Socioeconomic and ethnic disparities in preterm births in an English maternity setting: a population-based study of 1.3 million births.
Disparity
Ethnicity
Health inequalities
Preterm birth
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
20 Sep 2024
20 Sep 2024
Historique:
received:
01
11
2023
accepted:
17
06
2024
medline:
20
9
2024
pubmed:
20
9
2024
entrez:
19
9
2024
Statut:
epublish
Résumé
Preterm birth is a major cause of infant mortality and morbidity and accounts for 7-8% of births in the UK. It is more common in women from socially deprived areas and from minority ethnic groups, but the reasons for this disparity are poorly understood. To inform interventions to improve child survival and their quality of life, this study examined the socioeconomic and ethnic inequalities in preterm births (< 37 weeks of gestation at birth) within Health Trusts in England. This study investigated socioeconomic and ethnic inequalities in preterm birth rates across the National Health Service (NHS) in England. The NHS in England can be split into different units known as Trusts. We visualised between-Trust differences in preterm birth rates. Health Trusts were classified into five groups based on their standard deviation (SD) variation from the average national preterm birth rate. We used modified Poisson regression to compute risk ratios (RR) and 95% confidence intervals (95% CI) with generalised estimating equations. The preterm birth rate ranged from 6.8/100 births for women living in the least deprived areas to 8.8/100 births for those living in the most deprived areas. Similarly, the preterm birth rate ranged from 7.8/100 births for white women, up to 8.6/100 births for black women. Some Health Trusts had lower than average preterm birth rates in white women whilst concurrently having higher than average preterm birth rates in black and Asian women. The risk of preterm birth was higher for women living in the most deprived areas and ethnicity (Asian). There was evidence of variation in rates of preterm birth by ethnic group, with some Trusts reporting below average rates in white ethnic groups whilst concurrently reporting well above average rates for women from Asian or black ethnic groups. The risk of preterm birth varied substantially at the intersectionality of maternal ethnicity and the level of socioeconomic deprivation of their residency. In the absence of other explanations, these findings suggest that even within the same Health Trust, maternity care may vary depending on the women's ethnicity and/or whether she lives in an area of high socioeconomic deprivation. Thus, social factors are likely key determinants of inequality in preterm birth rather than provision of maternity care alone.
Sections du résumé
BACKGROUND
BACKGROUND
Preterm birth is a major cause of infant mortality and morbidity and accounts for 7-8% of births in the UK. It is more common in women from socially deprived areas and from minority ethnic groups, but the reasons for this disparity are poorly understood. To inform interventions to improve child survival and their quality of life, this study examined the socioeconomic and ethnic inequalities in preterm births (< 37 weeks of gestation at birth) within Health Trusts in England.
METHODS
METHODS
This study investigated socioeconomic and ethnic inequalities in preterm birth rates across the National Health Service (NHS) in England. The NHS in England can be split into different units known as Trusts. We visualised between-Trust differences in preterm birth rates. Health Trusts were classified into five groups based on their standard deviation (SD) variation from the average national preterm birth rate. We used modified Poisson regression to compute risk ratios (RR) and 95% confidence intervals (95% CI) with generalised estimating equations.
RESULTS
RESULTS
The preterm birth rate ranged from 6.8/100 births for women living in the least deprived areas to 8.8/100 births for those living in the most deprived areas. Similarly, the preterm birth rate ranged from 7.8/100 births for white women, up to 8.6/100 births for black women. Some Health Trusts had lower than average preterm birth rates in white women whilst concurrently having higher than average preterm birth rates in black and Asian women. The risk of preterm birth was higher for women living in the most deprived areas and ethnicity (Asian).
CONCLUSIONS
CONCLUSIONS
There was evidence of variation in rates of preterm birth by ethnic group, with some Trusts reporting below average rates in white ethnic groups whilst concurrently reporting well above average rates for women from Asian or black ethnic groups. The risk of preterm birth varied substantially at the intersectionality of maternal ethnicity and the level of socioeconomic deprivation of their residency. In the absence of other explanations, these findings suggest that even within the same Health Trust, maternity care may vary depending on the women's ethnicity and/or whether she lives in an area of high socioeconomic deprivation. Thus, social factors are likely key determinants of inequality in preterm birth rather than provision of maternity care alone.
Identifiants
pubmed: 39300558
doi: 10.1186/s12916-024-03493-x
pii: 10.1186/s12916-024-03493-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
371Informations de copyright
© 2024. The Author(s).
Références
Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattanakul K, Laopaiboon M, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(1):e37–46.
pubmed: 30389451
doi: 10.1016/S2214-109X(18)30451-0
Zeitlin J, Szamotulska K, Drewniak N, Mohangoo AD, Chalmers J, Sakkeus L, Irgens L, Gatt M, Gissler M, Blondel B. Preterm birth time trends in Europe: a study of 19 countries. BJOG. 2013;120(11):1356–65.
pubmed: 23700966
pmcid: 4285908
doi: 10.1111/1471-0528.12281
Preterm birth. https://www.who.int/news-room/fact-sheets/detail/preterm-birth#cms .
Premature birth, management, complications. https://www.intechopen.com/chapters/77092 .
Morgan AS, Mendonça M, Thiele N, David AL. Management and outcomes of extreme preterm birth. BMJ. 2022;376:e055924.
pubmed: 35012942
pmcid: 8744861
doi: 10.1136/bmj-2021-055924
Births in Scottish hospitals. https://publichealthscotland.scot/publications/births-in-scottish-hospitals/births-in-scottish-hospitals-year-ending-31-march-2021/ .
Northern Ireland Public Health Agency: Children’s health in Northern Ireland: a statistical profile of births using data drawn from the Northern Ireland Child Health System, Northern Ireland Maternity System and Northern Ireland Statistics and Research Agency. In. https://www.publichealth.hscni.net/sites/default/files/2023-05/RUAG%20Childrens%20Health%20in%20NI%20-%202021-22%20-%20FINAL.pdf ; 2019.
Birth characteristics in England and Wales: 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2020#:~:text=In%202020%2C%207.4%25%20of%20live,compared%20with%200.15%25%20in%202019 . [ https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2020#:~:text=In%202020%2C%207.4%25%20of%20live,compared%20with%200.15%25%20in%202019 .
Safer maternity care - the national maternity safety strategy - progress and next steps. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/662969/Safer_maternity_care_-_progress_and_next_steps.pdf .
NHS England: Saving babies lives: a care bundle for reducing stillbirth. In. Edited by NHS England. https://www.england.nhs.uk/wp-content/uploads/2016/03/saving-babies-lives-car-bundl.pdf ; 2017.
Story L, Simpson NAB, David AL, Alfirevic ZZ, Bennett PR, Jolly M, Shennan AH. Reducing the impact of preterm birth: preterm birth commissioning in the United Kingdom. Eur J Obstet Gynecol Reprod Biol X. 2019;3:100018.
pubmed: 31403111
pmcid: 6687377
Oliver-Williams C, Fleming M, Wood AM, Smith G. Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980–2008: a historical cohort study. BJOG. 2015;122(11):1525–34.
pubmed: 25626593
pmcid: 4611958
doi: 10.1111/1471-0528.13276
Castanon A, Brocklehurst P, Evans H, Peebles D, Singh N, Walker P, Patnick J, Sasieni P. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study. BMJ. 2012;345:e5174.
pubmed: 22899563
pmcid: 3421237
doi: 10.1136/bmj.e5174
Liu B, Roberts CL, Clarke M, Jorm L, Hunt J, Ward J. Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study. Sex Transm Infect. 2013;89(8):672–8.
pubmed: 24005255
doi: 10.1136/sextrans-2013-051118
Stock SJ, Horne M, Bruijn M, White H, Heggie R, Wotherspoon L, Boyd K, Aucott L, Morris RK, Dorling J, et al. A prognostic model, including quantitative fetal fibronectin, to predict preterm labour: the QUIDS meta-analysis and prospective cohort study. Health Technol Assess. 2021;25(52):1–168.
pubmed: 34751645
pmcid: 8287379
doi: 10.3310/hta25520
Stock SJ, Horne M, Bruijn M, White H, Boyd KA, Heggie R, Wotherspoon L, Aucott L, Morris RK, Dorling J, et al. Development and validation of a risk prediction model of preterm birth for women with preterm labour symptoms (the QUIDS study): a prospective cohort study and individual participant data meta-analysis. PLoS Med. 2021;18(7):e1003686.
pubmed: 34228732
pmcid: 8259998
doi: 10.1371/journal.pmed.1003686
Santhakumaran S, Statnikov Y, Gray D, Battersby C, Ashby D, Modi N. Survival of very preterm infants admitted to neonatal care in England 2008–2014: time trends and regional variation. Arch Dis Child Fetal Neonatal Ed. 2018;103(3):F208-f215.
pubmed: 28883097
doi: 10.1136/archdischild-2017-312748
Smith LK, Hindori-Mohangoo AD, Delnord M, Durox M, Szamotulska K, Macfarlane A, Alexander S, Barros H, Gissler M, Blondel B, et al. Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries. Lancet. 2018;392(10158):1639–46.
pubmed: 30269877
doi: 10.1016/S0140-6736(18)31651-9
Shennan A, Chandiramani M, Bennett P, David AL, Girling J, Ridout A, Seed PT, Simpson N, Thornton S, Tydeman G, et al. MAVRIC: a multicenter randomized controlled trial of transabdominal vs transvaginal cervical cerclage. Am J Obstet Gynecol. 2020;222(3):261.e261-261.e269.
doi: 10.1016/j.ajog.2019.09.040
National Collaborating Centre for Womens Childrens Health. NICE: clinical guidelines. In: Preterm labour and birth. 2015. https://maternityaudit.org.uk/pages/home .
Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco MC, Akolekar R, Cicero S, Janga D, Singh M, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377(7):613–22.
pubmed: 28657417
doi: 10.1056/NEJMoa1704559
Lamont RF, Nhan-Chang CL, Sobel JD, Workowski K, Conde-Agudelo A, Romero R. Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011;205(3):177–90.
pubmed: 22071048
pmcid: 3217181
doi: 10.1016/j.ajog.2011.03.047
MacDorman MF, Thoma M, Declercq E, Howell EA. The relationship between obstetrical interventions and the increase in U.S. preterm births, 2014–2019. PLoS One. 2022;17(3):e0265146.
pubmed: 35353843
pmcid: 8967025
doi: 10.1371/journal.pone.0265146
Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, Moller AB, Say L, Hosseinpoor AR, Yi M, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341–8.
pubmed: 30322584
doi: 10.1016/S0140-6736(18)31928-7
Zeitlin J, Alexander S, Barros H, Blondel B, Delnord M, Durox M, Gissler M, Hindori-Mohangoo AD, Hocquette A, Szamotulska K, et al. Perinatal health monitoring through a European lens: eight lessons from the Euro-Peristat report on 2015 births. BJOG. 2019;126(13):1518–22.
pubmed: 31260601
doi: 10.1111/1471-0528.15857
Delnord M, Hindori-Mohangoo AD, Smith LK, Szamotulska K, Richards JL, Deb-Rinker P, Rouleau J, Velebil P, Zile I, Sakkeus L, et al. Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data? BJOG. 2017;124(5):785–94.
pubmed: 27613083
doi: 10.1111/1471-0528.14273
Delnord M, Mortensen L, Hindori-Mohangoo AD, Blondel B, Gissler M, Kramer MR, Richards JL, Deb-Rinker P, Rouleau J, Morisaki N, et al. International variations in the gestational age distribution of births: an ecological study in 34 high-income countries. Eur J Public Health. 2018;28(2):303–9.
pubmed: 29020399
doi: 10.1093/eurpub/ckx131
Thomson K, Moffat M, Arisa O, Jesurasa A, Richmond C, Odeniyi A, Bambra C, Rankin J, Brown H, Bishop J, et al. Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis. BMJ Open. 2021;11(3):e042753.
pubmed: 33722867
pmcid: 7959237
doi: 10.1136/bmjopen-2020-042753
Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261–9.
pubmed: 18207020
doi: 10.1016/S0140-6736(08)60136-1
Aughey H, Blotkamp A, Carroll F, Geary R, Gurol-Urganci I, Harris T, Hawdon J, Heighway E, Jardine J, Knight H, et al. National Maternity and Perinatal Audit clinical report 2019. In. https://www.hqip.org.uk/resource/national-maternity-and-perinatal-audit-nmpa-clinical-report-2019/ : HQIP; 2019.
Births QMI. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/methodologies/birthsqmi .
Lower layer super output area population estimates (supporting information). https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/lowersuperoutputareamidyearpopulationestimates .
Lloyd CD, Norman PD, McLennan D. Deprivation in England, 1971–2020. Appl Spat Anal Policy. 2023;16(1):461–84.
pubmed: 36405332
doi: 10.1007/s12061-022-09486-8
Zou GY, Donner A. Extension of the modified Poisson regression model to prospective studies with correlated binary data. Stat Methods Med Res. 2011;22(6):661–70.
pubmed: 22072596
doi: 10.1177/0962280211427759
Yelland LN, Salter AB, Ryan P. Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. Am J Epidemiol. 2011;174(8):984–92.
pubmed: 21841157
doi: 10.1093/aje/kwr183
Aughey H, Jardine J, Knight H, Gurol-Urganci I, Walker K, Harris T, van der Meulen J, Hawdon J, Pasupathy D. Iatrogenic and spontaneous preterm birth in England: a population-based cohort study. BJOG. 2023;130(1):33–41.
pubmed: 36073305
doi: 10.1111/1471-0528.17291
Dekker GA, Lee SY, North RA, McCowan LM, Simpson NA, Roberts CT. Risk factors for preterm birth in an international prospective cohort of nulliparous women. PLoS ONE. 2012;7(7):e39154.
pubmed: 22815699
pmcid: 3398037
doi: 10.1371/journal.pone.0039154
Zhang Z. Multiple imputation with multivariate imputation by chained equation (MICE) package. Ann Transl Med. 2016;4(2):30.
pubmed: 26889483
pmcid: 4731595
Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991;10(4):585–98.
pubmed: 2057657
doi: 10.1002/sim.4780100410
Sterne JA, Davey Smith G. Sifting the evidence-what’s wrong with significance tests? BMJ. 2001;322(7280):226–31.
pubmed: 11159626
pmcid: 1119478
doi: 10.1136/bmj.322.7280.226
Taylor-Robinson D, Agarwal U, Diggle PJ, Platt MJ, Yoxall B, Alfirevic Z. Quantifying the impact of deprivation on preterm births: a retrospective cohort study. PLoS ONE. 2011;6(8):e23163.
pubmed: 21826237
pmcid: 3149630
doi: 10.1371/journal.pone.0023163
Janghorbani M, Stenhouse E, Millward A, Jones RB. Neighborhood deprivation and preterm birth in Plymouth, UK. J Matern Fetal Neonatal Med. 2006;19(2):85–91.
pubmed: 16581603
doi: 10.1080/14767050500363428
Harvey SM, Faber KS. Obstacles to prenatal care following implementation of a community-based program to reduce financial barriers. Fam Plann Perspect. 1993;25(1):32–6.
pubmed: 8432374
doi: 10.2307/2135990
Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, Neilson J, Ezzati M, Koopmans L, Ellwood D, et al. Stillbirths: the way forward in high-income countries. Lancet. 2011;377(9778):1703–17.
pubmed: 21496907
doi: 10.1016/S0140-6736(11)60064-0
McHale P, Maudsley G, Pennington A, Schluter DK, Barr B, Paranjothy S, Taylor-Robinson D. Mediators of socioeconomic inequalities in preterm birth: a systematic review. BMC Public Health. 2022;22(1):1134.
pubmed: 35668387
pmcid: 9172189
doi: 10.1186/s12889-022-13438-9
Li Y, Quigley MA, Macfarlane A, Jayaweera H, Kurinczuk JJ, Hollowell J. Ethnic differences in singleton preterm birth in England and Wales, 2006–12: analysis of national routinely collected data. Paediatr Perinat Epidemiol. 2019;33(6):449–58.
pubmed: 31642102
pmcid: 6900067
doi: 10.1111/ppe.12585
Opondo C, Gray R, Hollowell J, Li Y, Kurinczuk JJ, Quigley MA. Joint contribution of socioeconomic circumstances and ethnic group to variations in preterm birth, neonatal mortality and infant mortality in England and Wales: a population-based retrospective cohort study using routine data from 2006 to 2012. BMJ Open. 2019;9(7):e028227.
pubmed: 31371291
pmcid: 6677942
doi: 10.1136/bmjopen-2018-028227
Abel WM, Efird JT. The association between trust in health care providers and medication adherence among black women with hypertension. Front Public Health. 2013;1:66.
pubmed: 24350234
pmcid: 3860006
doi: 10.3389/fpubh.2013.00066
Armstrong K, Putt M, Halbert CH, Grande D, Schwartz JS, Liao K, Marcus N, Demeter MB, Shea JA. Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care. 2013;51(2):144–50.
pubmed: 23222499
pmcid: 3552105
doi: 10.1097/MLR.0b013e31827310a1
Yeo S. Language barriers and access to care. Annu Rev Nurs Res. 2004;22:59–73.
pubmed: 15368768
doi: 10.1891/0739-6686.22.1.59
Lau YZ, Widdows K, Roberts SA, Khizar S, Stephen GL, Rauf S, Heazell AEP. Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies’ lives care bundle to reduce stillbirth. BMJ Open Qual. 2020;9(2):e000756.
pubmed: 32327423
pmcid: 7254132
doi: 10.1136/bmjoq-2019-000756
Polus S, Lerberg P, Vogel J, Watananirun K, Souza JP, Mathai M, Gulmezoglu AM. Appraisal of WHO guidelines in maternal health using the AGREE II assessment tool. PLoS ONE. 2012;7(8):e38891.
pubmed: 22912662
pmcid: 3418264
doi: 10.1371/journal.pone.0038891
Carlisle N, Care A, Anumba DOC, Dalkin S, Sandall J, Shennan AH. How are hospitals in England caring for women at risk of preterm birth in 2021? The influence of national guidance on preterm birth care in England: a national questionnaire. BMC Pregnancy Childbirth. 2023;23(1):47.
pubmed: 36670432
pmcid: 9854090
doi: 10.1186/s12884-023-05388-w
Watson HA, Seed PT, Carter J, Hezelgrave NL, Kuhrt K, Tribe RM, Shennan AH. Development and validation of predictive models for QUiPP App vol 2: tool for predicting preterm birth in asymptomatic high-risk women. Ultrasound Obstet Gynecol. 2020;55(3):348–56.
pubmed: 31325332
doi: 10.1002/uog.20401
Watson HA, Carlisle N, Seed PT, Carter J, Kuhrt K, Tribe RM, Shennan AH. Evaluating the use of the QUiPP app and its impact on the management of threatened preterm labour: a cluster randomised trial. PLoS Med. 2021;18(7):e1003689.
pubmed: 34228735
pmcid: 8291648
doi: 10.1371/journal.pmed.1003689
Dibben C, Clemens T. Place of work and residential exposure to ambient air pollution and birth outcomes in Scotland, using geographically fine pollution climate mapping estimates. Environ Res. 2015;140:535–41.
pubmed: 26005952
pmcid: 4509782
doi: 10.1016/j.envres.2015.05.010
Opondo C, Jayaweera H, Hollowell J, Li Y, Kurinczuk JJ, Quigley MA. Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: an analysis of linked national data from 2006 to 2012. J Epidemiol Community Health. 2020;74(4):336–45.
pubmed: 31964723
doi: 10.1136/jech-2019-213093
Lynch CD, Zhang J. The research implications of the selection of a gestational age estimation method. Paediatr Perinat Epidemiol. 2007;21(Suppl 2):86–96.
pubmed: 17803622
doi: 10.1111/j.1365-3016.2007.00865.x
Committee opinion no 700: methods for estimating the due date. https://journals.lww.com/greenjournal/fulltext/2017/05000/committee_opinion_no_700__methods_for_estimating.50.aspx .
doi: 10.1097/AOG.0000000000002046