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  • Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis

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Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis
  1. Akilew A Adane1,2,
  2. Helen D Bailey1,
  3. Rhonda Marriott2,
  4. Brad M Farrant1,
  5. Scott W White3,4,
  6. Carrington C J Shepherd1,2,5
  1. 1 Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
  2. 2 Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia
  3. 3 Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, Western Australia, Australia
  4. 4 Maternal Fetal Medicine Service, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
  5. 5 Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
  1. Correspondence to Dr Akilew A Adane, Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Western Australia, Australia; akilew.adane{at}murdoch.edu.au

Abstract

Background The health disadvantages faced by Australian Aboriginal peoples are evidenced in early life, although few studies have focused on the reasons for population-level inequalities in more severe adverse outcomes. This study aimed to examine the scale of disparity in severe neonatal morbidity (SNM) and mortality between Aboriginal and non-Aboriginal births and quantify the relative contributions of important maternal and infant factors.

Method A retrospective cohort study with singleton live births (≥32 weeks’ gestation) was conducted using Western Australia linked whole population datasets, from 1999 to 2015. Aboriginal status was determined based on the mothers’ self-reported ethnic origin. An Australian validated indicator was adapted to identify neonates with SNM. The Oaxaca-Blinder method was employed to calculate the contribution of each maternal and infant factor to the disparity in SNM and mortality.

Results Analyses included 425 070 births, with 15 967 (3.8%) SNM and mortality cases. The disparity in SNM and mortality between Aboriginal and non-Aboriginal births was 2.9 percentage points (95% CI 2.6 to 3.2). About 71% of this gap was explained by differences in modelled factors including maternal area of residence (23.8%), gestational age (22.2%), maternal age (7.5%) and antenatal smoking (7.2%).

Conclusions There is a considerable disparity in SNM and mortality between Aboriginal and non-Aboriginal births in Western Australia with the majority of this related to differences in maternal sociodemographic factors, antenatal smoking and gestational age. Public health programmes targeting these factors may contribute to a reduction in early life health differentials and benefit Aboriginal population health through the life course.

  • epidemiology
  • health inequalities
  • infant
  • newborn
  • perinatal epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplementary information.

https://doi.org/10.1136/jech-2020-214507

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as online supplementary information.

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    Footnotes

    • Contributors AAA, CCJS and HDB conceived and designed the study. BMF, RM and SWW participated in the design of the study. AAA conducted all statistical analysis and drafted the manuscript. All authors critically reviewed and approved the final manuscript.

    • Funding This research was supported by funding from an Australian National Health and Medical Research Council (NHMRC) Project Grant (GNT1127265) which funded AAA, HDB and CCJS. BMF is funded by the Australian National Health and Medical Research Council (Project Grant 1098844).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.