Maternal and pregnancy factors contributing to the association between area deprivation and infant mortality in England: a retrospective cohort study.

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Europe Pub Date : 2024-10-01 eCollection Date: 2024-12-01 DOI:10.1016/j.lanepe.2024.101075

Frederick K Ho, Max Allan, Hui Shao, Kenneth K C Man, Bhautesh D Jani, Donald Lyall, Claire Hastie, Michael Fleming, Daniel Mackay, John G F Cleland, Christian Delles, Ruth Dundas, Jim Lewsey, Patrick Ip, Ian Wong, Paul Welsh, Anna Pearce, Charlotte M Wright, Helen Minnis, S Vittal Katikireddi, Jill P Pell

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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.

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英格兰地区剥夺与婴儿死亡率之间关系的孕产妇和妊娠因素：一项回顾性队列研究

背景：英国婴儿死亡率的社会经济不平等正在加剧。本研究旨在确定有助于解释区域剥夺与婴儿死亡率之间已知关联的孕产妇和妊娠因素。方法：使用2004年至2019年与多重剥夺指数（IMD）相关的临床实践研究数据链（CPRD）初级保健数据以及国家统计局死亡数据中的婴儿死亡率进行了一项队列研究。潜在的孕产妇和妊娠因素包括：孕产妇年龄、既往孕产妇健康状况、妊娠生活方式因素和并发症、妊娠期间药物的使用以及出生特征。采用基于反事实的分解分析来量化平衡这些因素以减少婴儿死亡率不平等的相对重要性。结果：本研究共纳入392,606对母子。在最贫困的五分之一人群中，婴儿死亡的总体风险最大(风险比2.13 [95% CI 1.58-2.90]；风险差异6.6[3.8-8.8]/ 10000例活产)。四个因素被确定为潜在的重要因素：早产（比例消除[PE] 15.25% [95% CI 9.44-24.12%]），怀孕期间吸烟（PE 13.61% [95% CI 3.96-80.97%]），产妇年龄解释：针对产妇心理健康、吸烟、少女怀孕和早产的多因素干预可能会减轻一定比例的社会经济不平等影响，但仅针对这些因素并不能阻止婴儿死亡率的上升。还需要作出结构性努力，减少社会经济不平等，以防止这些婴儿过多死亡。资助：英国医学研究委员会，苏格兰首席科学家办公室，威康信托基金。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.