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Original research
Persisting inequalities in birth outcomes related to neighbourhood deprivation
  1. Loes C M Bertens1,
  2. Lizbeth Burgos Ochoa1,
  3. Tom Van Ourti2,3,
  4. Eric A P Steegers1,
  5. Jasper V Been1,4,5
  1. 1 Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  2. 2 Erasmus School of Economics, University of Rotterdam, Rotterdam, The Netherlands
  3. 3 Tinbergen Institute, Amsterdam, The Netherlands
  4. 4 Division of Neonatology, Department of Paediatrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  5. 5 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Loes C M Bertens, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; l.bertens{at}erasmusmc.nl

Abstract

Introduction Health inequalities can be observed in early life as unfavourable birth outcomes. Evidence indicates that neighbourhood socioeconomic circumstances influence health. However, studies looking into temporal trends in inequalities in birth outcomes including neighbourhood socioeconomic conditions are scarce. The aim of this work was to study how inequalities in three different key birth outcomes have changed over time across different strata of neighbourhood deprivation.

Methods Nationwide time trends ecological study with area-level deprivation in quintiles as exposure. The study population consisted of registered singleton births in the Netherlands 2003–2017 between 24 and 41 weeks of gestation. Outcomes used were perinatal mortality, premature birth and small for gestational age (SGA). Absolute rates for all birth outcomes were calculated per deprivation quintile. Time trends in birth outcomes were examined using logistic regression models. To investigate relative inequalities, rate ratios for all outcomes were calculated per deprivation quintile.

Results The prevalence of all unfavourable birth outcomes decreased over time: from 7.2 to 4.1 per 1000 births for perinatal mortality, from 61.8 to 55.6 for premature birth, and from 121.9 to 109.2 for SGA. Inequalities in all birth outcomes have decreased in absolute terms, and the decline was largest in the most deprived quintile. Time trend analyses confirmed the overall decreasing time trends for all outcomes, which were significantly steeper for the most deprived quintile. In relative terms however, inequalities remained fairly constant.

Conclusion In absolute terms, inequalities in birth outcomes by neighbourhood deprivation in the Netherlands decreased between 2003 and 2017. However, relative inequalities remained persistent.

  • birth weight
  • health inequalities
  • perinatal
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/jech-2019-213162

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    Footnotes

    • Contributors LCMB, TVO and JVB: conceived the study. All authors participated in its design. LCMB did the statistical analysis; had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; is the guarantor. All authors were involved in interpreting the findings. LBO and LCMB: drafted the manuscript. All authors reviewed, edited, and approved the final manuscript.

    • Funding This study was funded by the Erasmus Initiative Smarter Choices for Better Health.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by Perined, no further ethical approval was needed.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. However, access may be granted upon request following the procedure available at https://www.perined.nl/.

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