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Child deaths linked to deprivation could be avoided

Over a fifth of all child deaths could be avoided if children living in the most deprived areas had the same mortality risk as those living in the least deprived regions, research has found.

The Child Mortality and Social Deprivation report found that at least one in 12 of all child deaths reviewed in 2019/20 had one or more factors related to deprivation identified at review.

"As this report makes clear, we are moving in the wrong direction. Infant mortality has risen over the last four years, particularly among families in more deprived areas. Extending the age range to under five mortality, in 2019 the UK ranked 22 out of 23 Western European countries. The report offers rising child poverty in the UK as a potential explanation," said the report, published by The National Child Mortality Database.

The report states that there was a clear association between the risk of death and the level of deprivation for children who died in England between April 2019 and March 2020. This association appeared to exist for all categories of death except malignancy.

The aim of the study was to identify, and quantify, any association between measures of deprivation and childhood mortality in the data reported to the National Child Mortality Database (NCMD) over the 2019/20 year.

The main analysis was based on deaths occurring between 1st April 2019 and the 31st March 2020, for which NCMD has complete coverage. A comparison between the number of deaths notified to NCMD and those reported by ONS from the death registrations was performed, with more complete coverage of all deaths in 2019 than the corresponding ONS data. The cohorts referred to throughout the report are “Cohort 1: Reported deaths” and “Cohort 2: Reviewed deaths”.

A total of 3,347 childhood deaths that occurred between April 2019 and March 2020 were reported to the NCMD. A total of 2,738 deaths among children were reviewed by a CDOP during the year. Deaths are reported to NCMD within 48 hrs, while death registration takes a long time in some cases due to coroner’s investigation or inquests. The main analysis was therefore based on deaths occurring from 1st April 2019 up to 31st March 2020 for which NCMD has complete coverage; however, not all of these deaths will have had a review completed by a CDOP. This is because it can take several months for the review to take place, for instance in sudden, unexpected deaths, requiring investigation by the coroner. In addition to deaths occurring during the year, a second cohort was identified which included deaths that were reviewed by a CDOP between 1st April 2019 and 31st March 2020 as more detailed information including category of death is available once the CDOP review is complete.

In the reported deaths in cohort one, the research found:

  • Of the childhood deaths that occurred between April 2019 and March 2020 which were reported to the NCMD, 96.4% or 3,227 children were linked to deprivation deciles.
  • The most common age at death was less than 1 year (63.0%).
  • A total of 752 of the deaths in Cohort 1 occurred on the first or second day of life.
  • More boys than girls died (56.5% vs 43.5% respectively).
  • The majority of children lived in areas defined as urban (87.8%).
  • Most – 62% - were of a white ethnic background.

As not all of these deaths had yet been reviewed by a CDOP, the category of death was not available for the majority of children (57.8%), but where it was available, perinatal/neonatal event (35.3%) was the most common category.

In the reviewed deaths in cohort two, the research highlighted:

  • Of the 2,738 deaths among children which were reviewed by a CDOP during the year, 2,688  - 98.2% - were linked to deprivation deciles.
  • All deaths reviewed had a category of death allocated, of which the most common was a perinatal/neonatal event (31.4%).
  • The demographic characteristics between the two cohorts were similar.
  • There was strong evidence that the proportion of deaths where a modifiable contributory factor was identified increased with increasing deprivation.

The research highlights that modifiable contributory factors include social environment such as family debt and parental mental health problems, service provision – difficulties accessed support services, physical environment for example poor housing and issues relating to the child such as poor maternal health during pregnancy or extreme prematurity.

“Over a fifth of all child deaths (23%) might be avoided if children who are among the most deprived half of the population had the same mortality risk as the least deprived. This translates to over 700 fewer children dying per year,” the report concluded.

The research recommends that the data in this report is used to develop and monitor the impact of future strategies to reduce social deprivation and inequalities.

Child Mortality and Social Deprivation

National Child Mortality Database Programme Thematic Report

Working Together For Children

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