Am J Perinatol
DOI: 10.1055/s-0042-1756141
Original Article

Social Determinants of Health and Risk of Stillbirth in the United States

April Adams 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Deepa Dongarwar
2   Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
,
Lena Shay 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Mariana Baroni
2   Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
,
Eunique Williams
2   Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
,
Priscilla Ehieze
2   Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
,
Rhanna Wilson
2   Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
,
Alexia Awoseyi
2   Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
,
Hamisu M. Salihu
2   Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
› Author Affiliations Funding This research was supported by a grant (number: 1 D34HP31024–01–00) award from the Health Resources and Services Administration (HRSA).
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Abstract

Objective Our aim was to evaluate the impact of social determinants of health (SDoH) risk factors on stillbirth among pregnancy-related hospitalizations in the United States.

Study Design We conducted a cross-sectional analysis of delivery-related hospital discharges using annualized data (2016–2017) from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The International Classification of Diseases, 10th Revision ICD-10-CM codes were used to select women with singleton stillbirth. Z-codes were utilized to identify SDoH risk factors and their subtypes. The association between SDoH risk factors and stillbirth was assessed using survey logistic regression models.

Results We analyzed 8,148,646 hospitalizations, out of which 91,140 were related to stillbirth hospitalizations, yielding a stillbirth incidence of 1.1%. An increased incidence was observed for non-Hispanic (NH) Blacks (1.7%) when compared with NH Whites (1.0%). The incidence of stillbirth was greater in hospitalizations associated with SDoH risk factors compared with those without risk factors [2.0% vs. 1.1% (p <0.001)]. Among patients with SDoH risk factors, the rate of stillbirth was highest in those designated as NH other (3.0%). Mothers that presented with SDoH risk factors had a 60% greater risk of stillbirth compared with those without (odds ratio [OR] = 1.61 [95% confidence interval (CI) = 1.33–1.95], p < 0.001). The SDoH issues that showed the most significant risk for stillbirth were: occupational risk (OR = 7.05 [95% CI: 3.54–9.58], p < 0.001), upbringing (OR = 1.87 [95% CI: 1.23–2.82], p < 0.001), and primary support group and family (OR = 5.45 [95% 3.84–7.76], p < 0.001).

Conclusion We found pregnancies bearing SDoH risk factors to be associated with a 60% elevated risk for stillbirth. Future studies should target a variety of risk reduction strategies aimed at modifiable SDoH risk factors that can be widely implemented at both the population health level as well as in the direct clinical setting.

Key Points

  • Health disparities exist in stillbirth rates, especially among NH Black women.

  • Social determinants of health risk factors increase the risk of stillbirth.

  • There is a need for further study on the impact of specific SDoH risk factors on stillbirth risk.

Keywords

stillbirth - health disparities - social determinants of health - ethnic disparities

Note

This research was presented as a poster at the 4th Annual Baylor College of Medicine Health Equity Research Summit in May 2021.




Publication History

Received: 28 October 2021

Accepted: 12 July 2022

Article published online:
02 September 2022

© 2022. Thieme. All rights reserved.

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