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

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.