org355: Stillbirth & prison

From The Guardian

Women in prison are five times more likely to have a stillbirth and twice as likely to give birth to a premature baby that needs special care, new data collected by the Observer shows.

1. What are the exposure (comparison) groups?

2. What are the ratio measures (in terms of the numeric figures) which are referred to here?

3. Are these incidence or prevalence figures?

A higher rate of drug and alcohol problems within prisons than in the general public could be one of many contributing factors to the poorer birth outcomes.

4. What's the epidemiologic concept refered to here? How would you deal with this situation in analysis?

Prisons are extremely stressful and traumatising environments that can affect a mother’s pregnancy, said Paradine.

5. What's the epidemiologic concept refered to here?

6. Can we do a trial to establish causation?

Re: Stillbirth & prison

by | NADA BASSAM JUMAH RABIE - Thursday, 9 December 2021, 9:00 AM

1.comparison group:

women outside prisons

2. risk or odds ratio

3. prevalence

4. confounding factors , you can deal with them either by stratification or regression model analysis

5. not sure , but this is a concept or "expert opinion" as I understand it

6. No, it will be unethical to put ladies ( I.e. expose him) just for the sake of conducting trial

Interesting discussion . Thank you for sharing it with us.

Re: Stillbirth & prison

by | Sujit Rathod - Thursday, 9 December 2021, 5:06 PM

Nada - welcome to Epi in the News, and thank you for opening the discussion! -s

Re: Stillbirth & prison

by | JUDITH MARGARET BURCHARDT - Thursday, 9 December 2021, 6:20 PM

Thank you Sujit and Nada,

Women in prison are five times more likely to have a stillbirth and twice as likely to give birth to a premature baby that needs special care, new data collected by the Observer shows.

1. What are the exposure (comparison) groups?

Pregnant women not in prison

2. What are the ratio measures (in terms of the numeric figures) which are referred to here?

20.9/1000 and 4.2/1000

3. Are these incidence or prevalence figures?

Incidence proportions of still births compared to births

A higher rate of drug and alcohol problems within prisons than in the general public could be one of many contributing factors to the poorer birth outcomes.

4. What's the epidemiologic concept refered to here? How would you deal with this situation in analysis?

Confounding. Adjust for this using Mantel-Haenszel stratification and weighting or by logistic regression.

Prisons are extremely stressful and traumatising environments that can affect a mother’s pregnancy, said Paradine.

5. What's the epidemiologic concept refered to here?

Effect modification. Prison life may be on the causal pathway between prison admission and stilllburth.

6. Can we do a trial to establish causation?

No - unethical

Best wishes

Judith

Re: Stillbirth & prison

by | JHONATAN BORIS QUINONES SILVA - Saturday, 11 December 2021, 7:27 AM

Good day Sujit, and thanks for the article

1. Exposure groups: Women in prison who are pregnant.
2. It is risk ratio, when we say x times more likely, it is incidence rather than prevalence.
3. It is incidence figure, it is not prevalence because RR is constructed by incidence of exposure group divided by incidence of not exposed group.
4. Here it is talking about confounder, and probably the poor outcomes in women imprisoned is due to the fact that they have more drug and alcohol problems. We can deal it by stratification according to drug and alcohol problems. Another way is restriction, in which we only take pregnant women with/without these problems.
5. Here we are talking about an intermediate variable. Women imprisoned->stressful and traumatising environment --> poor outcomes.
6. I think it is kind of unethical to do a trial in which we randomly allocate some women to prison. I cannot be done, especially when there is some evidence that there are poor outcomes in this group.

Jhonatan

Re: Stillbirth & prison

by | JUDITH MARGARET BURCHARDT - Saturday, 11 December 2021, 6:48 PM

Hi Jhonatan,

Thanks for your answers.

On point 4 thanks for reminding me about restriction as a way of dealing with confounding.

On point 5 I think you're right that this an intermediate variable. I think I was wrong to call it effect modification - this would have occurred if some women in prison (for example younger women) had been more likely to have stillbirths than other women in prison (for example older women).

Best wishes

Judith

Re: Stillbirth & prison

by | MADHUTANDRA SARKAR - Thursday, 16 December 2021, 1:30 PM

1. The comparison group is pregnant women in general population (women not in prison).
2. The ratio measure referred to here is risk ratio.
3. These are incidence figures.
4. Confounding effect.
We can deal with confounding in analysis by stratification and regression modelling.
5. Intermediate variable.
Extremely stressful and traumatising environments (intermediate variable) is on the causal pathway between prison (exposure) and poorer birth outcomes (outcome).
6. We cannot do a trial to establish causation. It’s unethical in this context.