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Stillbirth in Greece during the years of economic crisis: a population-based study

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Abstract

The recent economic crisis has been linked with declines in population health. Evidence on the impact of the crisis on stillbirth rates is scarce. The aim of this study was to assess trends of stillbirth rates in Greece during the pre-crisis (2004–2008) and crisis period (2009–2015) and explore risk factors. Nationwide data (n = 1,276,816 births; 5023 stillbirths) were used to assess rates and trends through Poisson and joinpoint regressions. Multivariable Poisson regressions by nationality were fitted. The overall annual stillbirth rate was 3.9/1000 births with higher rates among non-Greeks (5.0/1000) than Greeks (3.7/1000). Non-significant decreasing trends were noted for Greeks (− 0.5%, 95% confidence interval [CI] − 1.4, 0.4%) versus non-significant increasing trends in non-Greeks (1.4%, 95% CI − 0.5, 3.3%). After adjusting for possible confounders, the relative stillbirth risk (RR) increased during the crisis versus the pre-crisis period (RRGreeks 1.61, 95% CI 1.50, 1.74; RRnon-Greeks 1.92, 95% CI 1.64, 2.26). Multiplicity, birth order, birth size, maternal education, marital status, and parental age were risk factors.

Conclusions: Bidirectional stillbirth trends were observed among Greeks and non-Greeks, whereas the RR increased by 2-fold during the crisis. Persisting disparities require tailored employment of preventive measures ensuring optimal quality of the child’s and maternal health.

What is Known:

• Stillbirth rate is a key population health indicator reflecting economic development and health care services within a population.

• The recent economic crisis has been linked with declines in population health.

What is New:

• Economic crisis, ethnic minorities, and several modifiable factors seem to be significant determinants of stillbirth risk.

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Abbreviations

AGA:

Appropriate for gestational age

APC:

Annual Percent Change

CI:

confidence interval

DAG:

Directed acyclic graph

ELSTAT:

Hellenic Statistical Authority

IC:

Intergrowth curve

LGA:

Large for gestational age

PARp:

Partial population attributable fraction

RR:

Relative risk

SEM:

Structural Equation Modeling

SGA:

Small for gestational age

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Acknowledgments

ELSTAT has provided individual anonymized data.

Author information

Author notes

  1. Tania Siahanidou and Maria A. Karalexi contributed equally to this work.

Authors and Affiliations

  1. First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Tania Siahanidou & George P. Chrousos

  2. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Maria A. Karalexi, Maria Kantzanou, Nick Dessypris, Christos Christodoulakis, Petros Daoutakos, Kyveli Aggelou & Eleni Th. Petridou

  3. First Obstetric and Gynaecological Department of “Alexandra” Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Loutradis

  4. Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden

    Eleni Th. Petridou

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  1. Tania Siahanidou
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Contributions

TS, MK, GC, and EP were involved in the initial conception of the study. All authors contributed to the design, analysis, and interpretation of data. MK and CC developed the first draft of the manuscript; TS, ND, PD, DL, GC, and EP critically revised the manuscript and all authors approved the final version. ND, CC, and PD performed the statistical analyses. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The corresponding author ensures that all the journal’s administrative requirements are properly completed.

Corresponding author

Correspondence to Tania Siahanidou.

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The authors declare that they have no conflict of interest.

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There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Not required. Individual-level anonymized data on all births were provided during the period 2004–2015 following personal contact and a signed agreement with ELSTAT.

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Communicated by Mario Bianchetti

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Siahanidou, T., Karalexi, M.A., Kantzanou, M. et al. Stillbirth in Greece during the years of economic crisis: a population-based study. Eur J Pediatr 179, 1157–1166 (2020). https://doi.org/10.1007/s00431-020-03588-6

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  • DOI: https://doi.org/10.1007/s00431-020-03588-6

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