title: Socioeconomic inequalities in pregnancy outcome associated with Down syndrome: a population-based study.
abstract: OBJECTIVE
  To investigate socioeconomic inequalities in outcome of pregnancy associated with Down syndrome (DS) compared with other congenital anomalies screened for during pregnancy.
  
  
  METHODS
  Retrospective population-based registry study (East Midlands & South Yorkshire in England).
  
  
  METHODS
  All registered cases of DS and nine selected congenital anomalies with poor prognostic outcome (the UK Fetal Anomaly Screening Programme (FASP)9) with an end of pregnancy date between 1 January 1998 and 31 December 2007.
  
  
  METHODS
  Poisson regression models were used to explore outcome measures, including socioeconomic variation in rates of anomaly; antenatal detection; pregnancy outcome; live birth incidence and neonatal mortality. Deprivation was measured using the Index of Multiple Deprivation 2004 at super output area level.
  
  
  RESULTS
  There were 1151 cases of DS and 1572 cases of the nine severe anomalies combined. The overall rate of antenatal detection was 57% for DS, which decreased with increasing deprivation (rate ratio comparing the most deprived tenth with the least deprived: 0.76 (0.60 to 0.97)). Antenatal detection rates were considerably higher for FASP9 anomalies (86%), with no evidence of a trend with deprivation (0.99 95% CI (0.84 to 1.17)). The termination of pregnancy rate following antenatal diagnosis was higher for DS (86%) than the FASP9 anomalies (70%). Both groups showed wide socioeconomic variation in the termination of pregnancy rate (rate ratio: DS: 0.76 (0.58 to 0.99); FASP9 anomalies: 0.80 (0.65 to 0.97)). Consequently, socioeconomic inequalities in live birth and neonatal mortality rates associated with these anomalies arise that were not observed in utero.
  
  
  CONCLUSIONS
  Socioeconomic inequalities exist in the antenatal detection of DS, and subsequent termination rates are much higher for DS than other anomalies. Termination rates for all anomalies are lower in more deprived areas leading to wide socioeconomic inequalities in live born infants with a congenital anomaly, particularly DS, and subsequent neonatal mortality.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Judith L S
authors.initials: JL
authors.lastname: Budd
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Draper
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Robyn R
authors.initials: RR
authors.lastname: Lotto
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Berry
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Lucy K
authors.initials: LK
authors.lastname: Smith
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D004314:Down Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012042:Registries; D012189:Retrospective Studies; D012959:Socioeconomic Factors
keywords: Congenital Abnorm; Epidemiology; Fetal Medicine