Socioeconomic inequalities in survival and provision of neonatal care- population based study of very preterm infants..pdf (99.55 kB)
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Socioeconomic inequalities in survival and provision of neonatal care: Population based study of very preterm infants

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journal contribution
posted on 24.10.2012, 09:20 by Lucy K. Smith, Elizabeth S. Draper, Bradley N. Manktelow, David J. Field
Objectives To assess socioeconomic inequalities in survival and provision of neonatal care among very preterm infants. Design Prospective cohort study in a geographically defined population. Setting Former Trent health region of the United Kingdom (covering about a twelfth of UK births). Participants All infants born between 22+0 and 32+6 weeks’ gestation from 1 January 1998 to 31 December 2007 who were alive at the onset of labour and followed until discharge from neonatal care. Main outcome measures Survival to discharge from neonatal care per 1000 total births and per 1000 very preterm births. Neonatal care provision for very preterm infants surviving to discharge measured with length of stay, provision of ventilation, and respiratory support. Deprivation measured with the UK index of multiple deprivation 2004 score at super output area level. Results 7449 very preterm singleton infants were born in the 10 year period. The incidence of very preterm birth was nearly twice as high in the most deprived areas compared with the least deprived areas. Consequently rates of mortality due to very preterm birth per 1000 total births were almost twice as high in the most deprived areas compared with the least deprived (incidence rate ratio 1.94, 95% confidence interval 1.62 to 2.32). Mortality rates per 1000 very preterm births, however, showed little variation across all deprivation fifths (incidence rate ratio for most deprived fifth versus least deprived 1.02, 0.86 to 1.20). For infants surviving to discharge from neonatal care, measures of length of stay and provision of ventilation and respiratory support were similar across all deprivation fifths. Conclusions The burden of mortality and morbidity is greater among babies born to women from deprived areas because of increased rates of very preterm birth. After very preterm birth, however, survival rates and neonatal care provision is similar for infants from all areas.

Funding

This study was funded by NHS research and development funds from healthcare commissioners in the Trent region and by Action Medical Research.

History

Citation

BMJ 2009;339:b4702

Published in

BMJ 2009;339:b4702

Publisher

BMJ Publishing Group

issn

0959-8138

eissn

1756-1833

Acceptance date

30/09/2009

Available date

24/10/2012

Publisher version

http://www.bmj.com/content/339/bmj.b4702

Notes

Data sharing: Requests for data should be made to the corresponding author at lks1@leicester.ac.uk. Requests must be accompanied by a proposal, including an outline protocol and a description of data security measures, as required by original ethics approval.

Language

en

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