PhD student University of Liverpool Liverpool, England, United Kingdom
Background: Babies born to mothers living in more deprived areas are at a higher risk of dying during the neonatal period. Pre-term and unwell term babies are often cared for in neonatal intensive units (NICUs) and this population contributes significantly to the overall neonatal mortality rate. The extent and reasons for any socio-economic and ethnic inequalities in neonatal intensive care outcomes are unclear. Objective: The objective of this analysis is to further understand inequalities in both admission and mortality in babies admitted to NICUs. Design/Methods: For this retrospective analysis we analysed data on 1,005,114 individual babies born between 1st January 2012 and 31st December 2022 in the National Neonatal Research Database (NNRD) for England and Wales. We linked these data to information on small area deprivation of residence and undertook descriptive analyses, to understand inequalities in admission to neonatal intensive care units over time. To explore inequalities in mortality, we assessed inequalities in important risk factors, such as gestational age and maternal ethnicity by index of multiple deprivation (IMD) deciles. Results: Preliminary results show that 13.7% of the population were born to women from the most deprived decile, while only 5.6% were born to women from the least deprived decile, with a clear social gradient evident. 2.6% were extremely preterm, 5.6% were very preterm, 29.1% were moderate to late preterm and 62.6% were term. Babies from more disadvantaged areas were more likely to be born preterm and to die prior to discharge. The dataset captured 11,302 deaths (1.1%), with evidence of a social gradient, whereby 1.5% of babies in the most deprived decile died compared to 1.0% of babies in the least deprived decile. 1.2% of babies from a white ethnic background died, whilst 2.1% and 1.6% of babies from Black and Asian ethnicities died.
Conclusion(s): There are stark inequalities in the number of babies admitted to and who die in NICUs in England and Wales. Ongoing analyses explore the intersection of ethnicity and deprivation on outcomes, and the extent to which inequalities can be explained by differences in care related processes and case mix on admission.
