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Birth Factors Mostly Explain England's Child Mortality Rate

WEDNESDAY, May 9, 2018 -- Birth characteristics largely explain the higher child mortality in England versus Sweden, according to a study published online May 3 in The Lancet.

Ania Zylbersztejn, Ph.D., from the Farr Institute of Health Informatics Research in London, and colleagues used national hospital and administrative data to develop nationally representative cohorts of singleton livebirths in England (3.9 million) and Sweden (1.0 million) between Jan. 1, 2003, and Dec. 31, 2012, with longitudinal follow-up data from hospital admissions and mortality records.

The researchers found that there were 11,392 deaths in England and 1,927 deaths in the Swedish cohort. For England, the unadjusted hazard ratios were 1.66 for 2 to 27 days, 1.59 for 28 to 364 days, and 1.27 for 1 to 4 years, versus the Swedish cohort. Approximately three-quarters of the excess risk of death in England at 2 to 27 days (77 percent) was explained by birth characteristics (e.g., gestational age, birthweight, and congenital anomalies), and an additional 3 percent by socioeconomic factors (e.g., maternal age and socioeconomic status). Similarly, 68 percent of the excess risk of death in England at 28 to 364 days was explained by birth characteristics, and another 11 percent by socioeconomic factors. For deaths between 1 to 4 years, there were no significant differences in the adjusted hazard ratios between the countries.

"Policies to reduce child mortality in England could have most impact by reducing adverse birth characteristics through improving the health of women before and during pregnancy and reducing socioeconomic disadvantage," the authors write.

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Posted: May 2018