TY - JOUR
T1 - What is the relationship between deprivation, modifiable factors and childhood deaths
T2 - a cohort study using the English National Child MortalityDatabase
AU - Odd, Dawn
AU - Stoianova, Sylvia
AU - Williams, Tom
AU - Odd, Dawn
AU - Kurinczuk, Jennifer J.
AU - Wolfe, Ingrid
AU - Luyt, Karen
N1 - Funding Information:
The National Child Mortality Database (NCMD) Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement in patient outcomes. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. NCAPOP is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies www.hqip.org.uk/national-programmes . NHS England provided additional funding to the NCMD to enable rapid set up of the real-time surveillance system and staff time to support its function but had no input into the data analysis or interpretation.
Funding Information:
Funding The National Child Mortality Database (NCMD) Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement in patient outcomes. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. NCAPOP is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies www.hqip.org.uk/national-programmes. NHS England provided additional funding to the NCMD to enable rapid set up of the real-time surveillance system and staff time to support its function but had no input into the data analysis or interpretation.
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/12/9
Y1 - 2022/12/9
N2 - Objectives The aim of this analysis is to identify the patterns of social deprivation and childhood mortality; and identify potential points where public health, social and education interventions, or health policy may be best targeted. Design Decile of deprivation and underlying population distribution was derived using Office for National Statistics data. The risk of death was then derived using a Poisson regression model, calculating the increasing risk of death for each increasing deprivation decile. Setting England. Participants 2688 deaths before 18 years of age reviewed between April 2019 and March 2020. Main outcome measures The relationship between deprivation and risk of death; for deaths with, and without modifiable factors. Results There was evidence of increasing mortality risk with increase in deprivation decile, with children in the least deprived areas having a mortality of 13.25 (11.78-14.86) per 100 000 person-years, compared with 31.14 (29.13-33.25) in the most deprived decile (RR 1.08 (95% CI 1.07 to 1.10)); with the gradient of risk stronger in children who died with modifiable factors than those without (RR 1.12 (95% CI 1.09 to 1.15)) vs (RR 1.07 (95% CI 1.05 to 1.08)). Deprivation subdomains of employment, adult education, barriers to housing and services, and indoor living environments appeared to be the most important predictors of child mortality Conclusions There is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over one-fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities.
AB - Objectives The aim of this analysis is to identify the patterns of social deprivation and childhood mortality; and identify potential points where public health, social and education interventions, or health policy may be best targeted. Design Decile of deprivation and underlying population distribution was derived using Office for National Statistics data. The risk of death was then derived using a Poisson regression model, calculating the increasing risk of death for each increasing deprivation decile. Setting England. Participants 2688 deaths before 18 years of age reviewed between April 2019 and March 2020. Main outcome measures The relationship between deprivation and risk of death; for deaths with, and without modifiable factors. Results There was evidence of increasing mortality risk with increase in deprivation decile, with children in the least deprived areas having a mortality of 13.25 (11.78-14.86) per 100 000 person-years, compared with 31.14 (29.13-33.25) in the most deprived decile (RR 1.08 (95% CI 1.07 to 1.10)); with the gradient of risk stronger in children who died with modifiable factors than those without (RR 1.12 (95% CI 1.09 to 1.15)) vs (RR 1.07 (95% CI 1.05 to 1.08)). Deprivation subdomains of employment, adult education, barriers to housing and services, and indoor living environments appeared to be the most important predictors of child mortality Conclusions There is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over one-fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities.
KW - EPIDEMIOLOGY
KW - PAEDIATRICS
KW - PUBLIC HEALTH
UR - http://www.scopus.com/inward/record.url?scp=85144540327&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2022-066214
DO - 10.1136/bmjopen-2022-066214
M3 - Article
C2 - 36600341
AN - SCOPUS:85144540327
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 12
M1 - e066214
ER -
