Evolving stillbirth rates among Black and White women in the United States, 1980–2020: A population-based study

Background: Given slowing secular declines and persistent racial disparities, stillbirth remains a major health burden in the US. We investigate changes in stillbirth rates overall and for Black and White women, and determine how maternal age, delivery year (period), and birth year (cohort) have shaped trends. Methods: We designed a sequential time-series analysis utilising the 1980 to 2020 US vital records data of live births and stillbirths at ≥24 weeks gestation. Stillbirth rates overall and among Black and White women were examined. We undertook an age-period-cohort analysis to evaluate temporal changes in stillbirth trends. Findings: Of 157,192,032 live births and 710,832 stillbirths between 1980 and 2020, stillbirth rates per 1000 births declined from 10.6 (95% confidence interval [CI] 10.5, 10.7) in 1980 to 5.8 (95% CI 5.7, 5.8) in 2020. Stillbirth rates declined from 9.2 to 5.0 per 1000 births among White women (rate ratio [RR] 0.54, 95% CI 0.53, 0.55), and from 17.4 to 10.1 per 1000 births among Black women (RR 0.57, 95% CI 0.55, 0.59). Black women experienced persistent two-fold higher rates compared to White women (2.01, 95% CI 1.97, 2.05 in 2020). Stillbirth rates declined until 2005, increased from 2005 to the mid-2010s and plateaued thereafter. Strong cohort effects contributed to declining rates in earlier cohorts (1930–1955) and increasing rates among women born after 1980. Interpretation: Age, period, and birth cohorts greatly influenced US stillbirth rates over the last forty years. The decline in stillbirth rate was evident between 1980 and 2005, however subsequent declines have been minimal, reflecting no further gains for cohorts of women born in 1955–1980 and stagnation of period effects starting in 2005. A significant racial disparity persisted with a two-fold excess in stillbirth rates for Black compared to White women, underscoring the need for targeted health and social policies to address disparities. Funding: None.