title: Socioeconomic inequalities in stillbirth rates in Europe: measuring the gap using routine data from the Euro-Peristat Project.
abstract: BACKGROUND
  Previous studies have shown that socioeconomic position is inversely associated with stillbirth risk, but the impact on national rates in Europe is not known. We aimed to assess the magnitude of social inequalities in stillbirth rates in European countries using indicators generated from routine monitoring systems.
  
  
  METHODS
  Aggregated data on the number of stillbirths and live births for the year 2010 were collected for three socioeconomic indicators (mothers' educational level, mothers' and fathers' occupational group) from 29 European countries participating in the Euro-Peristat project. Educational categories were coded using the International Standard Classification of Education (ISCED) and analysed as: primary/lower secondary, upper secondary and postsecondary. Parents' occupations were grouped using International Standard Classification of Occupations (ISCO-08) major groups and then coded into 4 categories: No occupation or student, Skilled/ unskilled workers, Technicians/clerical/service occupations and Managers/professionals. We calculated risk ratios (RR) for stillbirth by each occupational group as well as the percentage population attributable risks using the most advantaged category as the reference (post-secondary education and professional/managerial occupations).
  
  
  RESULTS
  Data on stillbirth rates by mothers' education were available in 19 countries and by mothers' and fathers' occupations in 13 countries. In countries with these data, the median RR of stillbirth for women with primary and lower secondary education compared to women with postsecondary education was 1.9 (interquartile range (IQR): 1.5 to 2.4) and 1.4 (IQR: 1.2 to 1.6), respectively. For mothers' occupations, the median RR comparing outcomes among manual workers with managers and professionals was 1.6 (IQR: 1.0-2.1) whereas for fathers' occupations, the median RR was 1.4 (IQR: 1.2-1.8). When applied to the entire set of countries with data about mothers' education, 1606 out of 6337 stillbirths (25 %) would not have occurred if stillbirth rates for all women were the same as for women with post-secondary education in their country.
  
  
  CONCLUSIONS
  Data on stillbirths and socioeconomic status from routine systems showed widespread and consistent socioeconomic inequalities in stillbirth rates in Europe. Further research is needed to better understand differences between countries in the magnitude of the socioeconomic gradient.
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France. Jennifer.zeitlin@inserm.fr.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Laust
authors.initials: L
authors.lastname: Mortensen
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Prunet
authors.affiliation: Centre for Maternal and Child Health Research, City University London, London, England.
authors.forename: Alison
authors.initials: A
authors.lastname: Macfarlane
authors.affiliation: Department of Child Health, TNO, Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.
authors.forename: Ashna D
authors.initials: AD
authors.lastname: Hindori-Mohangoo
authors.affiliation: THL National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Department of Epidemiology, National Research Institute of Mother and Child, Kasprzaka 17 a, 01-211, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Szamotulska
authors.affiliation: Department of Child Health, TNO, Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: van der Pal
authors.affiliation: Department of Public Health Sciences, University of Alcalá, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Bolumar
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne-Marie Nybo
authors.initials: AM
authors.lastname: Andersen
authors.affiliation: Department of Obstetrics and Gynaecology, Landspitali University Hospital, Landspitali v/ Hringbraut, Reykjavík, Iceland.
authors.forename: Helga Sól
authors.initials: HS
authors.lastname: Ólafsdóttir
authors.affiliation: Perinatal Epidemiology and Reproductive Health Unit, Epidemiology, Biostatistics and Clinical Research Centre, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Zhang
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Blondel
authors.affiliation: Perinatal Epidemiology and Reproductive Health Unit, Epidemiology, Biostatistics and Clinical Research Centre, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Sophie
authors.initials: S
authors.lastname: Alexander
mesh_terms: D000328:Adult; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005220:Fathers / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth / Q000453:epidemiology; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D009790:Occupations / Q000706:statistics & numerical data; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*
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