Madonna Murphy Newfoundland and Labrador Centre for Health Information

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Presentation transcript:

Epidemiology of Stillbirth in Newfoundland and Labrador, Canada: A Population-Based Study Madonna Murphy Newfoundland and Labrador Centre for Health Information Research and Evaluation Department November 5, 2007

Overview Newfoundland and Labrador Centre for Health Information Background Objective Methods Results Conclusions Limitations Implications Questions

Newfoundland and Labrador Centre for Health Information Provincial crown agency reporting to the Minister of Health and Community Services Seven Departments - Infrastructure - Pharmacy Network - Electronic Health Record - Data Quality and Standards - Privacy and Corporate Services - Finance and Administration - Research and Evaluation

Newfoundland and Labrador Centre for Health Information Research and Evaluation Department - Staff are trained in Community Health and Epidemiologic research methods. - Business Lines: - Requests for Information - Preparing and Publishing Health Reports - Information/Database Management - EHR Benefits Evaluation - Applied Health Research - Databases maintained: - hospital data - births/deaths - fee-for-service physician claims - Census and population estimates (Statistics Canada) - National Surveys (CCHS, NPHS, etc.) - Other

Background Definition: - A Stillbirth is the delivery of a fetus which did not at any time after birth breathe or show signs of life. - Gestational age of 20 weeks or a birth weight of 500 grams is required for a stillbirth to be registered in Canada. Prevalence: - Higher in less developed countries - Rates of stillbirths in the US have been decreasing steadily in the last 2 decades. - The Canadian stillbirth rate has not fluctuated much in the last 10 years.

Objective To investigate the epidemiologic characteristics of stillbirth in the province of Newfoundland and Labrador, Canada.

Methods Data Sources: - Stillbirth database (1995-2005) - Live Birth system (1995-2005) Data Analysis: - Rates were calculated by dividing the number of stillbirths by the number of total births (live births and stillbirths) in a given time period, and multiplying the result by 1,000.

Stillbirth Rate Source: National Center for Health Statistics, 2007; Statistics Canada; Newfoundland and Labrador Centre for Health Information

Stillbirth Rate by Sex, 1995-2005

Stillbirth Rate by Maternal Age, 1995-2005

Stillbirth Rate by Season, 1995-2005

Stillbirth Rate by Gestational Age, 1995-2005

Stillbirth Rate by Birthweight, 1995-2005

Stillbirth Rate per 1,000 total births by Regional Health Authority, 1995-2005

Conclusions From 1995 to 2005, 286 stillbirths were recorded in NL - overall stillbirth rate of 5.2 per 1,000 total births Sex: - Males had a higher rate of stillbirth than females. Maternal Age: - Mothers < 20 years of age had the highest rate (7.8 per 1,000 total births). -significantly different from mothers aged 20-24 (P<0.001) and mothers aged 25-29 (P<0.05) Season: - Higher in spring (6.3 per 1,000 total births) than other seasons. - significantly different from Fall (P<0.05)

Conclusions Gestational Age: - Stillbirth rate is highest at very low gestations and decreases with increasing gestation. Birthweight: - Stillbirth rate is highest at low birthweights and decreases with increasing birthweight. Region: - The central health region had the highest rate of stillbirth (7.9 per 1,000 total births) - Significantly higher than the provincial rate (P<0.0001) and the Eastern rate (P<0.001).

Limitations Data were not available on important stillbirth risk factors, including: - smoking - maternal BMI - time of stillbirth (antepartum vs intrapartum)

Implications This study highlights epidemiologic features, geographic disparities and groups at greater risk of stillbirth in the province. This study will help guide future research and generate hypotheses as to why certain regions have higher rates of stillbirth - Effect of Previous Caesarean Section, Small for Gestational Age and Preterm Birth and the risk of Future Stillbirth in Newfoundland and Labrador Findings will be shared with the provincial government and regional health authorities.

Thank you Madonna Murphy, MSc, PhD (c) Epidemiologist Research and Evaluation Department Newfoundland and Labrador Centre for Health Information 28 Pippy Place, St. John’s NL, Canada A1B 3X4 Phone: 709-752-6037 Email: donnam@nlchi.nl.ca Web: www.nlchi.nl.ca