Rates of infant death remain high in parts of England, largely among deprived communities and ethnic minorities, finds a study published on bmj.com today.
Despite government targets to reduce the gap in infant mortality, recent data indicate that the rates of both infant and perinatal mortality (death before, during or shortly after birth) remain high in many primary care trusts (PCTs) across England.
PCTs with the worst infant mortality rates have been assigned "spearhead" status by the Department of Health, but it is unclear whether such outcomes arise from poor service provision and lack of expenditure or from patient demographics such as deprivation or ethnicity.
So a team of researchers obtained data on the number of infant and perinatal deaths, ethnicity, deprivation, maternal age, spending on maternal services, and "spearhead" status for all 303 PCTs in England.
They used this data to explain differences in infant and perinatal mortality between PCTs and identify trusts where outcomes were worse than expected.
Over a three-year study period, they found rates of infant mortality varied by PCT from 1.4 to 10.83 deaths per 1,000 live births, and perinatal mortality varied from 3.93 to 16.66 per 1,000 births.
A combination of deprivation, ethnicity and maternal age explained 80.5% of the differences in outcome between PCTs. In contrast, variation in PCT spending on maternal services did not explain any of the observed differences.
Two PCTs had higher than expected rates of perinatal mortality, but neither had "spearhead" status. The reasons for this are not clear, say the authors, and further local scrutiny is required in order to ascertain the likely causes and potential solutions for these extreme results.
On the basis of these findings, most PCTs can be confident that the social conditions and ethnicity of the communities they serve are more important determinants of these particular health outcomes than current variation in levels of expenditure on maternity services, say the authors.
Nevertheless, the absolute rates of infant and perinatal mortality remain high in parts of England, and the burden of avoidable deaths remains largely with deprived communities and ethnic minorities, they conclude.