Searching for socioeconomic risk factors in perinatal mortality in Kuwait:a case control study

The aim of this paper was to investigate whether socioeconomic factors such as parent's education, occupation, and income constitute risk factors in p erinatal mortality after controlling for biological variables such as birth weight and length of gestation, and maternal factors such as age, parity a nd reproductive history. A case-control study covering all perinatal deaths in Kuwait was conducted for one year from 1 October, 1997 to 30 September, 1998, Each case (perinatal death) was matched with a control (live birth). Matching criteria were: father's nationality, place, and date of birth. In formation was successfully collected on 463 matched pairs, 274 Kuwaitis and 189 non-Kuwaitis. Only singleton births were included in the analysis. Biv ariate analysis showed that several of the socioeconomic variables (e.g, lo wer education, lower income) increased the risk of a perinatal death. Howev er, none of these variables remained significant in the multivariate analys is in which birth weight and length of gestation emerged as the two major d eterminants of perinatal deaths among both nationality groups. Among the Ku waitis, primiparity and high parity, and previous history of miscarriage we re also significant risk factors. Among the non-Kuwaitis, none of the socio economic factors, or the maternal factors, were significant predictors of p erinatal mortality. For Kuwaitis, it appears that the government's policies and programs aimed at reducing social inequalities in the society have bee n effective in eliminating perinatal mortality differences between socioeco nomic groups. Among non-Kuwaitis, the lack of differences is reflective of the fact that this group is relatively homogenous and selective of the more affluent who can bring the family to Kuwait. Both nationality groups benef it from the government's free health services. However, charges for non-Kuw aitis are due to be levied soon which may increase disparities in access to health care. (C) 2000 Elsevier Science Ltd. All rights reserved.