Abstract
BackgroundAs Scotland strives to become a country where children flourish in their early years, it is faced with the challenge of socio-economic health inequalities, which are at risk of widening amidst austerity policies. The aim of this study was to explore trends in infant mortality rates (IMR) and stillbirth rates by socio-economic position (SEP) in Scotland, between 2000 and 2018, inclusive.MethodsData for live births, infant deaths, and stillbirths between 2000 and 2018 were obtained from National Records of Scotland. Annual IMR and stillbirth rates were calculated and visualised for all of Scotland and when stratified by SEP. Negative binomial regression models were used to estimate the association between SEP and infant mortality and stillbirth events, and to assess for break points in trends over time. The slope (SII) and relative (RII) index of inequality compared absolute and relative socio-economic inequalities in IMR and stillbirth rates before and after 2010.ResultsIMR fell from 5.7 to 3.2 deaths per 1000 live births between 2000 and 2018, with no change in trend identified. Stillbirth rates were relatively static between 2000 and 2008 but experienced accelerated reduction from 2009 onwards. When stratified by SEP, inequalities in IMR and stillbirth rates persisted throughout the study and were greatest amongst the sub-group of post-neonates. Although comparison of the SII and RII in IMR and stillbirths before and after 2010 suggested that inequalities remained stable, descriptive trends in mortality rates displayed a 3-year rise in the most deprived quintiles from 2016 onwards.ConclusionWhilst Scotland has experienced downward trends in IMR and stillbirth rates between 2000 and 2018, the persistence of socio-economic inequalities and suggestion that mortality rates amongst the most deprived groups may be worsening warrants further action to improve maternal health and strengthen support for families with young children.
Highlights
As Scotland strives to become a country where children flourish in their early years, it is faced with the challenge of socio-economic health inequalities, which are at risk of widening amidst austerity policies
In the context of concerning trends elsewhere in the United Kingdom (UK), and with a strong policy focus on early life health in Scotland, this study aimed to investigate trends in infant mortality rates (IMR) by socio-economic position (SEP) in Scotland, between 2000 and 2018 and examine if there was a change in absolute or relative inequality before and after the introduction of austerity in 2010
Time trends in infant mortality and stillbirth rates over time Observing Fig. 3, between 2000 and 2018, the IMR in Scotland decreased from 5.7 to 3.2 deaths per 1000 live births. In the latter years the downward trends appeared to flatten, with IMR fluctuating between 3.2–3.3 deaths per 1000 live births between 2016 and 2018 but addition of break points to the negative binomial regression models did not improve the Bayesian Information Criterion (BIC) and so it was concluded that there was insufficient evidence to indicate a break point in trend over time
Summary
As Scotland strives to become a country where children flourish in their early years, it is faced with the challenge of socio-economic health inequalities, which are at risk of widening amidst austerity policies. Persistent socio-economic inequalities in IMR in the UK are a cause for concern, with infants from the most deprived areas in England having a 94% higher risk of death compared to infants from the least deprived areas [4, 5]. The impact of austerity on mortality and socio-economic inequalities have been postulated to extend beyond the early years, with studies hypothesising that austerity may be contributing to the observation of stalling and in some instances worsening life expectancy in high-income countries [7]
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