Risk of child death linked to deprivation

Childhood mortality is linked with socio-economic deprivation, a report by the National Child Mortality Database (NCMD) has revealed. 

The report, Child Mortality and Social Deprivation, which is based on data for children who died between April 2019 and March 2020 in England, finds a clear association between the risk of child death and the level of deprivation (for all categories of death except cancer).

More specifically, the report found that more than a fifth of all child deaths might be avoided if children living in the most deprived areas had the same mortality risk as those living in the least deprived, which translates to more than 700 fewer children dying per year in England.

Commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, this report includes analysis of 3,347 children who died in England between April 1, 2019, and March 31, 2020, and investigates the characteristics of their deaths to identify if socio-economic deprivation is associated with childhood mortality.

The most common age at death was less than 1 year (63%) and more boys than girls died (56.5% vs 43.5%), while the majority of children who died lived in urban areas (87.8%).

By linking each child’s address to the UK government’s ten deciles of deprivation (calculated using seven indicators of income, employment, education, health, crime, access to housing and services, and living environment), it was determined that child mortality increased as deprivation increased. More specifically, on average, there was a 10% increase in the risk of death between each decile* of increasing deprivation.

For deaths that were reviewed by a Child Death Overview Panel (CDOP) as part of the national Child Death Review (CDR) process, this report is able to provide further insights.

A total of 2,738 child deaths were reviewed in the period from 1 April 2019 to 31 March 2020 (though the year of death ranged from 2012 to 2020) and, of these, we were able to link 98% to deprivation deciles.

Analysis of these more detailed data shows that the proportion of deaths with modifiable contributory factors increased with increasing deprivation (factors relating to the social environment were the most common). While, overall, at least one in 12 of all child deaths reviewed had one or more factors related to deprivation identified.

Importantly, Child Mortality and Social Deprivation also contains case studies from CDOPs that focus on poverty, with the aim of reducing the number of child deaths where deprivation appears to be a factor going forward.

These exemplar projects highlight the value of using local learning, and provide practical inspiration for the kinds of interventions that could be implemented across the country.

The report’s authors are now calling on policymakers and those involved in planning and commissioning public health services as well as health and social care professionals to use the data in this report to develop, implement and monitor the impact of strategies and initiatives to reduce social deprivation and inequalities.

Professor Karen Luyt, NCMD programme lead said: ‘This analysis shows what can be achieved when we pool our knowledge in order to learn lessons at a national level.

‘We now ask that everyone involved in planning and delivering child health or social care services implement strategies to reduce social deprivation.’

This request is underlined by Professor Sir Michael Marmot, Director of UCL Institute of Health Equity (who published the Marmot Review and its follow-up report on health inequalities in England in 2020) who wrote an insightful foreword for this report.

Known for the Build Back Fairer campaign, he states that ‘In a rich society, deprivation should be avoidable – particularly the kind that leads to deaths of infants and children’.

Not only does he welcome this report’s broad view of ‘avoidable’ (by focussing on deprivation) but he also commends the case studies of both children who have died and CDOPs that are implementing campaigns to reduce deaths related to deprivation.

The Department of Health and Social Care has been contacted for comment.

Photo Credit – Michał Parzuchowski