Disparities in Stillbirths in England: Analysis A Population-Based Study of 1.3 Million Births

Objective
To examine the variation in stillbirth rates between different ethnic and socioeconomic groups within each organisational hospital group (health trust).

Design
National registry study.

Setting
All health trusts (HT) in National Health Service England.

Population
All mothers and babies born between April 2015 and March 2017.

Methods
This observational study examined ethnic and socioeconomic disparities in stillbirth rates for 1 268 367 births in 133 HTs compared to the national average.

Outcome
Stillbirth at or after 24 gestational weeks.

Results
The average stillbirth rates ranged from 3.4/1000 births for White women up to 7.1/1000 births for Black women. The rates ranged from 2.9/1000 births for women living in the least deprived areas to 4.7/1000 births for those in the most deprived. The proportions of HTs with stillbirth rates well above the national average (more than 2 standard deviations) for White, Asian and Black women were 0.8%, 21.8% and 38.6%, respectively. When HTs were ranked by stillbirth rate, there were notable variations, with some trusts demonstrating lower than average stillbirth rates for White women while concurrently having higher than average stillbirth rates for Asian and/or Black women. There were no units exhibiting lower than national average stillbirth rates for Asian/Black women while concurrently having higher than average stillbirth rates for White women.

Conclusions
These findings suggest that access to and delivery of maternity care vary depending on the mother's ethnicity and level of socioeconomic deprivation. Social factors are likely determinants of inequality in stillbirth rather than maternity care alone.