Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.
Department of Child Health, Cardiff University School of Medicine, Cardiff, UK.
Paediatr Perinat Epidemiol. 2021 May;35(3):302-314. doi: 10.1111/ppe.12739. Epub 2021 Mar 5.
Stillbirth is a critical public health issue worldwide. While the rates in high-income countries are relatively low, there are persistent between-country disparities.
To compare stillbirth rates and trends in Wales and the State of Western Australia (WA), Australia, and provide insights into any differences.
In this international retrospective cohort study, we pooled population-based data collections of all births ≥24 weeks' gestation (excluding terminations for congenital anomalies) between 1993 and 2015, divided into six time periods. The stillbirth rate per 1000 births was estimated for each cohort in each time period. Multivariable Poisson regression analyses, adjusted for appropriateness of growth, socio-economic status, maternal age, and multiple birth, were performed to evaluate the interaction between cohort and time period. Relative risk (RR) and 95% confidence interval (CI) for each time period and cohort were calculated.
There were 767 731 births (3725 stillbirths) in Wales and 648 373 (2431 stillbirths) in WA. The overall stillbirth rate declined by 15.9% over the study period in Wales (from 5.3 in 1993-96 to 4.5 per 1000 births in 2013-15; P < .01) but by 40.4% in WA (from 4.9 to 2.9 per 1000 births in WA; P < .01). Using 1993-96 in WA as the reference group, the adjusted RRs for stillbirths at 37-38 weeks' gestation in the most recent study period (2013-15) were 0.85 (95% CI 0.64, 1.13) in Wales and 0.51 (95% CI 0.36, 0.73) in WA.
The stillbirth rates between Wales and WA have widened in the last two decades (especially among late-term births), although the absolute rates for both are distinctly higher than the best-performing nations. While the differences may be partly explained by timing of birth and maternal life style behaviours such as smoking, it is important to identify and ameliorate the associated risk factors to support a reduction in preventable stillbirths.
死胎是全球范围内一个严重的公共卫生问题。虽然高收入国家的发生率相对较低，但国家间仍存在持续的差异。
比较威尔士和澳大利亚西澳大利亚州（WA）的死胎率和趋势，并深入了解两者之间的差异。
在这项国际回顾性队列研究中，我们汇集了 1993 年至 2015 年间所有≥24 周妊娠（排除因先天异常而终止的妊娠）的人群数据，将其分为 6 个时间段。在每个时间段内，我们对每个队列的每 1000 例分娩中的死胎率进行了估计。采用多变量泊松回归分析，调整了生长适宜性、社会经济地位、母亲年龄和多胎妊娠等因素，以评估队列与时间段之间的相互作用。计算了每个时间段和每个队列的相对风险（RR）和 95%置信区间（CI）。
威尔士有 767731 例分娩（3725 例死胎），西澳大利亚有 648373 例分娩（2431 例死胎）。在研究期间，威尔士的死胎率总体下降了 15.9%（从 1993-96 年的 5.3 例降至 2013-15 年的 4.5 例/1000 例；P ＜0.01），而西澳大利亚的死胎率下降了 40.4%（从 4.9 例降至 2.9 例/1000 例；P ＜0.01）。以西澳大利亚的 1993-96 年为参照组，最近研究时间段（2013-15 年）37-38 周妊娠的校正 RR 为威尔士的 0.85（95%CI 0.64,1.13），西澳大利亚的 0.51（95%CI 0.36,0.73）。
在过去的 20 年里，威尔士和西澳大利亚的死胎率差距有所扩大（尤其是在晚期分娩中），尽管两者的绝对比率明显高于表现最好的国家。尽管这些差异部分可以通过分娩时间和母亲生活方式行为（如吸烟）来解释，但确定和改善相关风险因素以支持降低可预防的死胎率是很重要的。
