Socioeconomic inequalities in survival and provision of neonatal care: population based study of very preterm infants.
OBJECTIVE
To assess socioeconomic inequalities in survival and provision of neonatal care among very preterm infants.


METHODS
Prospective cohort study in a geographically defined population.


METHODS
Former Trent health region of the United Kingdom (covering about a twelfth of UK births).


METHODS
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.


METHODS
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.
Smith
Lucy K
LK
Department of Health Sciences, University of Leicester, Leicester LE1 6TP. lks1@leicester.ac.uk
Draper
Elizabeth S
ES
Manktelow
Bradley N
BN
Field
David J
DJ
D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D004739:England; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000458:organization & administration / Q000706:statistics & numerical data; D007902:Length of Stay; D018743:Perinatal Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011204:Poverty Areas; D012959:Socioeconomic Factors; D016019:Survival Analysis