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  • 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

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Original research
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
  1. Charles Opondo1,
  2. Hiranthi Jayaweera2,
  3. Jennifer Hollowell1,
  4. Yangmei Li1,
  5. Jennifer J Kurinczuk1,
  6. Maria A Quigley1
  1. 1 NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2 School of Anthropology, University of Oxford, Oxford, UK
  1. Correspondence to Dr Charles Opondo, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; charles.opondo{at}npeu.ox.ac.uk

Abstract

Background Risks of adverse birth outcomes in England and Wales are relatively low but vary across ethnic groups. We aimed to explore the role of mother’s country of birth on birth outcomes across ethnic groups using a large population-based linked data set.

Methods We used a cohort of 4.6 million singleton live births in England and Wales to estimate relative risks of neonatal mortality, infant mortality and preterm birth, and differences in birth weight, comparing infants of UK-born mothers to infants whose mothers were born in their countries or regions of ethnic origin, or elsewhere.

Results The crude neonatal and infant death risks were 2.1 and 3.2 per 1000, respectively, the crude preterm birth risk was 5.6% and the crude mean birth weight was 3.36 kg. Pooling across all ethnic groups, infants of mothers born in their countries or regions of ethnic origin had lower adjusted risks of death and preterm birth, and higher gestational age-adjusted mean birth weights than those of UK-born mothers. White British infants of non-UK-born mothers had slightly lower gestational age-adjusted mean birth weights than White British infants of UK-born mothers (mean difference −3 g, 95% CI −5 g to −0.3 g). Pakistani infants of Pakistan-born mothers had lower adjusted risks of neonatal death (adjusted risk ratio (aRR) 0.84, 95% CI 0.72 to 0.98), infant death (aRR 0.84, 95% CI 0.75 to 0.94) and preterm birth (aRR 0.85, 95% CI 0.82 to 0.88) than Pakistani infants of UK-born Pakistani mothers. Indian infants of India-born mothers had lower adjusted preterm birth risk (aRR 0.91, 95% CI 0.87 to 0.96) than Indian infants of UK-born Indian mothers. There was no evidence of a difference by mother’s country of birth in risk of birth outcomes among Black infants, except Black Caribbean infants of mothers born in neither the UK nor their region of origin, who had higher neonatal death risks (aRR 1.71, 95% CI 1.06 to 2.76).

Conclusion This study highlights evidence of better birth outcomes among UK-born infants of non-UK-born minority ethnic group mothers, and could inform the design of future interventions to reduce the risks of adverse birth outcomes through improved targeting of at-risk groups.

  • birth weight
  • child health
  • cohort studies
  • epidemiology
  • infant mortality
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/jech-2019-213093

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    Footnotes

    • Correction notice This article has been corrected since it first published online. The word 'significant' has been removed from the paragraph headed 'Sensitivity analysis.'

    • Contributors JH, JK and MQ conceived the study and were responsible for data acquisition. CO performed the statistical analysis with support from HJ, MQ and YL. CO wrote the first draft to which HJ, JH, JK, MQ and YL contributed and provided feedback during its development. All authors approved the final version of the manuscript. CO is responsible for the overall content as guarantor.

    • Funding This paper reports on an independent study which was funded by the NIHR Policy Research Programme in the Department of Health and Social Care, England (grant 108/0001). The Department of Health was not involved in any aspects of the study, and the views expressed are not necessarily those of the Department.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The project was approved by the NRES Committee South Central - Oxford B, Ref 15/SC/0493.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. The data were provided by the Office for National Statistics (ONS) under a contractual agreement that does not permit the sharing of data. All requests for data access should be made directly to the ONS.