The role of socioeconomic factors in perinatal mortality: a case-control study in Istanbul

Abstract Background Socioeconomic inequalities affect perinatal mortality (PM). This study aimed to investigate the relationship between socioeconomic status (SES) and PM in a district of Istanbul using a comprehensive SES index for the first time in Türkiye. Methods This case-control study was conducted in Istanbul, including perinatal deaths (2021-2023) as cases and randomly selected live births from the same period and district as controls. When the low SES frequency is assumed as 20% in the control group and 40% in the case group, the total sample size is calculated as 166, 83 cases and 83 controls, for 80% power and 0.05 alpha error. Data were collected from health records and telephone interviews. SES was evaluated through a validated index that used parents’ education and occupation, households’ vehicles and ownership of electrical devices, house ownership, and the land value of the living area and categorized as low, middle, or high. Logistic regression was used in the analysis. Results The study was completed with a total of 181 participants, including 84 cases and 97 controls. The multivariate model includes the chronic disease, anemia, preeclampsia, pregnancy order, congenital anomaly, type of pregnancy, SES index, mother's smoking status, time between the last two pregnancies, and mother's age. When high SES was used as the reference category, low SES was associated with an increased risk of PM (OR: 3.27, 95% CI: 1.09-9.85). Maternal anemia (OR: 2.52, 95% CI: 1.06-6.02), congenital anomalies (OR: 29.30, 95% CI: 3.42-250.69), and being a first pregnancy compared to a second or third (OR: 6.58, 95% CI: 2.27-19.12) were also found to increase the risk of PM. Conclusions Low SES, the presence of congenital anomalies and anemia, and the first pregnancy were found to increase the risk of PM. A multifactorial approach should be adopted to reduce PM and community-based interventions should be planned to reduce social inequalities. Key messages • Achieving equity should be the main target for decreasing perinatal mortality. • In order to reduce the negative effects of low SES on maternal and child health, it is important to facilitate access to health services, improve prenatal care, and increase the level of education.