Journal Article•
Geographical trends in infant mortality: England and Wales, 1970-2006.
TL;DR: Levels of infant mortality declined over time even in the most deprived areas with a narrowing of absolute differences in rates between areas, but within all regions and local authority types a strong relationship was found between ward level deprivation and infant mortality rates.
Abstract: At national level in England and Wales, infant mortality rates fell rapidly from the early 1970s and into the 1980s. Subnational areas have also experienced a reduction in levels of infant mortality. While rates continued to fall to 2006, the rate of reduction has slowed. Although the Government Office Regions Yorkshire and The Humber, the North West and the West Midlands and the Office for National Statistics local authority types Cities and Services and London Cosmopolitan have experienced relatively large absolute reductions in infant mortality, their rates remained high compared with the national average. Within all regions and local authority types, a strong relationship was found between ward level deprivation and infant mortality rates. Nevertheless, levels of infant mortality declined over time even in the most deprived areas with a narrowing of absolute differences in rates between areas. Areas in which the level of deprivation eased have experienced greater than average reductions in levels of infant mortality.
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TL;DR: There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women.
Abstract: Background: Infant mortality has shown a steady decline in recent years but a marked socioeconomic gradient persists. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but the effectiveness of specific antenatal care programmes as a means of reducing infant mortality in socioeconomically disadvantaged and vulnerable groups of women has not been rigorously evaluated. Methods: We conducted a systematic review, focusing on evidence from high income countries, to evaluate the effectiveness of alternative models of organising or delivering antenatal care to disadvantaged and vulnerable groups of women vs. standard antenatal care. We searched Medline, Embase, Cinahl, PsychINFO, HMIC, CENTRAL, DARE, MIDIRS and a number of online resources to identify relevant randomised and observational studies. We assessed effects on infant mortality and its major medical causes (preterm birth, congenital anomalies and sudden infant death syndrome (SIDS)). Results: We identified 36 distinct eligible studies covering a wide range of interventions, including group antenatal care, clinic-based augmented care, teenage clinics, prenatal substance abuse programmes, home visiting programmes, maternal care coordination and nutritional programmes. Fifteen studies had adequate internal validity: of these, only one was considered to demonstrate a beneficial effect on an outcome of interest. Six interventions were considered ‘promising’. Conclusions: There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women. Several interventions merit further more rigorous evaluation.
162 citations
Cites background from "Geographical trends in infant morta..."
...But throughout this period infant mortality has shown marked and persistent socioeconomic gradients within countries, even in countries with universal healthcare access [2-4]....
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TL;DR: In this paper, the authors use the Townsend index to identify whether small areas have changed their level of deprivation over time and thereby be able to assess the impact of area-based planning initiatives.
Abstract: The measurement of area level deprivation is the subject of a wide and ongoing debate regarding the appropriateness of the geographical scale of analysis, the input indicator variables and the method used to combine them into a single figure index. Whilst differences exist, there are strong correlations between schemes. Many policy-related and academic studies use deprivation scores calculated cross-sectionally to identify areas in need of regeneration and to explain variations in health outcomes. It would be useful then to identify whether small areas have changed their level of deprivation over time and thereby be able to: monitor the effect of industry closure; assess the impact of area-based planning initiatives; or determine whether a change in the level of deprivation leads to a change in health. However, the changing relationship with an outcome cannot be judged if the ‘before’ and ‘after’ situations are based on deprivation measures which use different, often time-point specific variables, methods and geographies. Here, for the whole of the UK, inputs to the Townsend index obtained from the 1991 and 2001 Censuses have been harmonised in terms of variable detail and with the 1991 data converted to the 2001 Census ward geography. Deprivation has been calculated so that the 1991 scores are directly comparable with those for 2001. Change over time can be then identified. Measured in this way, deprivation is generally shown to have eased due to downward trends in levels of lack of access to a car, non-home ownership, household overcrowding but most particularly, to reductions in levels of unemployment. Despite these trends, not all locations became less deprived with gradients of deprivation largely persisting within the UK’s constituent countries and in different area types. For England, Wales and Scotland, the calculation of Townsend scores can readily be backdated to incorporate data from the 1971 and 1981 Censuses to create a 1971–2001 set of comparable deprivation scores. The approach can also be applied to the Carstairs index. Due to differences in data availability prior to 1991, incorporating small areas in Northern Ireland would be challenging.
127 citations
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TL;DR: It is found that male premature mortality rates rose by over 14% in Scotland over the 10-year period between the early 1990s and 2000s in persistently deprived areas and that the rise among men in Scotland was driven by results for Glasgow where mortality rates rising by over 15% during the decade.
70 citations
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TL;DR: It is demonstrated that premature mortality rates increased significantly over this twenty year period in 638 persistently most deprived areas of Scotland, and it is suggested that these persistency most deprived Scottish areas deserve special attention and may be particularly appropriate sites for public health interventions related to these causes of premature death.
49 citations
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TL;DR: In this article, a social distribution of air quality analysis to consider how the distribution changed over the following decade (2001-2011), a period when significant efforts to meet EC air quality directive limits have been made, and air quality has improved.
Abstract: Air quality in Great Britain has improved in recent years, but not enough to prevent the European Commission (EC) taking legal action for non-compliance with limit values. Air quality is a national public health concern, with disease burden associated with current air quality estimated at 29 000 premature deaths per year due to fine particulates, with a further burden due to NO2. National small-area analyses showed that in 2001 poor air quality was much more prevalent in socioeconomically deprived areas. We extend this social distribution of air quality analysis to consider how the distribution changed over the following decade (2001-2011), a period when significant efforts to meet EC air quality directive limits have been made, and air quality has improved. We find air quality improvement is greatest in the least deprived areas, whilst the most deprived areas bear a disproportionate and rising share of declining air quality including non-compliance with air quality standards. We discuss the implications for health inequalities, progress towards environmental justice, and compatibility of social justice and environmental sustainability objectives.
38 citations
References
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TL;DR: Five years after a major reorganisation of England’s neonatal services, large and unexplained variations between regions in mortality among neonates still exist, concludes a new report from the House of Commons Public Accounts Committee.
Abstract: Five years after a major reorganisation of England’s neonatal services, large and unexplained variations between regions in mortality among neonates still exist, concludes a new report from the House of Commons Public Accounts Committee.
England’s 178 neonatal care units were ordered in 2003 to reorganise into 23 regional networks. But that reorganisation has failed to address discrepancies between regions; and two regions, Essex and the Northern, have still not formally merged into unified organisations after five years.
In 2005 the neonatal mortality rate among babies born at more than 22 weeks’ gestation varied from 1.8 deaths per 1000 live births in the Surrey and Sussex region …
3 citations