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Cande V. Ananth, PhD, MPH, Shiliang Liu, PhD, MB, Wendy L. Kinzler, MD and Michael S. Kramer, MD

Cande V. Ananth is with the Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey (UMDNJ)–Robert Wood Johnson Medical School, New Brunswick. Shiliang Liu is with the Health Surveillance and Epidemiology Division, Center of Healthy Human Development, Public Health Agency of Canada, Ottawa, Ontario. Wendy L. Kinzler is with the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick. Michael S. Kramer is with the Department of Pediatrics and the Department of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, and the Institute of Human Development and Child and Youth Health, Canadian Institutes of Health Research, Ottawa.

Correspondence: Requests for reprints should be sent to Cande V. Ananth, PhD, MPH, Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901-1977 (e-mail: cande.ananth{at}umdnj.edu).

Objectives. We examined age, period, and cohort (APC) effects on temporal trends in stillbirths among Black and White women in the United States.

Methods. We conducted a cohort study of Black and White women who delivered a singleton live-born or stillborn infant during 1981 through 2000. We analyzed stillbirth rates at 20 or more weeks of gestation within 7 age groups, 4 periods, and 10 "central" birth cohorts after adjusting for confounders.

Results. In both racial groups, women younger than 20 years or 35 years or older were at increased risk of stillbirth; risks decreased over successive periods in all age groups. Birth cohort had no impact on stillbirth trends among Blacks and only a small, nonsignificant effect among Whites. Analyses of various APC combinations showed that Blacks were at a 1.2- to 2.9-fold increased risk for stillbirth relative to Whites. Attributable fractions for stillbirth because of age, period, and cohort effects were 16.5%, 24.9%, and 0.1%, respectively, among Black women and 14.5%, 36.2%, and 2.1%, respectively, among White women.

Conclusions. Strong effects of age and period were observed in stillbirth trends, but these factors do not explain the persistent stillbirth disparity between Black and White women.

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