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. 2025 Dec;132(13):2168-2176.
doi: 10.1111/1471-0528.18274. Epub 2025 Jul 10.

Socio-Economic Inequalities in Stillbirth and Preterm Birth Rates Across Europe: A Population-Based Study

Lucy Smith  1 , Marianne Philibert  2 , Sonya Scott  3 , Maria Jose Vidal Benede  4 , Liili Abuladze  5 , Adela Recio Alcaide  6 , Marina Cuttini  7 , Maria Fernandez Elorriaga  8 , Alex Farr  9 , Alison Macfarlane  10 , Ewa Mierzejewska  11 , Jan Nijhuis  12 , Judith Racape  13 , Jennifer Zeitlin  2
Affiliations

Socio-Economic Inequalities in Stillbirth and Preterm Birth Rates Across Europe: A Population-Based Study

Lucy Smith et al. BJOG. 2025 Dec.

Abstract

Objective: To estimate socio-economic (SES) inequalities in stillbirth and preterm birth rates across European countries using population-based routine data.

Design: Cross-sectional study of national-level perinatal health and SES indicators (mother's education/occupation or area-level deprivation).

Setting: Twenty-four countries in the Euro-Peristat network.

Population: Seventeen million births in 2015-2019.

Methods: Rates of stillbirth, singleton very preterm birth (VPB) and singleton moderate/late preterm birth (MLPB) were derived from routine national birth data collected with a common protocol.

Main outcome measure: Percentage of excess adverse outcomes associated with SES and concentration indices.

Results: Median rates of adverse outcomes were higher in the lowest versus highest SES groups [Stillbirth: 4.9 (interquartile range (IQR):4.30-5.80)] versus 2.7 (IQR:2.25-3.14) per 1000 births; VPB: 1.0 (IQR: 0.87-1.12) versus 0.6 (IQR: 0.59-0.66) per 100 live births; MLPB: 5.8 (IQR: 5.27-6.40) versus 4.4 (IQR:4.13-4.65) per 100 live births. Excess adverse outcomes associated with lower SES varied greatly, particularly for stillbirth (range-3%, 51%) versus VPB (7%, 27%) and MLPB (5%, 20%). Concentration indices further highlighted varying socio-economic inequalities across countries. Median concentration indices were similar for countries with both lower and higher levels of adverse events, with median CIs of -0.12 for countries with both high and low levels of stillbirth.

Conclusion: We identified widespread but varying inequalities between countries. These seemed to be unrelated to the rate of adverse outcomes. This suggests the need for policy strategies directly targeted to the prevention of stillbirth and preterm birth in low SES populations. Our findings demonstrate the feasibility of monitoring inequalities internationally using routine data to identify effective action.

Keywords: preterm birth; socioeconomic inequalities; stillbirth.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Total number (n) and percentage distribution of livebirths from 24+0 weeks gestation by socio‐economic status (SES) level (low, medium and high) for each country.
FIGURE 2
FIGURE 2
Heatmap of rates of perinatal outcomes by socio‐economic status level and country. Colour key denotes rate of perinatal outcome and the width of the bar represents the proportion of births in that socio‐economic status (SES) level and country names in bold where the measure of SES is based on area‐level deprivation.
FIGURE 3
FIGURE 3
Concentration index of inequality by country for stillbirth rate per 1000 total births ≥ 24 weeks gestation, very preterm singleton birth rate per 100 singleton live births ≥ 22 weeks gestation and moderate and late preterm singleton birth rate per 100 singleton live births ≥ 32 weeks gestational age by country for period 2015–2019.
See this image and copyright information in PMC

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