Variations in infant and perinatal mortality rates.
Subject: Community health services (Management)
Primary nursing (Research)
Infants (Patient outcomes)
Infants (Demographic aspects)
Infants (Risk factors)
Pub Date: 10/01/2009
Publication: Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 Ten Alps Publishing ISSN: 1462-2815
Issue: Date: Oct, 2009 Source Volume: 82 Source Issue: 10
Topic: Event Code: 200 Management dynamics; 310 Science & research Computer Subject: Company business management
Product: SIC Code: 8399 Social services, not elsewhere classified
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 209163257

Rates of infant death remain high in parts of England, largely among deprived communities and ethnic minorities, a study has found. Infant mortality has been steadily declining in England, but this trend belies significant inequalities in avoidable deaths. Young mothers, those from lower socioeconomic groups, and those from some minority ethnic communities have consistently worse outcomes compared with the rest of the population. The latest Confidential Enquiry into Maternal and Child Health report indicates the underlying risk factors of perinatal mortality cluster around young and old maternal age, high levels of social deprivation and minority ethnic groups. To identify predictors of perinatal and infant mortality variations between primary care trusts (PCTs) and to identify outlier trusts where outcomes were worse than expected, researchers obtained data from the National Centre for Health Outcomes Development. This was on the number of infant and perinatal deaths, ethnicity, deprivation, maternal age, spending on maternal services, and 'Spearhead' status for all 303 PCTs in England. Spearhead status describes the 30% of PCTs that map on to the local authority areas in the bottom fifth nationally for three or more of the following factors: male life expectancy at birth, female life expectancy at birth, cancer mortality in the under 75s, and cardiovascular disease mortality in the under 75s.

Over a three-year period, infant mortality varied by PCT from 1.4 to 10.83 deaths per 1000 live births, and perinatal mortality from 3.93 to 16.66 per 1000 births. A combination of deprivation, ethnicity and maternal age explained 80.5% of the differences in outcome between PCTs, but variation in PCT spending on maternal services did not explain any. Two PCTs had higher than expected rates of perinatal mortality, but neither had Spearhead status. The reasons for this are not clear, say the authors, and further local scrutiny is required to ascertain likely causes and potential solutions. Most PCTs can be confident on the basis of these findings that the social conditions and ethnicity of the communities they serve are more important determinants of these health outcomes than variation in levels of expenditure on maternity services, they conclude. Nevertheless, absolute infant and perinatal mortality rates remain high in parts of England, and the burden of avoidable deaths remains largely with deprived and minority ethnic communities.

Freemantle N, Wood J, Griffin C, Gill P, Calvert M, Shankar A, Chambers J, MacArthur C. What factors predict differences in infant and perinatal mortality in primary care trusts in England? A prognostic model. BMJ, 2009; doi: 10.1136/bmj.b2892 (4 August 2009).
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