Area-level deprivation as a risk factor for stillbirth in upper-middle and high-income countries: A scoping review

Background: Socioeconomic deprivation has been associated with health inequalities and poor perinatal outcomes. Deprivation is described as a multidimensional concept, with composite indicators (e.g. area-based) developed internationally to study population health. Aim: This scoping review aims to examine published literature on the relationship between area-level deprivation and stillbirth in upper-middle to high-income countries. Methods: The Joanna Briggs Institute methodology for scoping reviews was utilised. The research question based on the Population (studies that examined stillbirth) Concept (area-level deprivation and its impact on stillbirth) Context (upper-middle- to high-income countries) framework. Six scientific databases were searched. Results were screened and reference lists searched to identify relevant literature. Data extraction on study characteristics and evidence of association provided was completed and a narrative summary reported the main findings. Results: A total of 29 studies were included, from 9 countries (majority UK-based: n = 20) published between 1998 and 2023. A variety of composite deprivation indices were utilised, the UK's Index of Multiple Deprivation (IMD) was the most common (n = 8), followed by the Townsend and Jarman indices (n = 6 and n = 3, respectively). Income, employment, education and access to services were the most common factors included as measures of deprivation in the indices. Twenty-two of the 29 studies (75.9%) showed positive correlations between stillbirth and areas identified more socioeconomically deprived. Conclusion: This review suggests that area-level deprivation seems an influencing factor on stillbirth in upper-middle to high-income countries. Focused initiatives to reduce stillbirth among those at higher deprivation related risk may be useful in improving maternal and perinatal outcomes.