title: Stillbirth rates among Indigenous and non-Indigenous women in Queensland, Australia: is the gap closing?
abstract: OBJECTIVE
  To determine whether the disparity gap is closing between stillbirth rates for Indigenous and non-Indigenous women and to identify focal areas for future prevention efforts according to gestational age and geographic location.
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  Queensland, Australia.
  
  
  METHODS
  All singleton births of at least 20 weeks of gestation or at least 400 g birthweight.
  
  
  METHODS
  Routinely collected data on births were obtained for the period 1995 to 2011. Indigenous and non-Indigenous stillbirth rates and percent reduction in the gap were compared over time and by geographic location and gestational age.
  
  
  METHODS
  All-cause and cause-specific stillbirth rates (per 1000 ongoing pregnancies).
  
  
  RESULTS
  Over the study period there was a 57.3% reduction in the disparity gap. Although marked reductions in the gap were shown for women in regional (57.0%) and remote (56.1%) locations, these women remained at increased risk compared with those in urban regions. There was no reduction for term stillbirths. Major conditions contributing to the disparity were maternal conditions (diabetes) (relative risk [RR] 3.78, 95% confidence intervals [95% CI] 2.59-5.51), perinatal infection (RR 3.70, 95% CI 2.54-5.39), spontaneous preterm birth (RR 3.08, 95% CI 2.51-3.77), hypertension (RR 2.22, 95% CI 1.45-3.39), fetal growth restriction (RR 1.78, 95% CI 1.17-2.71) and antepartum haemorrhage (RR 1.58, 95% CI 1.13-2.22).
  
  
  CONCLUSIONS
  The gap in stillbirth rates between Indigenous and non-Indigenous women is closing, but Indigenous women continue to be at increased risk due to a number of potentially preventable conditions. There is little change in the gap at term gestational ages.
authors.affiliation: Translating Research Into Practice (TRIP) Centre, Mater Research Institute-University of Queensland, Brisbane, Qld, Australia.|School of Population Health, University of Queensland, Brisbane, Qld, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Ibiebele
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Vic., Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
authors.forename: M
authors.initials: M
authors.lastname: Coory
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Qld, Australia.|Australia and New Zealand Stillbirth Alliance, Brisbane, Qld, Australia.
authors.forename: F M
authors.initials: FM
authors.lastname: Boyle
authors.affiliation: Queensland Maternal and Perinatal Quality Council, Brisbane, Qld, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Humphrey
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Qld, Australia.|Queensland Health Metro North Brisbane Public Health Unit, Brisbane, Qld, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Vlack
authors.affiliation: Translating Research Into Practice (TRIP) Centre, Mater Research Institute-University of Queensland, Brisbane, Qld, Australia.|Australia and New Zealand Stillbirth Alliance, Brisbane, Qld, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Flenady
mesh_terms: D002490:Central Nervous System / Q000002:abnormalities; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D054624:Health Status Disparities; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007239:Infections / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D014599:Uterus / Q000002:abnormalities; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Aboriginal and Torres Strait Islander; cause of death; fetal death; indigenous; stillbirth; trends; urban