Social inequality and infant health in the UK: systematic review and meta-analyses.
OBJECTIVE
To determine the association between area and individual measures of social disadvantage and infant health in the UK.


METHODS
Systematic review and meta-analyses.


METHODS
26 databases and websites, reference lists, experts in the field and hand-searching.


METHODS
36 prospective and retrospective observational studies with socioeconomic data and health outcomes for infants in the UK, published from 1994 to May 2011.


METHODS
2 independent reviewers assessed the methodological quality of the studies and abstracted data. Where possible, study outcomes were reported as ORs for the highest versus the lowest deprivation quintile.


RESULTS
In relation to the highest versus lowest area deprivation quintiles, the odds of adverse birth outcomes were 1.81 (95% CI 1.71 to 1.92) for low birth weight, 1.67 (95% CI 1.42 to 1.96) for premature birth and 1.54 (95% CI 1.39 to 1.72) for stillbirth. For infant mortality rates, the ORs were 1.72 (95% CI 1.37 to 2.15) overall, 1.61 (95% CI 1.08 to 2.39) for neonatal and 2.31 (95% CI 2.03 to 2.64) for post-neonatal mortality. For lowest versus highest social class, the odds were 1.79 (95% CI 1.43 to 2.24) for low birth weight, 1.52 (95% CI 1.44 to 1.61) for overall infant mortality, 1.42 (95% CI 1.33 to1.51) for neonatal and 1.69 (95% CI 1.53 to 1.87) for post-neonatal mortality. There are similar patterns for other infant health outcomes with the possible exception of failure to thrive, where there is no clear association.


CONCLUSIONS
This review quantifies the influence of social disadvantage on infant outcomes in the UK. The magnitude of effect is similar across a range of area and individual deprivation measures and birth and mortality outcomes. Further research should explore the factors that are more proximal to mothers and infants, to help throw light on the most appropriate times to provide support and the form(s) that this support should take.
Support Unit for Research Evidence (SURE), Information Services, Cardiff University, Cardiff, UK.
Alison L
AL
Weightman
Helen E
HE
Morgan
Michael A
MA
Shepherd
Hilary
H
Kitcher
Chris
C
Roberts
Frank D
FD
Dunstan