Skip to main content
SpringerLink
Log in

Social inequalities in perinatal mortality in a Southern European city

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

The objective of this study was to describe and explain inequalities in perinatal mortality by educational level and occupational social class in Barcelona for the years 1993–1997. This was a case–control study. Cases were singleton perinatal deaths, controls were singleton live births obtained from a 2% random sample of births. The association among educational level, social class, other confounding and explanatory variables and perinatal mortality was studied through crude and adjusted odds ratios (OR) obtained by logistic regression. The study comprised 423 cases and 1032 controls. The model with mother's age and educational level showed that women with primary education had an OR of 1.75 (95% CI: 1.26–2.42), this association disappearing when explanatory variables were included. We also found inequalities by educational level in fetal mortality. These results point out the need to improve the living conditions, behavioural factors and also the management of pregnancy, labour and the health care of the newborn of these mothers with greater risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Cnattingius S, Haglund B. Socioeconomic factors and feto-infant mortality. Scand J Soc Med 1992; 20: 11–13.

    Google Scholar 

  2. Dunn PM. Major ethical problems confronting perinatal care around the world. Int J Gynecol Obst 1995; 51: 205–210.

    Google Scholar 

  3. Ferrando J, Borrell C, Ricart M, Plasència A. Infradeclaración de la mortalidad perinatal: la experiencia de 10 años de vigilancia activa en Barcelona. (Undereporting of perinatal mortality: 10 years of experience of active surveillance in Barcelona). Med Clin (Barc) 1997; 108: 330–335.

    Google Scholar 

  4. Revert M, Rué M, Moreno C, et al. Análisis del ingrarregistro de la mortalidad perinatal y sus factores asociados en una región sanitaria de Cataluña (Undereporting of perintalal mortality and associated factors in one health region of Catalonia, Spain). Gac Sanit 1998; 12: 63–70.

    Google Scholar 

  5. Mosquera C, González M. Calidad del registro de muertes perinatales (Quality of perinatal death registry). Gac Sanit 1994; 8: 112–116.

    Google Scholar 

  6. Lardelli P, Masa J, Maderuelo A, Delgado M, Gálvez R. Infant, neonatal, postneonatal and perinatal mortality in Spain, 1975-1984. Interregional and interannual differences. Soc Sci Med 1991; 33: 613–620.

    Google Scholar 

  7. Lardelli P, Blanco JI, Delgado M, Bueno A, Luna JD, Gálvez R. Influence of socioeconomic and health care development on infant and perinatal mortality in Spain 1975-1986. J Epidemiol Comm Health 1993; 47: 260–264.

    Google Scholar 

  8. Domínguez-Berjón MF, Benach J, García-Arcal D, Borrell C. Infant and perinatal mortality in Spain 1981-1991: Interprovincial variations in Autonomous Communities with extreme economic levels. Eur J Epidemiol 1999; 15: 723–729.

    Google Scholar 

  9. Borrell C, Pasarín MI. The study of social inequalities in Spain: Where are we? J Epidemiol Comm Health 1999; 53: 388–389.

    Google Scholar 

  10. La salut a Barcelona 1997. L'experiència de 15 anys d'informes de salut a Barcelona. (Health in Barcelona. The experience of 15 years of health reports in Barcelona). Barcelona: Institut Municipal de Salut Pública, 1999.

    Google Scholar 

  11. OPS/OMS. Clasificación Internacional de Enfermedades, 9ª Revisión. Washington, OMS, 1975.

    Google Scholar 

  12. Salvador J, García-Miñaur S, Caballín MR, et al. Registros poblacionales de defectos congénitos en España. (Population registers of congenital defects in Spain). Anal Esp Ped 1998; 48: 575–582.

    Google Scholar 

  13. Domingo A, Marcos J. Propuesta de un indicador de la ‘clase social’ basado en la ocupación. (An indicator of social class based on occupation). Gac Sanit 1989; 3: 320–326.

    Google Scholar 

  14. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley & Sons Inc., 1989.

    Google Scholar 

  15. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.

    Google Scholar 

  16. Forssas E, Gissler M, Sihvonen M, Hemminki E. Maternal predictors of perinatal mortality: The role of birtweight. Int J Epidemiol 1999; 28: 475–478.

    Google Scholar 

  17. Shoham-Yakubovich I, Barell V. Maternal education as a modifier of the association between low birthweight and infant mortality. Int J Epidemiol 1988; 17: 370–377.

    Google Scholar 

  18. Olsen O, Madsen M. Effects of maternal education on infant mortality and stillbirths in Denmark. Scand J Public Health 1999; 2: 128–136.

    Google Scholar 

  19. Little RE, Weinberg CR. Risk factors for antepartum and intrapartum stillbirth. Am J Epidemiol 1993; 137: 1177–1189.

    Google Scholar 

  20. Arntzen A, Magnus P, Bakketeig LS. Different effects of maternal and paternal education on early mortality in Norway. Paediatr Perinat Epidemiol 1993; 7: 376–386.

    Google Scholar 

  21. Stoltenberg C, Magnus P, Lie RT, Daltveit AK, Irgens LM. Influence of consanguinity and maternal education on risk of stillbirth and infant death in Norway, 1967-1993. Am J Epidemiol 1998; 148: 452–459.

    Google Scholar 

  22. Olsen J, Frische G. Social differences in reproductive health. A study on birth weight, stillbirths and congenital malformations in Denmark. Scand J Soc Med 1993; 2: 90–97.

    Google Scholar 

  23. Haglund B, Cnattingiust S, Nordström ML. Social differences in late fetal death and infant mortality in Sweden 1985-1986. Paediatr Perinatal Epidemiol 1993; 7: 33–44.

    Google Scholar 

  24. Whitehead M, Drever F. Narrowing social inequalities in health? Analysis of trends in mortality among babies of lone mothers. Br Med J 1999; 318: 908–912.

    Google Scholar 

  25. Tzoumaka-Bakoula C, Lekea-Karanika V, Matsaniotis NS, Golding J. The Greek National Survey. II: Socioeconomic factors and perinatal mortality in Greece. Paediatr Perinatal Epidemiol 1989; 3: 41–52.

    Google Scholar 

  26. Zeitlin J, Combier E, De Caunes F, Papiernik E. Sociodemographic risk factors for perinatal mortality. Acta Obstet Gynecol Scand 1998; 77: 826–835.

    Google Scholar 

  27. Enk A, Buitendijk SE, Pal KM, Enk WJJ, Schulpen TWJ. Perinatal death in ethnic minorities in the Netherlands. J Epidemiol Comm Health 1998; 52: 735–739.

    Google Scholar 

  28. Wang PD, Lin RS. Perinatal mortality in Taiwan. Public Health 1999; 113: 27–33.

    Google Scholar 

  29. Roder D, Nguyen AM, Chan A. Trends in perinatal characterisitics in South Australia, 1981 to 1994, by place of residence of mother. Australian New Zealand J Public Health 1997; 21: 483–488.

    Google Scholar 

  30. Gould JB, Davey B, LeRoy S. Socioeconomic differentials and neonatal mortality: Racial comparisons of California singletons. Pediatrics 1989; 83: 181–186.

    Google Scholar 

  31. Rajmil L, Borrell C, Starfield B, Fernández E, Serra V, Schiaffino A, Segura A. The quality of care and influence of double health care coverage in Catalonia (Spain). Arch Dis Childhood 2000; 83: 211–214.

    Google Scholar 

  32. Borrell C, Fernández E, Schiaffino A, Benach J, Rajmil L, Villalb?´ JR, Segura A. Social class inequalities in the use of and access to health services in Catalonia (Spain): What is the influence of a supplemental private health insurance? Int J Quality Health Care 2001; 13: 117–125.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Municipal Institute of Public Health, Barcelona, Spain

    C. Borrell, E. Cirera, M. Ricart, M.I. Pasarín & J. Salvador

Authors
  1. C. Borrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Cirera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Ricart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M.I. Pasarín
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Salvador
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Borrell, C., Cirera, E., Ricart, M. et al. Social inequalities in perinatal mortality in a Southern European city. Eur J Epidemiol 18, 5–13 (2003). https://doi.org/10.1023/A:1022524914396

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1022524914396

Search

Navigation