Infant Mortality In England Research Articles

Race and Ethnicity, Deprivation, and Infant Mortality in England, 2019-2022

England has one of the highest infant mortality rates in Europe. Much of the variation in infant mortality rates between races and ethnicities may be due to socioeconomic factors, but how deprivation and race and ethnicity are associated with infant mortality is unclear. To investigate the association of infant race and ethnicity with the infant mortality rate in England, adjusted for preterm birth and level of deprivation. This cohort study included children who died younger than 1 year of age, born at or after 22 weeks' gestation, occurring from April 1, 2019, to March 31, 2022, in England. Characteristics of the infant were derived from death notifications. The racial and ethnic groups were derived from National Health Service data and were reported by the parents and characterized using the Office of National Statistics classification: Asian or Asian British (Bangladeshi, Chinese, Indian, Pakistani, or any other Asian background), Black or Black British (African, Caribbean, or any other Black background), multiracial (White and Asian, White and Black African, White and Black Caribbean, or any other multiracial background), White or White British (British, Irish, any other White background, or Gypsy or Irish Traveler), and other (Arab or any other racial or ethnic group). Risk of death for all racial and ethnic groups and relative risk of death compared with the reference group (White) were calcuated. Analyses were repeated, adjusting for deprivation, gestational age of infants, and region of England. A total of 5621 infants who died younger than 1 year of age were reported to the National Child Mortality Database. A total of 2842 of 5130 infants (55.4%) were male; the median gestational age was 33 weeks (IQR, 25-38 weeks); of 5149 infants, 927 (18.0%) were Asian, 448 (8.7%) were Black, 3318 (64.4%) were White, 343 (6.7%) were multiracial, and 113 (2.2%) were from other racial and ethnic groups; and the median deprivation score was 4 (IQR, 3-5). In the unadjusted analysis, the relative risk of death compared with White infants was higher for Black (1.93 [95% CI, 1.75-2.13]) and Asian (1.67 [95% CI, 1.55-1.80]) infants. The population attributable risk fraction for all mortality rates among infants who were not White was 12.0% (95% CI, 10.3%-13.8%) (unadjusted), 9.8% (95% CI, 8.0%-11.7%) (adjusted for deprivation), 7.7% (95% CI, 5.9%-9.5%) (adjusted for gestational age at birth), and 12.8% (95% CI, 11.0%-14.5%) (adjusted for region of England). This cohort study suggests that the proportion of infants who died before 1 year of age is associated with race and ethnicity, with a population attributable risk fraction of 12.0%. An overconservative adjustment for deprivation did not explain the overall patterns seen. Approximately half the population attributable risk fraction may be due to increased risk of preterm birth in Asian and Black communities. Work is needed to identify what can be done to reduce this incidence of infant mortality.

Infant Mortality in England, 1538-2000: Stability and the Beginnings of Change, 1837-1910

This paper, the third of four, discusses infant mortality during the Victorian and Edwardian periods, 1837-1910. It mainly uses sources generated by the civil registration of vital events, which was established in 1837, to identify trends and patterns, and more importantly, it discusses the beginnings of the secular decline in infant mortality that occurred during this period. The paper also includes examples of how research into this important topic can be carried out and it ends with suggestions for future research.

Infant mortality in England, 1538–2000: the parish register period, 1538–1837

This paper, the second of four, examines patterns and trends in infant mortality during the period 1538–1837 when the principal source available to examine these issues is parish registers. It explains how to calculate infant mortality rates from parish registers, identifies trends and discusses possible explanations for the patterns of change identified. The paper also shows how new estimates of infant mortality can be readily undertaken and ends with suggestions for future research.

Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000–2017: time trend analysis

ObjectiveTo determine whether there were inequalities in the sustained rise in infant mortality in England in recent years and the contribution of rising child poverty to these trends.DesignThis is an...

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

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...

Infant Mortality in England, 1538-2000: Trends, Methods and Sources

The infant mortality rate is considered to be one of the most important indicators of demographic well-being since infants are amongst the most vulnerable groups within society and their survival is influenced by a wide range of socioeconomic factors. This paper, the first of four, examines the trend in infant mortality over four centuries. It discusses the methods and sources needed to study infant mortality and it also establishes a framework whereby the various influences on infant mortality can be assessed.

Infant mortality and adult wellbeing: Evidence from wartime Britain

A growing literature argues that early environments affecting childhood health may influence significantly later-life health and socioeconomic status. In this article, we present new evidence on the relationship between infant mortality and later-life outcomes using variation in infant mortality in England and Wales at the onset of World War II. We exploit the variation in infant mortality across birth cohorts and regions to estimate associations between infant mortality and adult outcomes, such as health, disability, and employment. Our findings suggest that exposure to a higher infant mortality environment is significantly associated with higher likelihood of reporting poor health, a higher likelihood of reporting a disability, a lower probability of employment, and a higher probability of reporting no earned income. We also find that the effects of the infant health environment do not become manifest until after age 55.

1.5-O6Working ‘with and against’ ethnic categories to understand and tackle health inequalities: illustrations from research and practice relating to infant mortality in England

1.5-O6Working ‘with and against’ ethnic categories to understand and tackle health inequalities: illustrations from research and practice relating to infant mortality in England

The contribution of gestational age, area deprivation and mother's country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data.

ObjectivesWe aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother’s country of birth, and prematurity to these variations.MethodsWe analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006–2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age.ResultsIn the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89–1.17) and Black African infants (1.17, 1.06–1.29) but not in Pakistani (2.32, 2.15–2.50), Bangladeshi (1.47, 1.28–1.69), and Indian infants (1.24, 1.11–1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (<28, 28–31, 32–33, 34–36 weeks) fully explained increased risks in Black but not Pakistani and Bangladeshi infants. Sensitivity analyses with further adjustment for small for gestational age, or excluding deaths due to congenital anomalies did not fully explain the excess risk in South Asian groups.ConclusionsHigher infant mortality in South Asian and Black infants does not appear to be explained by sociodemographic characteristics. Higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups. Strategies targeting the prevention and management of preterm birth in Black groups and suboptimal birthweight and modifiable risk factors for congenital anomalies in South Asian groups might help reduce ethnic inequalities in infant mortality.

Gestation‐specific infant mortality in England and Wales, 2009

Gestation‐specific infant mortality in England and Wales, 2009

Different Places, Different Stories: Infant Mortality Decline in England and Wales, 1851–1911

This article presents a substantive analysis using the Great Britain Historical Geographical Information System (GIS), one of the earliest national historical GISs. It develops exploratory techniques to explore local patterns of demographic change and applies these to the study of infant mortality in England and Wales from 1851 to 1911. The techniques developed could be applied to a wide variety of fields where the aim is to explore long-term spatio-temporal change using data published for administrative units that are affected by boundary changes. The Victorian and Edwardian eras saw the origins of the sustained infant mortality decline that characterized the entire twentieth century. Although the period has been extensively studied for a century and more, our knowledge of this vital phase is still surprisingly limited. In particular, much of the research to date has focused on urban areas and has thus stressed urban explanations as to why infant mortality began to decline. Because this article uses a comprehensive GIS database, we are able to challenge some of the orthodoxies that have emerged. It reveals that patterns of infant mortality decline in different parts of the country were more complex than has previously been described. Far from the national rate being driven by changes in urban areas, the largest declines and earliest declines in infant mortality were found in rural parts of the southeast of England, as the rural periphery lagged far behind. Urban areas were slow to decline due to the specific conditions that existed in them in this period.

Predicting the impact of in vitro fertilisation and other forms of assisted conception on perinatal and infant mortality in England and Wales: examining the role of multiplicity

The increased risk of perinatal and infant mortality observed among in vitro fertilisation (IVF) births and other assisted conception births is thought to be largely attributable to multiplicity. Using mortality statistics and estimates of the proportion of births following infertility treatment, we predicted the excess stillbirths and infant deaths associated with twins and higher order births resulting from assisted conception in England and Wales. According to our results, approximately 73 deaths could have been avoided in 2001 if all IVF infants had been born as singletons or as naturally occurring monozygotic twins, equating to a population attributable risk fraction of around 1% for perinatal and infant deaths. If we include all types of assisted conception, this figure was estimated to be around 4% of deaths-more than 220 perinatal and infant deaths in 2001. We confirm the public health importance of multiple births associated with assisted conception.

Investigating variations in infant mortality in England and Wales by mother's country of birth, 1983–2001

The aim of this study was to investigate variations in infant mortality from 1983 to 2001 by birthweight, registration status, father's social class, age of mother at birth and cause of death, among babies of mothers born in countries that represent the largest ethnic minority groups in England and Wales. A total of 70,208 infant death registration records linked to their corresponding birth registration records were used. The study focused on infant deaths of babies of mothers born in the UK, Republic of Ireland, Caribbean, West Africa, East Africa, India, Pakistan and Bangladesh. From 1983 to 2001 infant mortality rates decreased overall, and this was also apparent in the rates by mother's country of birth. Overall, babies of mothers born in Pakistan consistently had the highest infant mortality rates. Low-birthweight babies of mothers born in West Africa had the highest infant, neonatal and postneonatal death rates. Differences were also seen by registration status, mother's age and between manual and non-manual occupations for all countries from 1983 to 2001. For babies of mothers born in the UK, Caribbean and West Africa, immaturity-related conditions were the most common cause of infant deaths. The leading cause of infant death among babies of mothers born in Pakistan and Bangladesh was congenital anomalies.

Small area variations in infant mortality in England and Wales in the inter-war period and their link with socio-economic factors

This paper considers the changing spatial pattern of infant mortality during the inter-war years (1921–1936) at Local Government District level in England and Wales. As well as vital statistics data for these areas, also available are 1921 and 1931 Census data on unemployment, housing, occupational structure and population density, with additional data on unemployment from 1927 to 1936 for the 62 counties in which Districts are located. The statistical analysis relating changing District mortality to these characteristics derives mortality gradients across categorical forms of the social indicators, and assesses impacts of model re-specification to allow for spatio-temporal correlation. Time varying gradients across unemployment, housing and policy status are then investigated with a view to assessing whether there was a widening in mortality inequalities in the regionalized economic depression of the 1930s.

Quantifying and explaining changes in geographical inequality of infant mortality in England and Wales since the 1890s

AbstractThis paper considers the changing spatial pattern of infant mortality in England and Wales over the last century for a constant area definition. The analysis proceeds at the level of registration districts as defined in the 1890s, generated using the British Isles Historical Geographical Information System. Infant mortality at this spatial definition is followed over four points in time, the most recent being the early 1990s. Using a variety of inequality measures, the analysis demonstrates a decline in relative small‐area differentials in the chances of infant deaths up to 1958, but some resurgence since then. Regression methods are then used to evaluate the effect of available social variables, such as population density and housing conditions. The analysis incorporates adjustments for the sampling variability in what are often small counts of infant deaths by adopting ‘pooling strength’ techniques. Urban–rural differentiation has followed the same evolution: it was most marked in the 1890s and reappears by the 1990s, after being reduced somewhat in the earliest years of the UK National Health Service. Differentials in infant mortality according to the housing quality and economic status of different registration districts also gain in importance in the twentieth century compared with the 1890s. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Quantifying and explaining changes in geographical inequality of infant mortality in England and Wales since the 1890s

Quantifying and explaining changes in geographical inequality of infant mortality in England and Wales since the 1890s

Infant feeding practices and infant mortality in England, 1900–1919

Studies of infant mortality in both historical and modern populations from around the world have shown that the most important single factor affecting the infant mortality rate (IMR) is the way in which babies are fed. When methods of infant feeding are unsatisfactory or dangerous, mortality is high; when improvements are made in feeding practices, mortality falls, often dramatically, in a short period of time. The degree to which changes in infant feeding alone can affect IMRs depends on other factors in the population concerned, primarily the health and nutritional status of the mother; sanitary conditions both within the household and in the surrounding environment; levels of endemic and epidemic diseases; the degree of wealth, education and sophistication of the population; and, if women are employed outside the home, the provision made for infant feeding and care by the child's family and by society.This article examines infant feeding practices in England during the first two decades of the twentieth century, arguably the most important 20 years in the fall in that nation's IMR between 1870 and 1920. The 1900s and 1910s saw many major changes in the ways in which infants were fed in all sections of society. Instigated by government, local Medical Officers of Health and their staff and voluntary organizations, the effect of the infant welfare movement in England in this period was that infants and their mothers were significantly better fed, cared for and able to resist disease in 1919 than in 1900.

Urban-rural differentials in infant mortality in Victorian England.

This paper examines the magnitude of urban-rural differentials in infant mortality in England during the nineteenth and early twentieth centuries and also compares the timing of decline for a selection of towns of varying size, and their immediate rural hinterlands. Most towns continued to experience short-term fluctuations in infant mortality until the very end of the nineteenth century; however, in some of the adjacent rural communities--where levels of infant mortality were much lower--conditions were sufficiently favourable to allow a continuous decline in infant mortality from at least the 1860s, if not before. The final part of the paper considers the causes of these patterns and their implications for explanations of infant mortality decline.

Thinking of England and taking care: family building strategies and infant mortality in England and Wales, 1891-1911.

"Debates concerning the origins and development of the late nineteenth- to early twentieth-century declines in marital fertility and infant mortality in England and Wales have been centred largely on the material provided by answers to the ¿special' questions in the 1911 census. In their published form these figures have restricted researchers to an examination of large scale geographic and social class differences in the levels and rates of decline of the two phenomena. This paper outlines research conducted on a sample of individual census returns from the 1911 census. From this data it becomes clear that for Victorian and Edwardian England ¿where one lived' was rather more important than ¿who one was' in determining both family building strategies and the survival of those children born."

La mortalité infantile en Grande-Bretagne : un bilan des connaissances historiques

This paper provides a concise review of what is known about long-term trends in infant mortality rates in Britain since the middle of the sixteenth century. It considers, first, various estimates of infant mortality based on E.A. Wrigley and R.S. Schofield's estimâtes of life expectancy at birth for England, 1541-1871, which it compares with equivalent series for groups of parishes and the families of the British peerage. Secondly, it explores the variations between infant mortality rates that were likely in different forms of environment, especially the urban and the rural. Thirdly, the paper suggests that the conditions affecting an individual's mortality in infancy may also have had a bearing on that same individual's life chance in adulthood. It considers this possibility further using Thomas Hollingsworth's data for the British peerage. Fourthly, the paper attempts to provide some estimates of the social class variations in infant mortality in England and Wales in comparison with those in the USA at the end of the nineteenth and early years of the twentieth century. Lastly, some of these regularities are considered form an epidemiological perspective by examining cause of death patterns among children.