title: Educational inequality in stillbirth: temporal trends in Québec from 1981 to 2009.
abstract: OBJECTIVE
  Educational inequality in stillbirth has been documented in high-income countries and the province of Québec, Canada, but temporal trends are poorly understood. Our objective was to determine time trends in inequality related to maternal education for all-cause and cause-specific stillbirth over the past three decades in Québec.
  
  
  METHODS
  We included 2,397,971 live births and 9,983 stillbirths from 1981 through 2009 using Québec vital statistics. For each decade, we computed measures of inequality capturing relative (relative index of inequality, RII) and absolute (slope index of inequality, SII) differences between the least- and most-educated mothers for all-cause and cause-specific stillbirth, adjusting for maternal characteristics.
  
  
  RESULTS
  Stillbirth rates decreased over time for all education levels. Absolute educational inequality (SII 2.5 per 1000 births, 95% CI 2.1-2.8; all periods combined) was stable over time, whereas relative inequality increased (RII(1981-1989) 1.8 vs. RII(2000-2009) 2.3). Absolute inequality decreased for stillbirths caused by placental abruption (SII(1981-1989) 0.6 vs. SII(2000-2009) 0.3), but increased for unspecified causes (SII(1981-1989) 0.2 vs. SII(2000-2009) 0.7).
  
  
  CONCLUSIONS
  Absolute educational inequality in stillbirth persisted and relative inequality increased over the past three decades, despite an overall decrease in stillbirth rates. The decrease in absolute inequality for placental abruption was countered by an increase for unspecified causes. A better understanding of the underlying components of unspecified causes is needed to further address educational inequality in stillbirth.
authors.affiliation: Department of Social and Preventive Medicine, University of Montréal, Montréal, QC.
authors.forename: Noémie
authors.initials: N
authors.lastname: Savard
authors.forename: Nathalie
authors.initials: N
authors.lastname: Auger
authors.forename: Alison L
authors.initials: AL
authors.lastname: Park
authors.forename: Ernest
authors.initials: E
authors.lastname: Lo
authors.forename: Jérôme
authors.initials: J
authors.lastname: Martinez
mesh_terms: D000328:Adult; D002423:Cause of Death / Q000639:trends*; D003644:Death Certificates; D004522:Educational Status; D005260:Female; D006801:Humans; D009035:Mothers / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult
keywords: Cause of death; educational status; fetal death; socioeconomic factors; stillbirth; temporal; trend