, Finland 11. Institute of Molecular Medicine and Surgery, Karolinska Institute , Stockholm, Sweden 12. Social Data Department, Institute for Quality Assurance and Transparency in Healthcare (IQTIG) , Berlin, Germany 13. Health Statistics Department, Health Information Centre, Institute of Hygiene , Vilnius, Lithuania 14. Department of Evaluation and Analysis, Epidemiology and Methodological Support Unit, Karolinska Institute , Stockholm, Sweden 15. Health Monitoring Unit, Ministry of Health , Nicosia, Cyprus 16. Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT) , Rome, Italy 17. Information Services Division, Public Health Scotland , Edinburgh, UK 18. Department of Child Life and Health, University of Edinburgh , Edinburgh, UK 19. Department of Public Health, University of Copenhagen , Copenhagen, Denmark 20. Denmark Statistics , Copenhagen, Denmark 21. Federal Statistical Office (FSO) , Neuchâtel, Switzerland 22. Estonian Institute for Population Studies, Tallinn University , Tallinn, Estonia 23. The National Perinatal Reporting System, Health Pricing Office , Dublin, Ireland 24. Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child , Warsaw, Poland 25. Institute for the Care of Mother and Child , Prague, Czechia 26. 3rd Faculty of Medicine, Charles University , Prague, Czechia 27. Department of Obstetrics & Gynecology—Research Unit, University Medical Centre , Ljubljana, Slovenia 28. Department of Epidemiology and Statistics, Directorate of Health , Luxembourg, Luxembourg 29. The Centre for Disease Prevention and Control of Latvia , Riga, Latvia 30. Public Health General Directorate, Valencia Regional Public Health Authority , Valencia, Spain 31. Public Health and Preventive Medicine Department, University of Valencia , Valencia, Spain 32. Centre for Network Biomedical Research in Epidemiology and Public Health (CIBERESP) , Madrid, Spain 33. Department of Health Sciences, College of Life Sciences, University of Leicester , Leicester, UK
Abstract
Abstract
Background
Despite concerns about worsening pregnancy outcomes resulting from healthcare restrictions, economic difficulties and increased stress during the COVID-19 pandemic, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth rates appeared stable. Like other shocks, the pandemic may have exacerbated existing socioeconomic disparities in pregnancy, but this remains to be established. Our objective was to investigate changes in PTB and stillbirth by socioeconomic status (SES) in European countries.
Methods
The Euro-Peristat network implemented this study within the Population Health Information Research Infrastructure (PHIRI) project. A common data model was developed to collect aggregated tables from routine birth data for 2015–2020. SES was based on mother’s educational level or area-level deprivation/maternal occupation if education was unavailable and harmonized into low, medium and high SES. Country-specific relative risks (RRs) of PTB and stillbirth for March to December 2020, adjusted for linear trends from 2015 to 2019, by SES group were pooled using random effects meta-analysis.
Results
Twenty-one countries provided data on perinatal outcomes by SES. PTB declined by an average 4% in 2020 {pooled RR: 0.96 [95% confidence intervals (CIs): 0.94–0.97]} with similar estimates across all SES groups. Stillbirths rose by 5% [RR: 1.05 (95% CI: 0.99–1.10)], with increases of between 3 and 6% across the three SES groups, with overlapping confidence limits.
Conclusions
PTB decreases were similar regardless of SES group, while stillbirth rates rose without marked differences between groups.
Funder
European Union’s Horizon 2020 research and innovation programme
Publisher
Oxford University Press (OUP)
|
|