Community child health, public health and epidemiology
Social deprivation and the causes of stillbirth and infant
mortality
Z E S Guildeaa, D L Fonec, F D Dunstanb, J R Siberta, P H T Cartlidgea
a Department
of Child Health, University of Wales College of Medicine, Heath Park,
Cardiff CF14 4XN, UK, b Department of Medical
Computing & Statistics, University of Wales College of Medicine, c Gwent Health Authority,
Mamhilad Park Estate, Pontypool, Gwent, UK
Correspondence to: Dr Cartlidge cartlidge{at}cf.ac.uk
Accepted 30 November
2000
AIMS
To investigate the relation
between social deprivation and causes of stillbirth and infant mortality.
METHODSStillbirths and infant
deaths in 6347 enumeration districts in Wales were linked with the
Townsend score of social deprivation. In 1993-98 there were 211 072
live births, 1147 stillbirths, and 1223 infant deaths. Poisson
regression analysis was used to estimate the magnitude of effect for
associations between the Townsend score and categories of death by age
and the causes of death. The relative risk of death between most and
least deprived enumeration districts was derived.
RESULTSRelative risk of combined
stillbirth and infant death was 1.53 (95% CI 1.35 to 1.74) in the most
deprived compared with the least deprived enumeration districts. The
early neonatal mortality rate was not significantly associated with
deprivation. Sudden infant death syndrome showed a 307% (95% CI 197%
to 456%) increase in mortality across the range of deprivation. Deaths
caused by specific conditions and infection were also associated with
deprivation, but there was no evidence of a significant association
with deaths caused by placental abruption, intrapartum asphyxia, and prematurity.
CONCLUSIONSCollaborative public
health action at national and local level to target resources in
deprived communities and reduce these inequalities in child health is
required. Early neonatal mortality rates and deaths from intrapartum
asphyxia and prematurity are not significantly associated with
deprivation and may be more appropriate quality of clinical care
indicators than stillbirth, perinatal, and neonatal mortality rates.
Keywords: social deprivation; cause of death; stillbirth; mortality
© 2001 by Archives of Disease in Childhood
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