A population-based case-control study of stillbirth: the relationship of significant life events to the racial disparity for African Americans

Am J Epidemiol. 2013 Apr 15;177(8):755-67. doi: 10.1093/aje/kws381. Epub 2013 Mar 26.

Abstract

Stillbirths (fetal deaths occurring at ≥20 weeks' gestation) are approximately equal in number to infant deaths in the United States and are twice as likely among non-Hispanic black births as among non-Hispanic white births. The causes of racial disparity in stillbirth remain poorly understood. A population-based case-control study conducted by the Stillbirth Collaborative Research Network in 5 US catchment areas from March 2006 to September 2008 identified characteristics associated with racial/ethnic disparity and interpersonal and environmental stressors, including a list of 13 significant life events (SLEs). The adjusted odds ratio for stillbirth among women reporting all 4 SLE factors (financial, emotional, traumatic, and partner-related) was 2.22 (95% confidence interval: 1.43, 3.46). This association was robust after additional control for the correlated variables of family income, marital status, and health insurance type. There was no interaction between race/ethnicity and other variables. Effective ameliorative interventions could have a substantial public health impact, since there is at least a 50% increased risk of stillbirth for the approximately 21% of all women and 32% of non-Hispanic black women who experience 3 or more SLE factors during the year prior to delivery.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Case-Control Studies
  • Confidence Intervals
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Income
  • Insurance, Health
  • Life Change Events*
  • Marital Status
  • Odds Ratio
  • Pregnancy
  • Risk Factors
  • Stillbirth / ethnology*
  • Surveys and Questionnaires
  • United States / epidemiology