title: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. j.degraaf@erasmusmc.nl
authors.forename: Johanna P
authors.initials: JP
authors.lastname: de Graaf
authors.forename: Anita C J
authors.initials: AC
authors.lastname: Ravelli
authors.forename: Marij A M
authors.initials: MA
authors.lastname: de Haan
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
mesh_terms: D000013:Congenital Abnormalities / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D007236:Infant, Small for Gestational Age; D008507:Medically Underserved Area; D009426:Netherlands / Q000453:epidemiology; D018743:Perinatal Care; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D012307:Risk Factors; D012923:Social Class; D019037:Urban Health Services