Four key factors have been identified that together account for more than a third of the inequality in child mortality between the most and least deprived areas of England.
Researchers say targeted interventions to tackle these factors – teenage pregnancy, maternal depression, premature birth and smoking during pregnancy – could go a long way in reducing inequality, although higher-level structural changes will also be needed to tackle socio-economic inequality.
Great Britain is currently in the rankings 10th out of 38 OECD countries for infant mortality (deaths in children under one year of age), recording four deaths per 1,000 live births.
It is known that children born to mothers who are poor, black or young are at increased risk, but where children are born also matters: according ONS data before 2022, the mortality rate for infants in the most deprived 10% of England was almost three times as high as for infants in the least deprived 10%.
“Inequality in infant mortality is at alarming levels,” said Dr Frederick Ho from the University of Glasgow School of Health, who led the research. “We also know that infant mortality is an indicator of the broader effectiveness of the health care system. We wanted to understand the reasons for this disparity because it could have policy implications for whether we could use the healthcare system to reduce or eliminate it.
To investigate this, Ho and his colleagues examined 392,606 linked maternal and child health records collected across England between 2004 and 2019. They looked at how 24 different social and biological factors contributed to child mortality during this period.
The study, published in The Lancet Regional Health Europefound that infants in the most deprived areas had double the mortality rate of those in the least deprived areas during the study period, and identified four factors – preterm birth, smoking during pregnancy, teenage pregnancy and maternal depression – which together accounted for 38% of this inequality.
While smoking and maternal depression can affect infants’ biological development, impacting their health, the association with teen pregnancy may have more to do with conditions such as reduced access to pre- and postnatal care, or access to fewer financial resources, Ho said. .
His data shows that interventions that target these factors – such as screening for depression in early pregnancy, improving primary care for teenage mothers, or continued efforts to phase out smoking – can help reduce inequality.
However, Ho added that “even if we have perfect interventions for these factors, we can only reduce inequality by about a third. This means we also need structural changes that target socio-economic inequality if we are to reduce it in a meaningful way.”
Prof Karen Luyt, neonatologist at the University of Bristol and director of the National Child Mortality Database (NCMD), said that while this was an important study of deaths prior to the Covid-19 pandemic, it is likely to have underestimated the current impact of deprivation on infant survival.
She said: “The recent NCMD child mortality data for England from April 2019 to March 2023 highlighted growing social disparities in child mortality, with a year-on-year increase in the most deprived quintile, in stark contrast to a stable infant mortality rate in the United States. the least well-off quintile.
“(The study) also confirms the causal link between social deprivation and infant mortality due to preterm birth, estimating that approximately 15% of infant deaths due to deprivation are due to being born prematurely.
“With targeted investments in providing equitable access to (evidence-based health care interventions), it is possible to prevent preterm birth and improve infant survival when preterm birth is unavoidable.”
Alex Kennedy, policy and engagement manager at the Health Foundationa UK health charity and think tank, said: “If the new government is to achieve its goal of halving the gap in healthy life expectancy between regions, there must be an explicit focus on children’s health and reducing child mortality . A key part of this is reducing poverty and ensuring communities have access to the building blocks of healthcare, including education, employment and decent housing.”