369 - Ethnicity, deprivation, and childhood mortality. Findings from the National Child Mortality Database

Publication Number: 369.4708

David Odd, Cardiff University, Axbridge, England, United Kingdom; Joanna Garstang, University of Birmingham, Birmingham, England, United Kingdom; Tom Williams, University of Bristol, Bristol, England, United Kingdom; Sylvia Stoianova, University of Bristol, Bristol, England, United Kingdom; Karen Luyt, University of Bristol, Bristol, England, United Kingdom

Background: Each year in England around 3400 children die before the age of 18 years. Currently England has one of the highest infant mortality rates in Europe with substantial variation in mortality linked to socioeconomic factors. Similar disparities are seen across the USA and Europe, and understanding the reasons for increased child mortality associated with ethnicity and deprivation is key to addressing this long-standing social inequity

Objective: The aim of this work is to investigate the relationship between childhood mortality (deaths before 18 years of age) and the ethnicity of the child; and how this is related to local measures of deprivation.

Design/Methods: All child deaths in England, born at, or over, a gestation of 22 weeks, from April 1, 2019, to March 31, 2023, notified to the National Child Mortality Database (NCMD), were identified. Category of death was coded and baseline characteristics such as sex, ethnic group, region, gestational age, and local deprivation were recorded. Characteristics and death categories were compared by ethnicity, and the rate of death was calculated using a Poisson distribution. Incident Rate Ratios (IRRs) were derived using White children as a baseline, adjusting for deprivation, age, sex, region of England, and area type. Sensitivity analyses repeated the calculations across different demographics and with detailed ethnic categories.

Results: Over the 48 months, a total of 12,142 eligible deaths were reported to the NCMD. Rate of death varied by ethnicity (p < 0.001). After adjusting for confounders, children from Asian (IRR 2.37 (2.26-2.49), Black (IRR 3.20 (2.99-3.43)) and Other ethnicities (IRR 1.74 (1.56-1.94), but not Mixed backgrounds (IRR 1.06 (0.98-1.14)), had a higher rate of death than White children (Table). The associations for all ethnic groups appeared to attenuate as the local level of deprivation reduced; associations were strongest in the most deprived areas (p < 0.001) (Figure).

Conclusion(s): In England, children from Asian or Asian British, or Black or Black British backgrounds had the highest rate of death before their 18th birthday, and around 1 in 6 deaths in England would be avoided if all children had the rate of death experienced by White children. This association was highest in the youngest children and in the most deprived areas.

Table. Incident rate ratios (IRR) of CYP death by ethnicity, stratified by provisional cause


Figure. Unadjusted rate of death per 100,000 person years, by ethnic group, and local deprivation