Aims Infant mortality rates (IMRs) and causes of death vary according to ethnicity in the UK. IMRs are highest in infants of Pakistani ethnicity. Incidence of congenital anomaly (CA) death is higher in Asian infants. Child Death Overview Panels (CDOPs) perform statutory reviews of all child deaths to identify potentially modifiable factors and prevent future deaths. Reviews are multi-professional, detailed, and systematic. Using CDOP data, we aimed to further describe factors associated with CA infant deaths, in an ethnically diverse, deprived district, with a high IMR.
Methods Anonymised CDOP data for all infant deaths 2008– 2013 was used to compare CA deaths (CDOP Category 7 – Chromosomal, genetic and CAs), with deaths from all other causes. IMRs per 1000 live births were calculated using denominator data obtained from maternity information systems, for all causes, and for CA cause, according to ethnic group (Pakistani, White British and Other) and for all ethnic groups combined. Logistic regression analysis was performed to assess independent associations with CA mortality.
Results There were 166 Pakistani, 96 White British and 53 Other deaths. IMRs from all causes (2008–2013) were: Pakistani 9.45 (CI 8.12–10.99), White British 4.09 (CI 3.35–4.99), Other 5.20 (3.98–6.80) and All 6.15 (CI 5.51–6.86). IMRs from CA cause (2008–2013) were: Pakistani 5.46 (CI 4.48–6.66), White British 1.19 (CI 0.83–1.72), Other 1.57 (CI 0.97–2.55) and All 2.73 (CI 2.32–3.22). CA death was independently associated with Pakistani ethnicity (OR 3.40, CI 1.89–6.09), parental consanguinity (OR 4.27, CI 2.32–7.89), and term birth (OR 4.52, CI 2.15– 9.53). CA deaths were not associated with deprivation. CA deaths were less likely to be from limitation of life sustaining treatment (OR 0.38, CI 0.22–0.66), less likely to be ‘modifiable’ (OR 0.18, CI 0.06–0.58), and less likely to be associated with maternal smoking (OR 0.39, CI 0.17–0.89). All p£0.025.
Conclusions The high IMR in this district’s Pakistani infants is substantially explained by an excess of deaths from CA cause. CA deaths occurred more commonly in consanguineous families. Sensitive use of this information may enable better professional and community understanding of genetic inheritance, improve access to appropriate services, and could contribute to reducing congenital anomaly deaths in future.
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