153 Socioeconomic Inequalities in Neonatal Mortality: The Impact of Preterm Birth on the Widening Deprivation Gap

Abstract

Background and aims: Socio-economic inequalities in neonatal mortality exist within many developed countries despite improvements in mortality rates. In the UK, the deprivation gap is widening in spite of attempts to address it. We aimed to investigate time trends in socioeconomic inequalities in cause-specific neonatal mortality in England 1997-2007.Methods: Information about all live births and neonatal deaths (18524 deaths) of singleton infants were obtained. Deprivation was measured using the UK Government Index of Multiple Deprivation. Socioeconomic inequalities in cause-specific neonatal mortality rates over time were estimated using Poisson regression models.Results: The all-cause mortality rate ratio between the most deprived decile and the least deprived decile increased from 2.08 in 1997-1999 to 2.68 in 2003-2005 before a slight fall to 2.35 in 2006-2007. Mortality due to immaturity (< 24 weeks gestation) did not decrease over time and had the widest deprivation gap. Mortality rates for all other causes fell over time. The deprivation gap widened between 1997-1999 and 2003-2005 before a slight fall in 2006-2007 for congenital anomalies; immaturity; and accidents and other specific causes. In contrast mortality rates fell slightly more among the more deprived quintile for intra-partum events and sudden infant deaths leading to a narrowing of the deprivation gap but they comprised only 16.8% of deaths.Conclusions: 80% of the deprivation gap in all-cause mortality was explained by immaturity and congenital anomalies. Understanding the link between deprivation and preterm birth should be a major research priority so interventions to reduce preterm birth can be identified.