Neighborhood deprivation and the risk of stillbirth in New York

Abstract

Stillbirth (fetal death ≥ 20 weeks gestation) occurs in approximately 21,000 births each year in the United States. Previous studies have observed associations between neighborhood deprivation and adverse perinatal outcomes. We estimated associations between neighborhood deprivation and singleton stillbirth in New York. We performed a cross-sectional study of stillbirths and live births from hospital claims data from the Statewide Planning and Research Cooperative System (2022-2024). Neighborhood deprivation index (NDI) at the census tract level was assigned to geocoded addresses at delivery. Risk ratios (RR) and 95% confidence intervals (CIs) were estimated using a generalized estimating equations model adjusted for individual-level maternal variables of age at delivery, race/ethnicity, marital status, and primary health insurance payer. Our analysis included 3,128 stillbirths and 552,361 live births. The NDI quartiles were associated with stillbirth, with higher levels of deprivation corresponding to increased risk compared to the least deprived quartiles. We observed the highest risk of stillbirth among women in the most deprived quartile (RR 1.42; 95% CI 1.25-1.61). The association of NDI quartile on the risk of stillbirth did not differ by race/ethnicity. Our findings highlight that women residing in the most deprived NDI quartile could benefit from enhanced prenatal services and support.