Disparity and social determinants of preterm birth in Taiwan - a study of national data

Background Preterm birth is the leading cause of newborn deaths and social determinants of health play a major role. In Taiwan, increasing preterm rates were observed from 8.5% to 9.3% of live births over the past decade. This study aims to examine the disparities in preterm birth among mothers characterized by their socio-demographic factors. Method We used Birth Reporting Database and Birth Registration Database to obtain comprehensive information of the mothers and the newborns; then linked the data with Assisted Reproduction Database governed for information about utilization of assisted reproductive technology. Infant deaths were indentified by linking birth data with the death certificates. A total of 1,206,965 live births from 2004 to 2009 were included for analysis. Result The socio-demographic risk factors of preterm birth including: mothers aged less than 20 years old and over 30 years old, lower educational attainment of the mother, indigenous mothers and mothers lived in mountain area or remote area after adjusted other relative factors. Mothers who used assisted reproductive technology for conception also had higher chance of preterm births (OR= 1.30; CI: 1.23-1.37). Conclusions The results demonstrated preterm birth rates varies among sub-populations characterized by their socio-demographic factors. In spite of the well-recognized and universal coverage National Health Insurance and well-established prenatal care services, gaps in rates of preterm birth were observed. Comprehensive approaches that enable timely identification of high risk mothers and well-delivery of services to the need are essential to prevent pre-term birth and may subsequently reduce avoidable infant mortality.