Socioeconomic inequalities in neonatal intensive care admission rates
- 1Queen’s University Belfast, Paediatric Department, Antrim Hospital, Antrim, UK
- 2Queen’s University Belfast, UK
- 3University of Ulster, Jordanstown, UK
- Correspondence to Dr John Jenkins, Queen’s University Belfast, Paediatric Department, Antrim Hospital, Antrim BT41 2RL, Northern Ireland, UK;
- Accepted 12 May 2009
- Published Online First 19 May 2009
Objective: To examine socioeconomic inequalities in neonatal intensive care (NIC) admissions relating to preterm birth, intrauterine growth restriction (IUGR), multiple births and other conditions.
Methods: Retrospective review of all NIC admissions from 1996 to 2001 throughout a geographically defined region. Area deprivation indices were grouped into quintiles from least (1) to most (5) deprived. Admissions were classified by predefined hierarchical criteria.
Results: The rate of admissions was 31.4 per 1000 births. There was a J-shaped relation with socioeconomic group (28.1 NIC admissions per 1000 in quintile 1, 34.0 in quintile 5 and below 28 in the other quintiles). The most deprived areas had a rate 19% above the regional average. The relation with socioeconomic group differed significantly according to primary reason for admission. The rates of admissions with significant prematurity (34% of all admissions) and IUGR as primary reason were highest in quintile 5 (18% and 41% above the regional average, respectively). This contrasted with the rate of admission for multiple birth which was highest in quintile 1 (45% above average). These differences provided the main explanation for the J-shaped overall curve.
Conclusions: Measures to alleviate deprivation and to improve the preterm birth and IUGR rates in deprived groups would have the greatest potential to reduce inequality in need for NIC admission. Efforts to achieve targets for reduction in infant mortality need to take account of the different effects of socioeconomic inequalities for different conditions and groups of infants.
Funding This project was funded by the Research and Development Office of the Northern Ireland Health and Personal Social Services.
Competing interests None.
Provenance and Peer review Not commissioned; externally peer reviewed.