Origins of disparities in preventable child mortality in England and Sweden: a birth cohort study

Abstract

ObjectiveTo compare mortality in children aged <5 years from two causes amenable to healthcare prevention in England and Sweden: respiratory tract infection (RTI) and sudden unexpected death in infancy (SUDI).DesignBirth cohort study using linked administrative health databases from England and Sweden.Setting and participantsSingleton live births between 2003 and 2012 in England and Sweden, followed up from age 31 days until the fifth birthday, death or 31 December 2013.Main outcome measuresThe main outcome measures were HR for RTI-related mortality at 31–364 days and at 1–4 years and SUDI mortality at 31–364 days in England versus Sweden estimated using Cox proportional hazards models. We calculated unadjusted HRs and HRs adjusted for birth characteristics (gestational age, birth weight, sex and congenital anomalies) and socioeconomic factors (maternal age and socioeconomic status).ResultsThe English cohort comprised 3 928 483 births, 768 RTI-related deaths at 31–364 days, 691 RTI-related deaths at 1–4 years and 1166 SUDIs; the corresponding figures for the Swedish cohort were 1 012 682, 131, 118 and 189. At 31–364 days, unadjusted HR for RTI-related death in England versus Sweden was 1.52 (95% CI 1.26 to 1.82). After adjusting for birth characteristics, the HR reduced to 1.16 (95% CI 0.96 to 1.40) and for socioeconomic factors to 1.11 (95% CI 0.92 to 1.34). At 1–4 years, unadjusted HR was 1.58 (95% CI 1.30 to 1.92) and decreased to 1.32 (95% CI 1.09 to 1.61) after adjusting for birth characteristics and to 1.30 (95% CI 1.07 to 1.59) after further adjustment for socioeconomic factors. For SUDI, the respective HRs were 1.59 (95% CI 1.36 to 1.85) in the unadjusted model, and 1.40 (95% CI 1.20 to 1.63) after accounting for birth characteristics and 1.19 (95% CI 1.02 to 1.39) in the fully adjusted model.ConclusionInterventions that improve maternal health before and during pregnancy to reduce the prevalence of adverse birth characteristics and address poverty could reduce child mortality due to RTIs and SUDIs in England.

Cause-specific child and adolescent mortality in the UK and EU15+ countries

“…Similar to our findings, Tambe et al 10 11 found higher CYP mortality rates for infections in the UK compared with Sweden and others have shown poor UK outcomes and slow rates of decline for childhood infections such as pneumonia and meningococcal disease. [12][13][14][15] We found the UK to have significantly higher mortality for common infections than the EU15+ in children aged 1-9 years old (both sexes), boys aged 10-14 and girls aged [15][16][17][18][19], and ranked in the bottom three countries across all age groups and both sexes. Although common infections account for a relatively small proportion of total CYP deaths, reducing UK mortality to the EU15+ median would save around 85 lives a year in those aged 1-19 years old (see online supplementary material).…”

“…The 3-year lagged mean number of deaths in CYP aged [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] in 2015 in the UK was 2110 (1281 boys and 829 girls), and the 3-year lagged all-cause mortality rate was 14.6 per 100 000. Of the deaths, 44.8% were among 15-19 year olds, 15.7% were among 10-14 year olds, 14.6% were among 5-9 year olds and 24.9% were among 1-4 year olds.…”

“…Among girls aged 15-19, the UK also had significantly higher mortality than the EU15+ for digestive disorders, neurological disorders and diabetes/urological/blood/endocrine disorders (DUBE). UK mortality was significantly lower than the EU15+ for transport injuries among boys aged [15][16][17][18][19]. Table 4 shows the most recent UK mortality rank by age group and sex compared with the other EU15+ countries using the 3-year lagged mortality rate per 100 000 in 2015 (or latest available date) for each country.…”

“…After excluding redistributed deaths, the UK still had significantly higher mortality for common infections in children aged 1-4 years old (both sexes), chronic respiratory diseases in children aged 10-14 years old (both sexes) and neurological conditions in girls aged [15][16][17][18][19]. The UK had significantly lower mortality than the EU15+ for transport injuries in boys aged 15-19, unintentional injuries in children aged 1-4 (both sexes) and self-harm in girls aged [15][16][17][18][19]. The IRR for other age/cause groups identified in the main analysis as having higher mortality in the UK compared with the EU15+ was similar in the sensitivity analysis, but no longer reached significance using the reduced number on December 13, 2020 by guest.…”

“…UK mortality outcomes for children and young people (CYP) are worse than in comparable highincome countries. [1][2][3] In 2014 we estimated excess UK mortality to result in around 1000 additional deaths in infants and young children and 300 extra deaths in adolescents and young adults (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) each year, 4 when compared with the median mortality in a group of similar countries (the EU15+: European Union countries pre-2004, Norway, Australia and Canada). Our recent updated analysis demonstrated continued poor UK outcomes for all-cause and non-communicable diseases (NCD), particularly in younger children.…”