Neonatal mortality disparities by gestational age in European countries
Authors & affiliation
Victor Sartorius, Marianne Philibert, Kari Klungsoyr, Jeannette Klimont, Katarzyna Szamotulska, Zeljka Drausnik, Petr Velebil, Laust Mortensen, Mika Gissler, Jeanne Fresson, Jan Nijhuis, Wei Hong Zhang, Karin Källén, Tonia A. Rihs, Vlad Tica, Ruth Matthews, Lucy Smith, Jennifer Zeitlin, Alex Farr, Sophie Alexander, Judith Racapé, Gisèle Vandervelpen, Vasos Coutellas, Theopisti Kyprianou, Jitka Jirova, Luule Sakkeus, Liili Abuladze, Béatrice Blondel, Annick Vilain, Mélanie Durox, Guenther Heller, István Sziller, Johanna Gunnarsdóttir, Helga Sól Ólafsdóttir, Izabela Sikora, Sinead O'Hara, Karen Kearns, Marina Cuttini, Marzia Loghi, Rosaria Boldrini, Marilena Pappagal, Stefano Marchetti, Serena Donati, Janis Misins, Irisa Zile-Velika, Jelena Isakova, Aline Lecomte, Jessica Pastore, Daniel Álvarez, Miriam Gatt, PW Achterberg, Lisa Broeders, Rupali Akerkar, Hilde Engjom, Ewa Mierzejewska, Henrique Barros, Lucian Puscasiu, Mihaela-Alexandra Budianu, Alexandra Cucu, Vlad Tica, Miha Lučovnik, Ivan Verdenik, Maria Fernandez Elorriaga, Oscar Zurriaga, Adela Recio Alcaide, Anastasia Nyman, Alison Macfarlane, Sonya Scott, Kirsten Monteath, Siobhan Morgan, Craig Thomas, Sinead Magill, Greg Ceely, [missing] Euro Peristat Network
Abstract
IMPORTANCE There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of lifeafter live birth per 1000 live births) between countries in Europe, indicating potential for improvement. Comparing country-specific patterns of births and deaths with countries with low mortality rates can facilitate the development of effective intervention strategies. OBJECTIVE To investigate how these disparities are associated with the distribution of gestational age (GA) and GA-specific mortality rates. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional study of all live births in 14 participating European countries using routine data compiled by the Euro-Peristat Network. Live births with a GA of 22 weeks or higher from 2015 to 2020 were included. Data were analyzed from May to October 2023. EXPOSURES GA at birth. MAIN OUTCOMES AND MEASURES The study investigated excess neonatal mortality, defined as a rate difference relative to the pooled rate in the 3 countries with the lowest NMRs (Norway, Sweden,and Finland; hereafter termed the top 3). The Kitagawa method was used to divide this excess into the proportion explained by the GA distribution of births and by GA-specific mortality rates. A sensitivity analysis was conducted among births 24 weeks’ GA or greater. RESULTS There were 35 094 neonatal deaths among 15 123 428 live births for an overall NMR of 2.32 per 1000. The pooled NMR in the top 3 was 1.44 per 1000 (1937 of 1 342 528). Excess neonatal mortality compared with the top 3 ranged from 0.17 per 1000 in the Czech Republic to 1.82 per 1000 in Romania. Excess deaths were predominantly concentrated among births less than 28 weeks’ GA (57.6%overall). Full-term births represented 22.7%of the excess deaths in Belgium, 17.8%in France, 40.6%in Romania and 17.3%in the United Kingdom. Heterogeneous patternswere observed when partitioning excess mortality into the proportion associated with the GA distribution vs GA-specific mortality. For example, these proportions were 9.2%and 90.8%in France, 58.4%and 41.6%in the United Kingdom, and 92.9%and 7.1% in Austria, respectively. These associations remained stable after removing births under 24 weeks’ GA in most, but not all, countries. CONCLUSIONS AND RELEVANCE This cohort study of 14 European countries found wide NMR disparities with varying patterns by GA. This knowledge is important for developing effective strategies to reduce neonatal mortality.
Publication date:
2024