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

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.

Publication DOI: https://doi.org/10.1016/j.lanepe.2024.101075
Divisions: College of Health & Life Sciences > Aston Pharmacy School
Funding Information: The authors are grateful to all the patients contributing data to CPRD. This study was completed using the CPRD GOLD data under protocol ID 20_111. RD, AP and SVK acknowledges funding from the Medical Research Council (MC_UU_00022/2), the Scottish Governm
Additional Information: Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).
Uncontrolled Keywords: Cohort study,Infant Mortality,Health Inequality,Socioeconomic Deprivation
Publication ISSN: 2666-7762
Last Modified: 31 Mar 2025 07:27
Date Deposited: 16 Jan 2025 17:53
Full Text Link:
Related URLs: https://www.the ... 0242-4/fulltext (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2024-12
Published Online Date: 2024-10-01
Accepted Date: 2024-09-05
Authors: Ho, Frederick K.
Allan, Max
Shao, Hui
Man, Kenneth K. C.
Jani, Bhautesh D.
Lyall, Donald
Hastie, Claire
Fleming, Michael
Mackay, Daniel
Cleland, John G. F.
Delles, Christian
Dundas, Ruth
Lewsey, Jim
Ip, Patrick
Wong, Ian (ORCID Profile 0000-0001-8242-0014)
Welsh, Paul
Pearce, Anna
Wright, Charlotte M.
Minnis, Helen
Katikireddi, S. Vittal
Pell, Jill P.

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