Regional Disparities in Stillbirth Rates in France in 2012–2013.

Stillbirth and perinatal mortality rates are essential data for monitoring and guiding perinatal policies at both the national and regional levels. Various studies have identified certain risk factors for stillbirth and the role of social determinants. In France, in 2007, the stillbirth rate was 9.3 per 1,000. However, since 2008, monitoring this rate has no longer been possible due to changes in civil registration procedures. The use of hospital medical-administrative databases (PMSI) makes it possible to recalculate the stillbirth rate according to the thresholds recommended by the World Health Organization. Furthermore, stillbirths can be broken down into spontaneous stillbirths and induced stillbirths (medical terminations of pregnancy). This article focuses on a study conducted over two cumulative years (2012 and 2013) to obtain a sufficient number of births at the regional level to allow for statistical analysis. It was based on the delivery outcome codes listed in the mothers’ hospital discharge summaries. On average, in 2012–2013, the overall crude stillbirth rate stood at 8.9 per 1,000 total births. Variations between regions were significant, with the highest rates observed in the French departments of the Americas (DFA), at 16.3 per 1,000, and in Réunion (11.4 per 1,000). Spontaneous stillbirths amounted to 5.3 per 1,000. The total stillbirth rate varied according to gestational age, maternal age, or multiple birth status. Analysis of regional disparities showed no association between regional stillbirth rates and the proportions of preterm births, births to mothers of extreme ages, or twin births. Regional spontaneous stillbirth rates were compared after adjusting for gestational age, multiple births, and maternal age at delivery, for both singleton and twin births on the one hand, and for singleton births alone on the other, using the Île-de-France region as a reference. The results confirm notably higher rates in the DFA and Lorraine regions, and lower rates in Languedoc-Roussillon and the Pays-de-la-Loire region. The PMSI enables the monitoring of stillbirths by taking into account the mothers’ age, the number of fetuses, and gestational age at the time of delivery, and thus appears capable of producing reliable data on regional disparities in stillbirth rates.

Author(s): Mouquet MC, Rey S

Publishing year: 2015

Pages: 92-101

Weekly Epidemiological Bulletin, 2015, n° 6-7, p. 92-101

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