Neonatal Mortality Disparities by Gestational Age in European Countries

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; Euro-Peristat Network

doi:10.1001/jamanetworkopen.2024.24226

Neonatal Mortality Disparities by Gestational Age in European Countries

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 AlexanderJudith 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, Euro-Peristat Network

^*Corresponding author for this work

Registries & Epidemiological Studies

Research output: Contribution to journal › Article › Research › peer-review

Abstract

IMPORTANCE There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of life after 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 patterns were 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.

Original language	English
Pages (from-to)	e2424226
Journal	JAMA network open
Volume	7
Issue number	8
DOIs	https://doi.org/10.1001/jamanetworkopen.2024.24226
Publication status	Published - 1 Aug 2024

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Sartorius, V., Philibert, M., Klungsoyr, K., Klimont, J., Szamotulska, K., Drausnik, Z., Velebil, P., Mortensen, L., Gissler, M., Fresson, J., Nijhuis, J., Zhang, W. H., Källén, K., Rihs, T. A., Tica, V., Matthews, R., Smith, L., Zeitlin, J., Farr, A., ... Euro-Peristat Network (2024). Neonatal Mortality Disparities by Gestational Age in European Countries. JAMA network open, 7(8), e2424226. https://doi.org/10.1001/jamanetworkopen.2024.24226

@article{00976bd1a9a445039533864468d44ee3,

title = "Neonatal Mortality Disparities by Gestational Age in European Countries",

abstract = "IMPORTANCE There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of life after 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{\textquoteright} 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{\textquoteright} 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 patterns were 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{\textquoteright} 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.",

author = "Victor Sartorius and Marianne Philibert and Kari Klungsoyr and Jeannette Klimont and Katarzyna Szamotulska and Zeljka Drausnik and Petr Velebil and Laust Mortensen and Mika Gissler and Jeanne Fresson and Jan Nijhuis and Zhang, {Wei Hong} and Karin K{\"a}ll{\'e}n and Rihs, {Tonia A.} and Vlad Tica and Ruth Matthews and Lucy Smith and Jennifer Zeitlin and Alex Farr and Sophie Alexander and Judith Racap{\'e} and Gis{\`e}le Vandervelpen and Vasos Coutellas and Theopisti Kyprianou and Jitka Jirova and Luule Sakkeus and Liili Abuladze and B{\'e}atrice Blondel and Annick Vilain and M{\'e}lanie Durox and Guenther Heller and Istv{\'a}n Sziller and Johanna Gunnarsd{\'o}ttir and {\'O}lafsd{\'o}ttir, {Helga S{\'o}l} and Izabela Sikora and Sinead O'Hara and Karen Kearns and Marina Cuttini and Marzia Loghi and Rosaria Boldrini and Marilena Pappagal and Stefano Marchetti and Serena Donati and Janis Misins and Irisa Zile-Velika and Jelena Isakova and Aline Lecomte and Jessica Pastore and Daniel {\'A}lvarez and Miriam Gatt and {Euro-Peristat Network}",

note = "Funding This work was supported by grants from the Luxembourg National Research Fund (FNR) within the National Centre of Excellence in Research on Parkinson{\textquoteright}s disease [NCERPD(FNR/NCER13/BM/11264123)]. The funding body played no role in the design of the study and collection, analysis, interpretation of data, and in writing the manuscript. Publisher Copyright: {\textcopyright} 2024 Sartorius V et al.",

year = "2024",

month = aug,

day = "1",

doi = "10.1001/jamanetworkopen.2024.24226",

language = "English",

volume = "7",

pages = "e2424226",

journal = "JAMA network open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "8",

}

Sartorius, V, Philibert, M, Klungsoyr, K, Klimont, J, Szamotulska, K, Drausnik, Z, Velebil, P, Mortensen, L, Gissler, M, Fresson, J, Nijhuis, J, Zhang, WH, Källén, K, Rihs, TA, Tica, V, Matthews, R, Smith, L, Zeitlin, J, Farr, A, Alexander, S, Racapé, J, Vandervelpen, G, Coutellas, V, Kyprianou, T, Jirova, J, Sakkeus, L, Abuladze, L, Blondel, B, Vilain, A, Durox, M, Heller, G, Sziller, I, Gunnarsdóttir, J, Ólafsdóttir, HS, Sikora, I, O'Hara, S, Kearns, K, Cuttini, M, Loghi, M, Boldrini, R, Pappagal, M, Marchetti, S, Donati, S, Misins, J, Zile-Velika, I, Isakova, J, Lecomte, A , Pastore, J, Álvarez, D, Gatt, M & Euro-Peristat Network 2024, 'Neonatal Mortality Disparities by Gestational Age in European Countries', JAMA network open, vol. 7, no. 8, pp. e2424226. https://doi.org/10.1001/jamanetworkopen.2024.24226

TY - JOUR

T1 - Neonatal Mortality Disparities by Gestational Age in European Countries

AU - Sartorius, Victor

AU - Philibert, Marianne

AU - Klungsoyr, Kari

AU - Klimont, Jeannette

AU - Szamotulska, Katarzyna

AU - Drausnik, Zeljka

AU - Velebil, Petr

AU - Mortensen, Laust

AU - Gissler, Mika

AU - Fresson, Jeanne

AU - Nijhuis, Jan

AU - Zhang, Wei Hong

AU - Källén, Karin

AU - Rihs, Tonia A.

AU - Tica, Vlad

AU - Matthews, Ruth

AU - Smith, Lucy

AU - Zeitlin, Jennifer

AU - Farr, Alex

AU - Alexander, Sophie

AU - Racapé, Judith

AU - Vandervelpen, Gisèle

AU - Coutellas, Vasos

AU - Kyprianou, Theopisti

AU - Jirova, Jitka

AU - Sakkeus, Luule

AU - Abuladze, Liili

AU - Blondel, Béatrice

AU - Vilain, Annick

AU - Durox, Mélanie

AU - Heller, Guenther

AU - Sziller, István

AU - Gunnarsdóttir, Johanna

AU - Ólafsdóttir, Helga Sól

AU - Sikora, Izabela

AU - O'Hara, Sinead

AU - Kearns, Karen

AU - Cuttini, Marina

AU - Loghi, Marzia

AU - Boldrini, Rosaria

AU - Pappagal, Marilena

AU - Marchetti, Stefano

AU - Donati, Serena

AU - Misins, Janis

AU - Zile-Velika, Irisa

AU - Isakova, Jelena

AU - Lecomte, Aline

AU - Pastore, Jessica

AU - Álvarez, Daniel

AU - Gatt, Miriam

AU - Euro-Peristat Network

N1 - Funding This work was supported by grants from the Luxembourg National Research Fund (FNR) within the National Centre of Excellence in Research on Parkinson’s disease [NCERPD(FNR/NCER13/BM/11264123)]. The funding body played no role in the design of the study and collection, analysis, interpretation of data, and in writing the manuscript. Publisher Copyright: © 2024 Sartorius V et al.

PY - 2024/8/1

Y1 - 2024/8/1

N2 - IMPORTANCE There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of life after 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 patterns were 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.

AB - IMPORTANCE There are wide disparities in neonatal mortality rates (NMRs, deaths <28 days of life after 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 patterns were 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.

UR - http://www.scopus.com/inward/record.url?scp=85200828358&partnerID=8YFLogxK

UR - https://pubmed.ncbi.nlm.nih.gov/39110462/

U2 - 10.1001/jamanetworkopen.2024.24226

DO - 10.1001/jamanetworkopen.2024.24226

M3 - Article

C2 - 39110462

AN - SCOPUS:85200828358

SN - 2574-3805

VL - 7

SP - e2424226

JO - JAMA network open

JF - JAMA network open

IS - 8

ER -

Neonatal Mortality Disparities by Gestational Age in European Countries

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