France: Downs syndrome and socioeconomic disparities

The authors assessed socioeconomic differences in probabilities of prenatal diagnoses of Downs syndrome and continuation of pregnancies after such diagnoses.

Unit on Perinatal and Women’s Health, Institut National de la Sante et de la Recherche Medicale (INSERM), U149, Paris: The authors assessed socioeconomic differences in probabilities of prenatal diagnoses of Downs syndrome and continuation of pregnancies after such diagnoses, along with the effects of these differences on disparities in live-birth prevalences of Downs syndrome. Using population-based data derived from 1433 cases of Downs syndrome and 3731 control births, they assessed age-adjusted effects of maternal occupation and geographic origin on prenatal diagnoses, as well as overall and live-birth odds, of Downs syndrome.

Maternal occupation and geographic origin had significant effects on the probability of a prenatal diagnosis of Downs syndrome and on continuation of pregnancy after such a diagnosis. Women in lower-status occupational categories had higher odds of delivering a live-born infant with Downs syndrome. In comparison with women in the highest-status occupational category, the age-adjusted odds ratio for a Downs syndrome live birth among women without an occupation was 2.4 (95% confidence interval [CI] = 1.7, 3.3). By contrast, there were no disparities in age-adjusted overall likelihood of Downs syndrome.

The authors concluded that socioeconomic differences in use of prenatal testing have created disparities in the live-birth prevalence of Downs syndrome. Overall Downs syndrome risk does not vary according to socioeconomic status.

Advances in medical technology and creation of disparities: the case of Down syndrome. Khoshnood B, De Vigan C, Vodovar V, Breart G, Goffinet F, Blondel B. American Journal of Public Health. 2006 Dec;96(12):2139-44. Epub 2006 Oct 31. Email: khoshnood@vjf.inserm.fr