Ho, FK;
Allan, M;
Shao, H;
Man, KKC;
Jani, BD;
Lyall, D;
Hastie, C;
... Pell, JP; + view all
(2024)
Maternal and pregnancy factors contributing to the association between area deprivation and infant mortality in England: a retrospective cohort study.
The Lancet Regional Health - Europe
, Article 101075. 10.1016/j.lanepe.2024.101075.
(In press).
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Abstract
Background: Socioeconomic inequality in infant mortality in the UK is rising. This study aims to identify contributory maternal and pregnancy factors that can explain the known association between area deprivation and infant mortality. Methods: A cohort study was conducted using Clinical Practice Research Datalink (CPRD) primary care data between 2004 and 2019 linked to the Index of Multiple Deprivation (IMD), and infant mortality from the Office for National Statistics death data. Potential maternal and pregnancy contributory factors included: maternal age, prior maternal health conditions, pregnancy lifestyle factors and complications, use of medications during pregnancy, and characteristics of birth. Counterfactual-based decomposition analysis was used to quantify the relative importance of equalising these factors to reduce inequalities in infant mortality. Findings: A total of 392,606 mother-child dyads were included in this study. The overall risk of infant mortality was greatest for individuals in the most deprived quintile (risk ratio 2.13 [95% CI 1.58–2.90]; risk difference 6.6 [3.8–8.8] per 10,000 live births) compared with the least deprived. Four contributory factors were identified as potentially important: preterm birth (Proportion eliminated [PE] 15.25% [95% CI 9.44–24.12%]), smoking during pregnancy (PE 13.61% [95% CI 3.96–80.97%]), maternal age <20 years at childbirth (PE 10.52% [95% CI 2.93–21.35%]) and maternal depression (PE 9.13% [95% CI 4.47–14.93%]). These collectively accounted for more than one-third of the socioeconomic inequality in mortality. Interpretation: Multifactorial interventions targeting maternal mental health, smoking, teenage pregnancy and preterm birth may mitigate a proportion of the effects of socioeconomic inequality but targeting these, alone, will not stem the rise in infant mortality. Structural efforts to reduce socioeconomic inequalities will also be required to prevent these excess infant deaths. Funding: UK Medical Research Council,Scottish Chief Scientist Office, Wellcome Trust.
| Type: | Article |
|---|---|
| Title: | Maternal and pregnancy factors contributing to the association between area deprivation and infant mortality in England: a retrospective cohort study |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.lanepe.2024.101075 |
| Publisher version: | http://dx.doi.org/10.1016/j.lanepe.2024.101075 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Health inequality; Socioeconomic deprivation; Infant mortality; Cohort study |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10200920 |
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