The contribution of gestational age, area deprivation and mother's country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data

• Published in: PloS one 2018-04, Vol.13 (4), p.e0195146-e0195146
• Main Authors: Li, Yangmei, Quigley, Maria A, Dattani, Nirupa, Gray, Ron, Jayaweera, Hiranthi, Kurinczuk, Jennifer J, Macfarlane, Alison, Hollowell, Jennifer
• Format: Article
• Language: English
• Subjects: Adjustment; Age; Analysis; Biology and Life Sciences; Birth; Birth weight; Births; Childbirth & labor; Cohort analysis; Congenital anomalies; Congenital defects; Cultural differences; Deprivation; Ethnicity; Gestational age; Health risk assessment; Infant mortality; Infants; Influence; Maternal & child health; Medicine and Health Sciences; Minority & ethnic groups; Mortality; People and Places; Premature birth; Regression analysis; Risk analysis; Risk factors; Sensitivity analysis; Small for gestational age; Studies; Systematic review; Variation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0195146

We aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother's country of birth, and prematurity to these variations. We analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006-2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age. In the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89-1.17) and Black African infants (1.17, 1.06-1.29) but not in Pakistani (2.32, 2.15-2.50), Bangladeshi (1.47, 1.28-1.69), and Indian infants (1.24, 1.11-1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (