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Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000–2017: time trend analysis
Abstract
Objective: To determine whether there were inequalities in the sustained rise in infant mortality in England in recent years and the contribution of rising child poverty to these trends. Design: This is an analysis of trends in infant mortality in local authorities grouped into five categories (quintiles) based on their level of income deprivation. Fixed-effects regression models were used to quantify the association between regional changes in child poverty and regional changes in infant mortality. Setting: 324 English local authorities in 9 English government office regions. Participants: Live-born children under 1 year of age. Main outcome measure: Infant mortality rate, defined as the number of deaths in children under 1 year of age per 100 000 live births in the same year. Results: The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266). Conclusion: This study provides evidence that the unprecedented rise in infant mortality disproportionately affected the poorest areas of the country, leaving the more affluent areas unaffected. Our analysis also linked the recent increase in infant mortality in England with rising child poverty, suggesting that about a third of the increase in infant mortality from 2014 to 2017 may be attributed to rising child poverty.
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“Compared with other HICs, the UK and Republic of Ireland (ROI) perform poorly in terms of both infant and maternal mortality.2 10 11”
From Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis (2021) · cites this paper as [2]
In the citing paper
“Austerity has been associated with widening inequalities in a variety of health outcomes, including infant mortality rate.2 107”
From Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis (2021) · cites this paper as [2]
In the citing paper
“As such, poverty experienced by those in lower SES might also be a pathway leading to worse pregnancy outcomes alongside poorer nutrition, housing insecurity, financial stress2 and the wider social determinants of health.”
From Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis (2021) · cites this paper as [2]
In the citing paper
“Consequently, more children are born into poverty with associated inequalities in health outcomes such as those identified in this review, as well as infant mortality that disproportionally impacts deprived communities.2”
From Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis (2021) · cites this paper as [2]
In the citing paper
“Cross-country analysis does, however, suggest there may be important differences in pregnancy outcomes2 10 11 and health more generally.122”
From Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis (2021) · cites this paper as [2]
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Suicides associated with the 2008-10 economic recession in England: time trend analysis
Barr, B., Taylor-Robinson, D., Scott-Samuel, A., McKee, M., & Stuckler, D. (2012) · BMJ · doi:10.1136/bmj.e5142 · Cited by 452
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The COVID-19 pandemic and health inequalities
Bambra, C., Riordan, R., Ford, J., & Matthews, F. (2020) · Journal of Epidemiology and Community Health · doi:10.1136/jech-2020-214401 · Cited by 2,118
Self-citationThomson, K., Moffat, M., Arisa, O., Jesurasa, A., Richmond, C., Odeniyi, A., Bambra, C., Rankin, J., Brown, H., Bishop, J., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-042753 · Cited by 154
Self-citationThe Social Determinants of Health: Time to Re-Think?
Frank, J., Abel, T., Campostrini, S., Cook, S., Lin, V. K., & McQueen, D. V. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17165856 · Cited by 96
Health inequalities are worsening in the North East of England
Corris, V., Dormer, E., Brown, A., Whitty, P., Collingwood, P., Bambra, C., & Newton, J. L. (2020) · British Medical Bulletin · doi:10.1093/bmb/ldaa008 · Cited by 61
Self-citation
Metadata
- Authors
- Taylor-Robinson, D., Lai, E. T. C., Wickham, S., Rose, T., Norman, P., Bambra, C., Whitehead, M., & Barr, B.
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-10
- Volume
- 9
- Issue
- 10
- Pages
- e029424
- ISSN
- 2044-6055
- Cited by
- 100
- References
- 2
- Language
- en
- Funders
- Medical Research Council (MR/P008577/1)
- Wellcome Trust (108538/Z/15/Z)
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