Childhood Deaths, Deprivation, And Modifiable Factors: Findings From The National Child Mortality Database

ObjectivesThe aim of this analysis is to identify and report the patterns of social deprivation in relation to childhood mortality; and identify potential points where public health, social and education interventions or health policy may be best targeted. DesignDecile of deprivation and underlying population distribution was derived using Office for National Statistics (ONS) data. The risk of death was then derived using a Poisson regression model, calculating the increasing risk of death for each increasing deprivation decile. SettingEngland Participants2688 childhood deaths in England reviewed between the April 2019 and March 2020. Main Outcome MeasuresThe relationship between deprivation and risk of death; for deaths with, and without modifiable factors. ResultsThere was evidence of increasing mortality risk with increase in deprivation decile (RR 1.08 (1.07 to 1.10)), with the gradient of risk stronger in children who died with modifiable factors than those without (RR 1.12 (1.09 to 1.15)) vs (RR 1.07 (1.05 to 1.08)). Deprivation sub-domains of Employment, Adult Education, Barriers to Housing and Services, and Indoor Living Environments appeared to be the most important predictors of child mortality ConclusionsThere is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over a fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment and education, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities.