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Background: Tabulating annual national health indicators sorted by outcome may be misleading for two reasons. The implied rank order is largely a result of heterogeneous population sizes. Distinctions between geographically adjacent regions are not visible. Methods: Regional data are plotted in a geographical map shaded in terms of percentiles of the indicator value. Degree of departure is determined relative to control limits of a corresponding funnel plot. Five methods for displaying outcome and degree of departure from a reference level are proposed for four indicators selected from the 2004 European Perinatal Health Report. Results: Spread of indicator values was generally largest for small population sizes, with results for large populations lying mostly close to respective European medians. The high neonatal mortality rate for Poland (4.9 per 1000); high low-birthweight rates for England and Wales (7.8%), Germany (7.3%) and Estonia (4.5%); and high caesarean section rates for Italy (37.8%), Poland (26.3%), Portugal (33.1%) and Germany (27.3%) were statistically significant exceptions to this pattern. Estonia also showed an extreme result for maternal mortality (29.6 per 100 000). Conclusion: Extreme deviations from EU reference levels are either correlated with small population sizes or may be interpreted in terms of differing medical practices, as in the case of caesarean section rate. EURO-PERISTAT has now decided to use 5-year averages for maternal mortality to reduce the variance in outcome. Use of two colours in three intensities and solid fill versus crosshatching is best suited to display rate and significance of difference. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM PUBLISHER]

Background: The PERISTAT project aimed to develop an indicator set for monitoring and describing perinatal health in Europe. The challenge was to define indicators that cover common concerns and have the same meaning within the different European health care systems. Methods: PERISTAT included i) a review of existing recommendations on perinatal health indicators, ii) a DELPHI consensus process with a scientific advisory committee composed of a clinician and an epidemiologist or statistician from each European member state as well as with a panel of midwives, and iii) a study of the availability of national statistics to construct recommended indicators. This article describes the first two components. Results: The review identified 10 international and 13 national recommended indicator sets. It also included indicators routinely compiled by WHO, EUROSTAT and OECD. Because of the methodological limits to using existing indicators for European comparisons, a high priority was placed on improving indicators already collected. Using the DELPHI method based on the results of the review, the scientific committee achieved a consensus on ten core and 23 recommended indicators, including 12 requiring further development. Conclusions: The PERISTAT project was successful in identifying a set of indicators, which drew on and consolidated previous work. Consensus was not achieved on precise indicators in areas where uncertainty about appropriate indicators was high, although areas were targeted for future development. Finally, the feasibility study, which is in progress, is an essential part of the project, since it will enable member states to evaluate their capacity to produce these indicators. [ABSTRACT FROM AUTHOR]

Deals with the increasing multiple maternity rates in European countries as of March 2003. Consequences of the rise in multiple maternity rates; Factors which influence trends in multiple maternities; Impact of management of subfertility on the incidence of multiple births.

Levin JB (Department of Applied Statistics, University of Reading, Whiteknights, PO Box 217, Reading RG6 2AN, UK), Macfarlane A and Bennett S. The comparison of trends in perinatal mortality in small areas. 1990, 19: 78–89 Year to year changes in perinatal mortality rates for small populations are difficult to interpret. Because local rates are based on small numbers of events, they are subject to apparently large fluctuations. A technique for analysing trends in mortality, for detecting changes in trends and comparing variations in trends between areas is described. It is illustrated by an analysis of perinatal mortality rates for Area Health Authorities in the West Midlands Region of England from 1974–1981, but the same techniques could be used to analyse trends at other times and in other places. [ABSTRACT FROM PUBLISHER]

Macfarlane A (National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford 0X2 6HE, UK) ‘ A time to die’? 1984, : 38– 44. In both the newborn and the elderly, medical care is increasingly able to prolong or curtail life. It is difficult to assess what effect this may have on the population as a whole and what implication it may have for the interpretation of both short-term and longer-term changes in mortality. The definition of cut-off points for age groups is critical to the interpretation of the way changes in medical care could affect infant mortality rates. [ABSTRACT FROM PUBLISHER]