Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

Mika Gissler; Melanie Durox; Lucy Smith; Beatrice Blondel; Lisa Broeders; Ashna Hindori-Mohangoo; Karen Kearns; Rumyana Kolarova; Marzia Loghi; Urelija Rodin; Katarzyna Szamotulska; Petr Velebil; Guy Weber; Oscar Zurriaga; Jennifer Zeitlin; Gerald Haidinger; Jeannette Klimont; Sophie Alexander; Gisèle Vandervelpen; Wei Hong Zhang; Evelin Yordanova; Rumyana Kolarova; Boris Filipovic-Grcic; Zeljka Drausnik; Urelija Rodin; Theopisti Kyprianou; Vasos Scoutellas; Petr Velebil; Laust Mortensen; Luule Sakkeus; Mika Gissler; Anna Heino; Beatrice Blondel; Anne Chantry; Catherine Deneux Tharaux; Guenther Heller; Nicholas Lack; Aris Antsaklis; István Berbik; Helga Sól Ólafsdóttir; Karen Kearns; Izabela Sikora; Marina Cuttini; Marzia Loghi; Cristina Tamburini; Serena Donati; Janis Misins; Irisa Zile; Jelena Isakova; Audrey Billy; Sophie Couffignal; Aline Lecomte; Guy Weber; Miriam Gatt; Peter Achterberg; Lisa Broeders; Ashna Hindori-Mohangoo; Jan Nijhuis; Rupali Akerkar; Kari Klungsøyr; Ewa Mierzejewska; Katarzyna Szamotulska; Henrique Barros; Mihai Horga; Vlad Tica; Jan Cap; Natasa Tul; Ivan Verdenik; Francisco Bolumar; Mireia Jane; Adela Recio Alcaide; Maria Jose Vidal; Oscar Zurriaga; Karin Källen; Anastasia Nyman; Sylvan Berrut; Melanie Riggenbach; Tonia A. Rihs; Alison MacFarlane; Lucy Smith; Rachael Wood; Jennifer Zeitlin; Melanie Durox; Marie Delnord; Alice Hocquette

doi:10.1093/eurpub/ckac001

Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

Mika Gissler^*, Melanie Durox, Lucy Smith, Beatrice Blondel, Lisa Broeders, Ashna Hindori-Mohangoo, Karen Kearns, Rumyana Kolarova, Marzia Loghi, Urelija Rodin, Katarzyna Szamotulska, Petr Velebil, Guy Weber, Oscar Zurriaga, Jennifer Zeitlin, Gerald Haidinger, Jeannette Klimont, Sophie Alexander, Gisèle Vandervelpen, Wei Hong ZhangEvelin Yordanova, Rumyana Kolarova, Boris Filipovic-Grcic, Zeljka Drausnik, Urelija Rodin, Theopisti Kyprianou, Vasos Scoutellas, Petr Velebil, Laust Mortensen, Luule Sakkeus, Mika Gissler, Anna Heino, Beatrice Blondel, Anne Chantry, Catherine Deneux Tharaux, Guenther Heller, Nicholas Lack, Aris Antsaklis, István Berbik, Helga Sól Ólafsdóttir, Karen Kearns, Izabela Sikora, Marina Cuttini, Marzia Loghi, Cristina Tamburini, Serena Donati, Janis Misins, Irisa Zile, Jelena Isakova, Audrey Billy, Sophie Couffignal, Aline Lecomte, Guy Weber, Miriam Gatt, Peter Achterberg, Lisa Broeders, Ashna Hindori-Mohangoo, Jan Nijhuis, Rupali Akerkar, Kari Klungsøyr, Ewa Mierzejewska, Katarzyna Szamotulska, Henrique Barros, Mihai Horga, Vlad Tica, Jan Cap, Natasa Tul, Ivan Verdenik, Francisco Bolumar, Mireia Jane, Adela Recio Alcaide, Maria Jose Vidal, Oscar Zurriaga, Karin Källen, Anastasia Nyman, Sylvan Berrut, Melanie Riggenbach, Tonia A. Rihs, Alison MacFarlane, Lucy Smith, Rachael Wood, Jennifer Zeitlin, Melanie Durox, Marie Delnord, Alice Hocquette

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Abstract

Background: Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods: We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks' GA was analyzed separately. Results: Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8-1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3-0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0-23%, average 1.8%). Conclusions: Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.

Original language	English
Pages (from-to)	200-206
Number of pages	7
Journal	European Journal of Public Health
Volume	32
Issue number	2
DOIs	https://doi.org/10.1093/eurpub/ckac001
Publication status	Published - 1 Apr 2022

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10.1093/eurpub/ckac001Licence: CC BY

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Gissler, M., Durox, M., Smith, L., Blondel, B., Broeders, L., Hindori-Mohangoo, A., Kearns, K., Kolarova, R., Loghi, M., Rodin, U., Szamotulska, K., Velebil, P., Weber, G., Zurriaga, O., Zeitlin, J., Haidinger, G., Klimont, J., Alexander, S., Vandervelpen, G., ... Hocquette, A. (2022). Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right? European Journal of Public Health, 32(2), 200-206. https://doi.org/10.1093/eurpub/ckac001

@article{8a376f15b7bc4ad48885a0bfe89a3d30,

title = "Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?",

abstract = "Background: Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods: We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks' GA was analyzed separately. Results: Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8-1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3-0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0-23%, average 1.8%). Conclusions: Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.",

author = "Mika Gissler and Melanie Durox and Lucy Smith and Beatrice Blondel and Lisa Broeders and Ashna Hindori-Mohangoo and Karen Kearns and Rumyana Kolarova and Marzia Loghi and Urelija Rodin and Katarzyna Szamotulska and Petr Velebil and Guy Weber and Oscar Zurriaga and Jennifer Zeitlin and Gerald Haidinger and Jeannette Klimont and Sophie Alexander and Gis{\`e}le Vandervelpen and Zhang, {Wei Hong} and Evelin Yordanova and Rumyana Kolarova and Boris Filipovic-Grcic and Zeljka Drausnik and Urelija Rodin and Theopisti Kyprianou and Vasos Scoutellas and Petr Velebil and Laust Mortensen and Luule Sakkeus and Mika Gissler and Anna Heino and Beatrice Blondel and Anne Chantry and Tharaux, {Catherine Deneux} and Guenther Heller and Nicholas Lack and Aris Antsaklis and Istv{\'a}n Berbik and {\'O}lafsd{\'o}ttir, {Helga S{\'o}l} and Karen Kearns and Izabela Sikora and Marina Cuttini and Marzia Loghi and Cristina Tamburini and Serena Donati and Janis Misins and Irisa Zile and Jelena Isakova and Audrey Billy and Sophie Couffignal and Aline Lecomte and Guy Weber and Miriam Gatt and Peter Achterberg and Lisa Broeders and Ashna Hindori-Mohangoo and Jan Nijhuis and Rupali Akerkar and Kari Klungs{\o}yr and Ewa Mierzejewska and Katarzyna Szamotulska and Henrique Barros and Mihai Horga and Vlad Tica and Jan Cap and Natasa Tul and Ivan Verdenik and Francisco Bolumar and Mireia Jane and Alcaide, {Adela Recio} and Vidal, {Maria Jose} and Oscar Zurriaga and Karin K{\"a}llen and Anastasia Nyman and Sylvan Berrut and Melanie Riggenbach and Rihs, {Tonia A.} and Alison MacFarlane and Lucy Smith and Rachael Wood and Jennifer Zeitlin and Melanie Durox and Marie Delnord and Alice Hocquette",

note = "Funding: The Euro-Peristat project received funding from the European Commission through the Health Programme (grant numbers 20101301 and 664691). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2022 The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.",

year = "2022",

month = apr,

day = "1",

doi = "10.1093/eurpub/ckac001",

language = "English",

volume = "32",

pages = "200--206",

journal = "European Journal of Public Health",

issn = "1101-1262",

publisher = "Oxford University Press",

number = "2",

}

Gissler, M, Durox, M, Smith, L, Blondel, B, Broeders, L, Hindori-Mohangoo, A, Kearns, K, Kolarova, R, Loghi, M, Rodin, U, Szamotulska, K, Velebil, P, Weber, G, Zurriaga, O, Zeitlin, J, Haidinger, G, Klimont, J, Alexander, S, Vandervelpen, G, Zhang, WH, Yordanova, E, Kolarova, R, Filipovic-Grcic, B, Drausnik, Z, Rodin, U, Kyprianou, T, Scoutellas, V, Velebil, P, Mortensen, L, Sakkeus, L, Gissler, M, Heino, A, Blondel, B, Chantry, A, Tharaux, CD, Heller, G, Lack, N, Antsaklis, A, Berbik, I, Ólafsdóttir, HS, Kearns, K, Sikora, I, Cuttini, M, Loghi, M, Tamburini, C, Donati, S, Misins, J, Zile, I, Isakova, J, Billy, A , Couffignal, S , Lecomte, A, Weber, G, Gatt, M, Achterberg, P, Broeders, L, Hindori-Mohangoo, A, Nijhuis, J, Akerkar, R, Klungsøyr, K, Mierzejewska, E, Szamotulska, K, Barros, H, Horga, M, Tica, V, Cap, J, Tul, N, Verdenik, I, Bolumar, F, Jane, M, Alcaide, AR, Vidal, MJ, Zurriaga, O, Källen, K, Nyman, A, Berrut, S, Riggenbach, M, Rihs, TA, MacFarlane, A, Smith, L, Wood, R, Zeitlin, J, Durox, M, Delnord, M & Hocquette, A 2022, 'Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?', European Journal of Public Health, vol. 32, no. 2, pp. 200-206. https://doi.org/10.1093/eurpub/ckac001

TY - JOUR

T1 - Clarity and consistency in stillbirth reporting in Europe

T2 - why is it so hard to get this right?

AU - Gissler, Mika

AU - Durox, Melanie

AU - Smith, Lucy

AU - Blondel, Beatrice

AU - Broeders, Lisa

AU - Hindori-Mohangoo, Ashna

AU - Kearns, Karen

AU - Kolarova, Rumyana

AU - Loghi, Marzia

AU - Rodin, Urelija

AU - Szamotulska, Katarzyna

AU - Velebil, Petr

AU - Weber, Guy

AU - Zurriaga, Oscar

AU - Zeitlin, Jennifer

AU - Haidinger, Gerald

AU - Klimont, Jeannette

AU - Alexander, Sophie

AU - Vandervelpen, Gisèle

AU - Zhang, Wei Hong

AU - Yordanova, Evelin

AU - Kolarova, Rumyana

AU - Filipovic-Grcic, Boris

AU - Drausnik, Zeljka

AU - Rodin, Urelija

AU - Kyprianou, Theopisti

AU - Scoutellas, Vasos

AU - Velebil, Petr

AU - Mortensen, Laust

AU - Sakkeus, Luule

AU - Gissler, Mika

AU - Heino, Anna

AU - Blondel, Beatrice

AU - Chantry, Anne

AU - Tharaux, Catherine Deneux

AU - Heller, Guenther

AU - Lack, Nicholas

AU - Antsaklis, Aris

AU - Berbik, István

AU - Ólafsdóttir, Helga Sól

AU - Kearns, Karen

AU - Sikora, Izabela

AU - Cuttini, Marina

AU - Loghi, Marzia

AU - Tamburini, Cristina

AU - Donati, Serena

AU - Misins, Janis

AU - Zile, Irisa

AU - Isakova, Jelena

AU - Billy, Audrey

AU - Couffignal, Sophie

AU - Lecomte, Aline

AU - Weber, Guy

AU - Gatt, Miriam

AU - Achterberg, Peter

AU - Broeders, Lisa

AU - Hindori-Mohangoo, Ashna

AU - Nijhuis, Jan

AU - Akerkar, Rupali

AU - Klungsøyr, Kari

AU - Mierzejewska, Ewa

AU - Szamotulska, Katarzyna

AU - Barros, Henrique

AU - Horga, Mihai

AU - Tica, Vlad

AU - Cap, Jan

AU - Tul, Natasa

AU - Verdenik, Ivan

AU - Bolumar, Francisco

AU - Jane, Mireia

AU - Alcaide, Adela Recio

AU - Vidal, Maria Jose

AU - Zurriaga, Oscar

AU - Källen, Karin

AU - Nyman, Anastasia

AU - Berrut, Sylvan

AU - Riggenbach, Melanie

AU - Rihs, Tonia A.

AU - MacFarlane, Alison

AU - Smith, Lucy

AU - Wood, Rachael

AU - Zeitlin, Jennifer

AU - Durox, Melanie

AU - Delnord, Marie

AU - Hocquette, Alice

N1 - Funding: The Euro-Peristat project received funding from the European Commission through the Health Programme (grant numbers 20101301 and 664691). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Publisher Copyright: © 2022 The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Background: Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods: We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks' GA was analyzed separately. Results: Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8-1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3-0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0-23%, average 1.8%). Conclusions: Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.

AB - Background: Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods: We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks' GA was analyzed separately. Results: Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8-1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3-0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0-23%, average 1.8%). Conclusions: Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.

UR - http://www.scopus.com/inward/record.url?scp=85128161136&partnerID=8YFLogxK

UR - https://pubmed.ncbi.nlm.nih.gov/35157046

U2 - 10.1093/eurpub/ckac001

DO - 10.1093/eurpub/ckac001

M3 - Article

C2 - 35157046

AN - SCOPUS:85128161136

SN - 1101-1262

VL - 32

SP - 200

EP - 206

JO - European Journal of Public Health

JF - European Journal of Public Health

IS - 2

ER -

Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

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