Tracking State-Level Racial Disparities in Stillbirth Rates, 2016-2021 Restricted; Files Only
Maduforo, Sandra (Spring 2023)
Abstract
Background: Stillbirths are fetal deaths that occur at 20 or more weeks of gestation. In 2020, non-Hispanic Black, non-Hispanic Native Hawaiian, and other Pacific Islander mothers had the highest stillbirth rates, which were more than double the rate among non-Hispanic White mothers. These disparities are not new; however, whether and to what degree they have changed over time is unknown. Using 2016-2021 state-level stillbirth data, we assessed whether there was correlation between stillbirth rates and racial disparities, and explored trends in racial disparities.
Methods: Fetal death and live birth data (2016-2021) for the 50 US states and Washington D.C. were extracted from CDC WONDER. States were ranked by 2021 stillbirth rate and racial disparities. Stillbirth rates among non-Hispanic Black mothers were compared to two reference groups: non-Hispanic White, and all other races/ethnicities. The Pearson correlation coefficient was used to assess correlation between stillbirth rates and racial disparities in 2021. Using 3-year moving averages, the Mann-Kendall trend test was used to evaluate linear trends in racial disparities.
Results: There was no correlation between overall stillbirth rates and racial disparities in 2021.
Stillbirth rates were highest in Nevada, Wyoming, and the Southeast region of the US. Racial disparities were most prominent in Massachusetts (RRs: 3.00 & 3.17, comparing NH-Black to all other races and NH-White, respectively), Kansas (RRs: 2.57 & 2.65), Iowa (RRs: 2.51 & 2.75), and Delaware (RRs: 2.97 & 3.98). Florida, Louisiana, Mississippi, Pennsylvania, and Wisconsin had a consistent decline in the 3-year moving averages of racial disparities, while Indiana, Massachusetts, Virginia, Washington, and Arizona experienced a consistent widening of the moving averages. Colorado and Louisiana had the largest percent decrease in racial disparities, while Washington experienced the largest percent increase. Most states had constant racial disparities (RRs: 1.40-2.97 & 1.49-3.98).
Conclusion: There is no correlation between overall stillbirth rates and racial disparities at the state-level, though some areas might experience overlap. While some states had evidence of increasing or decreasing trends in racial disparities in stillbirth rates, disparities remained stable in most places. Strategies to address stillbirth rates and racial disparities are needed to reduce negative stillbirth outcomes nationally.
Table of Contents
Introduction - 1
Methods - 3
Results - 4
Discussion - 6
Conclusion - 8
Tables and Figures - 9
Appendix - 15
References - 16
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File download under embargo until 18 May 2025 | 2023-04-19 21:41:55 -0400 | File download under embargo until 18 May 2025 |
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