Stillbirths in the United States, 1981-2000: an age, period, and cohort analysis.
OBJECTIVE
We examined age, period, and cohort (APC) effects on temporal trends in stillbirths among Black and White women in the United States.


METHODS
We conducted a cohort study of Black and White women who delivered a singleton live-born or stillborn infant during 1981 through 2000. We analyzed stillbirth rates at 20 or more weeks of gestation within 7 age groups, 4 periods, and 10 "central" birth cohorts after adjusting for confounders.


RESULTS
In both racial groups, women younger than 20 years or 35 years or older were at increased risk of stillbirth; risks decreased over successive periods in all age groups. Birth cohort had no impact on stillbirth trends among Blacks and only a small, nonsignificant effect among Whites. Analyses of various APC combinations showed that Blacks were at a 1.2- to 2.9-fold increased risk for stillbirth relative to Whites. Attributable fractions for stillbirth because of age, period, and cohort effects were 16.5%, 24.9%, and 0.1%, respectively, among Black women and 14.5%, 36.2%, and 2.1%, respectively, among White women.


CONCLUSIONS
Strong effects of age and period were observed in stillbirth trends, but these factors do not explain the persistent stillbirth disparity between Black and White women.
Ananth
Cande V
CV
Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-1977, USA. cande.ananth@umdnj.edu
Liu
Shiliang
S
Kinzler
Wendy L
WL
Kramer
Michael S
MS
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D050497:Stillbirth / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People