Joint contribution of socioeconomic circumstances and ethnic group to variations in preterm birth, neonatal mortality and infant mortality in England and Wales: a population-based retrospective cohort study using routine data from 2006 to 2012

Abstract

ObjectivesThis study aimed to describe the variation in risks of adverse birth outcomes across ethnic groups and socioeconomic circumstances, and to explore the evidence of mediation by socioeconomic circumstances of the effect of ethnicity on birth outcomes.SettingEngland and Wales.ParticipantsThe data came from the 4.6 million singleton live births between 2006 and 2012.ExposureThe main exposure was ethnic group. Socioeconomic circumstances, the hypothesised mediator, were measured using the Index of Multiple Deprivation (IMD), an area-level measure of deprivation, based on the mother’s place of residence.Primary and secondary outcome measuresThe primary outcomes were birth outcomes, namely: neonatal death, infant death and preterm birth. We estimated the slope and relative indices of inequality to describe differences in birth outcomes across IMD, and the proportion of the variance in birth outcomes across ethnic groups attributable to IMD. We investigated mediation by IMD on birth outcomes across ethnic groups using structural equation modelling.ResultsNeonatal mortality, infant mortality and preterm birth risks were 2.1 per 1000, 3.2 per 1000 and 5.6%, respectively. Babies in the most deprived areas had 47%–129% greater risk of adverse birth outcomes than those in the least deprived areas. Minority ethnic babies had 48%–138% greater risk of adverse birth outcomes compared with white British babies. Up to a third of the variance in birth outcomes across ethnic groups was attributable to differences in IMD, and there was strong statistical evidence of an indirect effect through IMD in the effect of ethnicity on birth outcomes.ConclusionThere is evidence that socioeconomic circumstances could be contributing to the differences in birth outcomes across ethnic groups.

Adverse Pregnancy Outcomes Attributable to Socioeconomic and Ethnic Inequalities in England: A National Cohort Study

“…Other factors related to ethnicity, religion and culture may contribute to a societal disadvantage in such a way that it increases the risk of poor pregnancy outcomes. 24 In addition, there are physiological differences between ethnic groups that may lead to differences in maternal immunological, vascular and endocrine response to pregnancy. 25 All this indicates that more detailed causal mediation analysis is a research priority.…”

Perinatal mortality in Ireland: inequalities by socio-economic group and country of birth

“…In keeping with similar work, 3 , 6 , 8 the analysis was restricted to singleton births as differential access to fertility treatment could lead to a greater incidence of multiple births in more socio-economically advantaged individuals and perinatal mortality is generally higher in multiple births relative to singleton births. 6 To examine changes in inequalities over time, the analysis included data from 2004 to 2019, grouped into two time periods—2004–11 and 2012–19.…”

Advances in paediatrics in 2019: current practices and challenges in allergy, endocrinology, gastroenterology, public health, neonatology, nutrition, nephrology, neurology, respiratory diseases and rheumatic diseases

“…Of note, mortality index among immigrants were higher than among Italians. Accordingly, in England ethnic minority newborns had twice risk of adverse events at birth than British infants [53]. Several explanations may be offered to explain these findings.…”