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The perinatal mortality rate, which includes stillbirths and neonatal deaths, is an important public health indicator. Unlike neonatal deaths, stillbirths have stopped declining and remain a largely untargeted prevention opportunity. Both are reported to the New York City (NYC) health department as part of mandatory routine vital event surveillance. Birth data are widely used to inform programs addressing perinatal mortality, but stillbirth data are not and have poorly understood quality. We hypothesized that data providers (physicians and hospital staff) report poorer quality demographic, medical, and cause of death information for stillbirths than neonatal deaths, despite being very similar events along the perinatal mortality continuum. We compared NYC vital records information for stillbirths and neonatal deaths from 2007–2011.
METHODS:
Using NYC vital records, we compared data completeness and cause of death information for third-trimester stillbirths (n=1930) and deaths among infants born alive in the third-trimester who died at ≤28 days of life (i.e., neonatal deaths; n=735) using chi-squared tests. Similarly, we evaluated the impact of NYC’s 2011 implementation of both an electronic stillbirth registration system and the revised 2003 US standard report of fetal death, comparing cause of death information and data completeness pre- and post-revision.
RESULTS:
Data providers supplied less complete data for stillbirths than neonatal deaths on most items including maternal demographics, risk factors, and prenatal care information (p<0.0001). Ill-defined causes of death were reported much more frequently for stillbirths (67% vs. 5%). For most ill-defined causes of stillbirth (73%), providers reported stillbirth synonyms as the cause of death, e.g., “fetal demise.” After adopting the revised US standard report of fetal death, total ill-defined causes of stillbirth decreased from 67% to 61% (p<0.01). Hospitals exhibited substantial variation in stillbirth reporting quality: range 7–95% of reports containing unknown values and 28–97% with ill-defined causes of death.
CONCLUSIONS:
NYC stillbirth records lack demographic, medical, and cause of death information compared with neonatal death records. Implementing the revised stillbirth report and electronic system improved cause of death information. Substantial reporting variability by hospital suggests opportunities for improvement exist. Third trimester stillbirths have similar risk factors, causes, and prevention opportunities as many neonatal deaths, making stillbirth research essential to perinatal mortality prevention. Our findings have implications for public health practitioners who use vital statistics data to evaluate perinatal mortality trends. An investment in improving stillbirth data is recommended to enable researchers to further understand and reduce these deaths.