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Original research
Social inequalities in access to care at birth and neonatal mortality: an observational study
  1. Morgane Michel1,2,3,
  2. Corinne Alberti1,4,5,
  3. Jean-Claude Carel6,7,
  4. Karine Chevreul1,2,3
  1. 1 ECEVE, Université de Paris, Paris, France
  2. 2 URC Eco, Hôtel Dieu / Unité d'épidémiologie clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France
  3. 3 UMR 1123, Inserm, Paris, France
  4. 4 Unité d’épidémiologie clinique / Unité de recherche clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France
  5. 5 UMR 1123 / CIC-EC 1426, Inserm, Paris, France
  6. 6 Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France
  7. 7 NeuroDiderot, Inserm, Université de Paris, Paris, France
  1. Correspondence to Dr Morgane Michel, Inserm UMR 1123, Université de Paris, Paris, Île-de-France, France; morgane.michel{at}aphp.fr

Abstract

Objective To look at the association of socioeconomic status (SES) with the suitability of the maternity where children are born and its association with mortality.

Design Retrospective analysis of a prospective cohort constituted using hospital discharge databases.

Setting France

Population Live births in 2012–2014 in maternity hospitals in mainland France followed until discharge from the hospital.

Main outcome measure Unsuitability of the maternity to newborns’ needs based on birth weight and gestational age, early transfers (within 24 hours of birth) and in-hospital mortality.

Results 2 149 454 births were included, among which 155 646 (7.2%) were preterm. Preterm newborns with low SES were less frequently born in level III maternities than those with high SES. They had higher odds of being born in an unsuitable maternity (OR=1.174, 95% CI 1.114 to 1.238 in the lowest SES quintile compared with the highest), and no increase in the odds of an early transfer (OR=0.966, 95% CI 0.849 to 1.099 in the lowest SES quintile compared with the highest). Overall, newborns from the lowest SES quintile had a 40% increase in their odds of dying compared with the highest (OR=1.399, 95% CI 1.235 to 1.584).

Conclusions Newborns with the lowest SES were less likely to be born in level III maternity hospitals compared with those with the highest SES, despite having higher prematurity rates. This was associated with a significantly higher mortality in newborns with the lowest SES. Strategies must be developed to increase health equity among mothers and newborns.

  • epidemiology
  • health services research
  • neonatology
  • mortality

Data availability statement

Data may be obtained from a third party and are not publicly available. Access to the original database used in this study may be granted by the French Agence technique de l'information sur l'hospitalisation to researchers complying with French regulations.

https://doi.org/10.1136/archdischild-2021-321967

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Access to the original database used in this study may be granted by the French Agence technique de l'information sur l'hospitalisation to researchers complying with French regulations.

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    Footnotes

    • Contributors MM made substantial contributions to the design of the work and to the acquisition, analysis and interpretation of data, drafted the initial manuscript and reviewed and revised the manuscript. CA made substantial contributions to the design of the work and to the analysis and interpretation of data and reviewed and revised the manuscript. J-CC made substantial contributions to the design of the work and to the analysis and interpretation of data and reviewed and revised the manuscript. KC made substantial contributions to the design of the work and to the analysis and interpretation of data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This research was supported by a grant from the French Ministry of Social Affairs and Health (PREPS-14-0530).

    • Disclaimer The funder played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report and in the decision to submit the article for publication.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.