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Assessing the deprivation gap in stillbirths and neonatal deaths by cause of death: a national population-based study
  1. Kate E Best1,
  2. Sarah E Seaton2,
  3. Elizabeth S Draper2,
  4. David J Field2,
  5. Jennifer J Kurinczuk3,
  6. Bradley N Manktelow2,
  7. Lucy K Smith2
  1. 1 Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
  2. 2 Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3 National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  1. Correspondence to Dr Lucy K Smith, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; lucy.smith{at}leicester.ac.uk

Abstract

Objective To investigate socioeconomic inequalities in cause-specific stillbirth and neonatal mortality to identify key areas of focus for future intervention strategies to achieve government ambitions to reduce mortality rates.

Design Retrospective cohort study.

Setting England, Wales, Scotland and the UK Crown Dependencies.

Participants All singleton births between 1 January 2014 and 31 December 2015 at ≥24 weeks’ gestation.

Main outcome measure Cause-specific stillbirth or neonatal death (0–27 days after birth) per 10 000 births by deprivation quintile.

Results Data on 5694 stillbirths (38.1 per 10 000 total births) and 2368 neonatal deaths (15.9 per 10 000 live births) were obtained from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). Women from the most deprived areas were 1.68 (95% CI 1.56 to 1.81) times more likely to experience a stillbirth and 1.67 (95% CI 1.48 to 1.87) times more likely to experience a neonatal death than those from the least deprived areas, equating to an excess of 690 stillbirths and 231 neonatal deaths per year associated with deprivation. Small for gestational age (SGA) unexplained antepartum stillbirth was the greatest contributor to excess stillbirths accounting for 33% of the deprivation gap in stillbirths. Congenital anomalies accounted for the majority (59%) of the deprivation gap in neonatal deaths, followed by preterm birth not SGA (24–27 weeks, 27%).

Conclusions Cause-specific mortality rates at a national level allow identification of key areas of focus for future intervention strategies to reduce mortality. Despite a reduction in the deprivation gap for stillbirths and neonatal deaths, public health interventions should primarily focus on socioeconomic determinants of SGA stillbirth and congenital anomalies.

  • stillbirth
  • neonatal death
  • socioeconomic inequality

https://doi.org/10.1136/archdischild-2018-316124

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    Footnotes

    • Contributors KEB undertook the statistical analysis and wrote the first draft of the paper. LKS, JJK, SES, BM, ESD and DF made substantial contributions to conception and design. LKS, BM and ESD were responsible for acquisition of data. SES made a substantial contribution to the statistical analysis. All authors contributed to interpretation of the data, writing of the paper and revising it critically for important intellectual content. All authors approved the final version of the paper.

    • Funding LKS is funded by a National Institute for Health Research Career Development Fellowship. This article presents independent research funded by the National Institute for Health Research (NIHR). KEB is funded by a Newcastle University Medical Sciences Faculty Fellowship.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Ethics approval Specific research ethics committee approval was not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.