Peer-reviewed article
Socioeconomic differences in perinatal health outcomes: perinatal health surveillance through a health-equity prism
Smith L, Farr A, Zurriaga O, Cuttini M, Verdenik I et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how socioeconomic status affects perinatal health outcomes across 17 European countries using routine birth data from 2015 to 2020. Mothers with lower education levels had worse outcomes for preterm birth, stillbirth, and neonatal death, with risk ratios typically 1.5 to 3 times higher than advantaged groups. Caesarean delivery rates showed inconsistent patterns across countries, with some showing higher rates among disadvantaged groups and others showing the reverse. The findings demonstrate that European countries can monitor socioeconomic inequalities in perinatal health, though data collection methods vary considerably.
Key points
- Lower maternal education was associated with preterm birth, stillbirth, and neonatal death, with risk ratios between 1.5 and 3.0 comparing most to least disadvantaged groups
- 17 countries provided education-based data, 5 provided area-based deprivation data, and 1 provided occupation-based data
- Caesarean delivery rates showed reversed gradients between countries: higher in advantaged groups in Croatia, Latvia, Lithuania and Spain, but higher in disadvantaged groups in Denmark, Luxembourg, the Netherlands and Italy
- Different countries used different socioeconomic indicators (maternal education, parental occupation, area-based deprivation), limiting comparability
- The study demonstrates the feasibility of monitoring perinatal health inequalities through existing routine data systems across Europe
Limitations
The study cannot explain the causes of observed socioeconomic inequalities or determine why caesarean delivery gradients differ between countries. The variation in SES measurement approaches across countries limits the strength of cross-country comparisons.
Abstract
Abstract Background Socioeconomic status (SES) is strongly associated with perinatal health outcomes, perpetuating intergenerational health inequalities. Our aim was to assess the utility of population data in Europe to monitor social inequalities in key perinatal health indicators. Methods Using the PHIRI federated analysis protocol to aggregate routine birth data from across Europe, we collected data on selected perinatal health indicators by SES from 2015 to 2020. Mothers’ education level (primary/lower secondary; upper secondary; postsecondary) was the preferred SES indicator; if unavailable, parents’ occupation or area-based deprivation scores were provided. The International Standard Classification of Occupations was used to group parents’ occupations into 4 categories, while area-based deprivation scores were measured in quintiles. For each country, we calculated risk ratios (RR) for preterm birth, stillbirth, neonatal death and caesarean delivery (CD) comparing the most with the least disadvantaged group Results 17 countries provided data on maternal education, 5 on area-based deprivation, 1 on parents’ occupation and 2 could not provide data. For preterm birth, stillbirth and neonatal death, lower SES was associated with worse outcomes with most RR between lowest and highest groups in the range of 1.5 to 3.0. In contrast, in some countries, such as Croatia, Latvia, Lithuania and Spain, CD rates were higher for socially advantaged groups whereas the gradient was reversed in others (Denmark, Luxembourg, the Netherlands and Italy). Conclusions European countries can provide perinatal health indicators by SES, revealing marked socioeconomic inequalities in perinatal health. The differing SES gradient between countries for CD raise questions about care organization and clinical practice. Further exploration of the harmonization of differing SES measure across countries is required, while countries that do not monitor SES data should aim to improve existing systems.