Stillbirth and infant death among generations of Pakistani immigrant descent: a population-based study

ObjectiveTo examine the risk of stillbirth and infant death among offspring of Pakistani-born and Norwegian-born women of Pakistani immigrant descent. DesignPopulation-based study linking the Medical Birth Registry of Norway to immigration data from Statistics Norway. SettingNorway. PopulationBirths to women of Pakistani immigrant descent classified as Pakistani-born (n=8814) or Norwegian-born (n=1801), and to the host population of Norwegian descent (n=712430) from 1995 to 2010. MethodsThe relative risk of stillbirth and infant death by country of descent and birth was estimated by odds ratios with 95% confidence intervals (95% CI) using logistic regression. Main outcome measuresStillbirth and infant death. ResultsRisk of stillbirth was highest in the Pakistani-born group (7.4/1000, 95% CI 5.7-9.4) followed by the Norwegian-born group (5.0/1000, 95% CI 1.7-8.3) and finally the host population (3.5/1000, 95% CI 3.3-3.6). Relative to the host population, risk of stillbirth was higher in both Pakistani-born (odds ratios 2.8, 95% CI 2.2-3.6) and Norwegian-born (odds ratios 2.2, 95% CI 1.1-4.2) groups, after adjustment for year of birth, age, parity and residence. For infant death, absolute risks were 6.9/1000 (95% CI 5.2-8.8), 5.6/1000 (95% CI 2.7-10.2), and 2.9/1000 (95% CI 2.7-3.0), with adjusted odds ratios of 2.8 (95% CI 2.1-3.7) and 2.4 (95% CI 1.3-4.6), respectively. ConclusionsAn elevated risk of stillbirth and infant death persists across generations of Pakistani immigrant descent living in Norway. While translating into few excess deaths, the elevated risks should be taken into account by obstetric and pediatric care providers.