An Exploratory Analysis of the Association Between State-Level Urban Sociodemographic Factors and Fetal Death in...

Despite evidence linking urban environments to adverse birth outcomes, fetal death remains insufficiently studied within a biocultural perspective.

To describe geographic patterns of fetal mortality in Mexico and evaluate the association between state-level fetal death rates and sociodemographic indicators of urban environments.

An exploratory and population-based study that analyzes all cases (116, 250 cases) of fetal deaths in Mexico recorded between 2020 and 2024. Total (TFDR: all gestational ages), early (EFDR: ≤ 27 weeks of gestation), and late (LFDR: > 27 weeks of gestation) fetal death rates were expressed as the number of fetal deaths per 1000 total births. Simple and multiple linear regression models were used to analyze the association between state-level rate of fetal deaths and the percentage of urban population, population density, income inequality, and crime rate.

The national TFDR was 12.96 cases per 1000 births. The highest rates were concentrated in the center of the country (Mexico City: 24.98 and the State of Mexico: 20), while the lowest rates were recorded in the south (Oaxaca: 6.24 and Guerrero: 6.70). The simple regressions showed that the percentage of urban population, population density, and crime incidence rate were positively associated with TFDR and EFDR; the multiple regression showed that the percentage of urban population was significantly associated with these outcomes. Crime rate was associated with LFDR in simple and multiple analyses.

Recorded fetal death in Mexico shows marked geographic heterogeneity patterned by urban sociodemographic factors that reflect structural stressors and ecological pressures inherent to modern metropolitan life.