The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69953

Birgit Reime, DSc MPH¹, Clarissa Schwarz, MPH², Paul Wenzlaff, MSc³, and Beate Schuecking, MD². (1) Dept. of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Ave, Vancouver, BC V6T 1Z3, Canada, (604) 806 9119, breime@cw.bc.ca, (2) Dept. Health and Illness Research, Osnabrueck University, Albrechtstr. 28, Osnabrueck, Germany, (3) Center of Quality Management, Physician's chamber of Lower Saxony, PB 4749, Hannover, Germany

Background: Past studies from Germany about the relationship between unemployment and perinatal mortality were restricted to small samples or regions, and were based on outdated statistics. We analysed the relationships between maternal unemployment and perinatal mortality in the federal state of Lower Saxony, Germany, for 1999. Methods: This is a retrospective cohort study restricted to singletons (n=70,701). The sample consists of routine perinatal data from Lower Saxony, Germany, for 1999 (97% hospital participation rate). Information about socio-demographic, behavioral, and pregnancy- and birth-related medical factors were collected by obstetricians and midwives during antenatal visits and at birth. Using logistic regression models the associations between perinatal mortality and maternal unemployment (>3 months) were tested in four steps: (1) crude analyses, (2) adjusting for socio-demographic variables, (3) adjusting for these and behavioral variables such as smoking and prenatal visits, (4) adjusting for all these additional to medical confounder such as prematurity, and maternal chronic diseases. Results: The crude relationship between perinatal mortality and maternal unemployment is significant (OR=3.03, 95%-CI=1.52-6.01). The result remained stable after adjusting for socio-demographic (OR=3.15, 95%-CI=1.55-6.39), socio-demographic and behavioral (OR=2.92, 95%-CI=1.29-6.58), socio-demographic, behavioral and medical confounders (OR=2.83, 95%-CI=0.99-8.06). Conclusion: Although interpretations of these results are limited due to large confidence intervals, maternal unemployment seems to be an independent risk factor for perinatal death. Further studies should examine the pathways of this link. Due to adjustment for maternal diseases, “healthy worker bias” is implausible. Prevention strategies in the community such as supported employment and limitations of the study are discussed.

Learning Objectives:

• 1.To identify unemployment as an independent risk factor for perinatal mortality.
• 2.To discuss possible prevention strategies in the community such as supported jobs or telephone crisis intervention for unemployed mothers-to-be.

Keywords: Underserved Populations, Maternal and Child Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.