Background

Socioeconomic deprivation and minority ethnic background are risk factors for adverse pregnancy outcomes. We aimed to quantify the magnitude of these socioeconomic and ethnic inequalities at the population level in England.

Methods

In this cohort study, we used data compiled by the National Maternity and Perinatal Audit, based on birth records from maternity information systems used by 132 National Health Service hospitals in England, linked to administrative hospital data. We included women who gave birth to a singleton baby with a recorded gestation between 24 and 42 completed weeks. Terminations of pregnancy were excluded. We analysed data on stillbirth, preterm birth (<37 weeks of gestation), and fetal growth restriction (FGR; liveborn with birthweight <3rd centile by the UK definition) in England, and compared these outcomes by socioeconomic deprivation quintile and ethnic group. We calculated attributable fractions for the entire population and specific groups compared with least deprived groups or White women, both unadjusted and with adjustment for smoking, body-mass index (BMI), and other maternal risk factors.

Findings

We identified 1 233 184 women with a singleton birth between April 1, 2015, and March 31, 2017, of whom 1 155 981 women were eligible and included in the analysis. 4505 (0·4%) of 1 155 981 births were stillbirths. Of 1 151 476 livebirths, 69 175 (6·0%) were preterm births and 22 679 (2·0%) were births with FGR. Risk of stillbirth was 0·3% in the least socioeconomically deprived group and 0·5% in the most deprived group (p<0·0001), risk of a preterm birth was 4·9% in the least deprived group and 7·2% in the most deprived group (p<0·0001), and risk of FGR was 1·2% in the least deprived group and 2·2% in the most deprived group (p<0·0001). Population attributable fractions indicated that 23·6% (95% CI 16·7–29·8) of stillbirths, 18·5% (16·9–20·2) of preterm births, and 31·1% (28·3–33·8) of births with FGR could be attributed to socioeconomic inequality, and these fractions were substantially reduced when adjusted for ethnic group, smoking, and BMI (11·6% for stillbirths, 11·9% for preterm births, and 16·4% for births with FGR). Risk of stillbirth ranged from 0·3% in White women to 0·7% in Black women (p<0·0001); risk of preterm birth was 6·0% in White women, 6·5% in South Asian women, and 6·6% in Black women (p<0·0001); and risk of FGR ranged from 1·4% in White women to 3·5% in South Asian women (p<0·0001). 11·7% of stillbirths (95% CI 9·8–13·5), 1·2% of preterm births (0·8–1·6), and 16·9% of FGR (16·1–17·8) could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking, and BMI only had a small effect on these ethnic group attributable fractions (13·0% for stillbirths, 2·6% for preterm births, and 19·2% for births with FGR). Group-specific attributable fractions were especially high in the most socioeconomically deprived South Asian women and Black women for stillbirth (53·5% in South Asian women and 63·7% in Black women) and FGR (71·7% in South Asian women and 55·0% in Black women).

Interpretation

Our results indicate that socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with FGR in England. The largest inequalities were seen in Black and South Asian women in the most socioeconomically deprived quintile. Prevention should target the entire population as well as specific minority ethnic groups at high risk of adverse pregnancy outcomes, to address risk factors and wider determinants of health.

Funding

Healthcare Quality Improvement Partnership.

中文翻译：

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英国社会经济和种族不平等导致的不良妊娠结局：一项全国队列研究

背景

社会经济剥夺和少数民族背景是不良妊娠结局的危险因素。我们旨在量化英格兰人口水平上这些社会经济和种族不平等的严重程度。

方法

在这项队列研究中，我们使用了由国家妇产和围产期审计编制的数据，这些数据基于英国 132 家国家卫生服务医院使用的产妇信息系统的出生记录，并与行政医院数据相关联。我们包括生下单胎婴儿且记录的妊娠周数在 24 至 42 周之间的妇女。终止妊娠被排除在外。我们分析了英格兰死产、早产（<37 周妊娠）和胎儿生长受限（FGR；根据英国定义，出生体重<3 分位数的活产儿）的数据，并按社会经济剥夺五分位数和种族群体比较了这些结果。我们计算了整个人口和特定群体的可归因分数，与最贫困群体或白人女性相比，未经调整和调整吸烟，

发现

我们确定了 2015 年 4 月 1 日至 2017 年 3 月 31 日期间单胎分娩的 1 233 184 名女性，其中 1 155 981 名女性符合条件并纳入分析。1 155 981 例新生儿中有 4505 例（0·4%）为死产。在 1 151 476 例活产中，69 175 例（6·0%）为早产，22 679 例（2·0%）为 FGR 分娩。死产的风险在社会经济最贫困的群体中为 0·3%，在最贫困的群体中为 0·5% (p<0·0001)，早产风险在最贫困的群体中为 4·9%，在最贫困的群体中为 7·在最贫困组中为 2% (p<0·0001)，FGR 风险在最贫困组中为 1·2%，在最贫困组中为 2·2% (p<0·0001)。人口归因分数表明 23·6% (95% CI 16·7–29·8) 死产，18·5% (16·9–20·2) 早产，31·1% (28·3–33·8) 的 FGR 新生儿可归因于社会经济不平等，并且在针对种族、吸烟和 BMI 进行调整后，这些比例大幅降低（死产为 11·6%，11 ·早产为 9%，FGR 分娩为 16·4%）。死产风险从白人女性的 0·3% 到黑人女性的 0·7% (p<0·0001)；白人女性早产风险为 6·0%，南亚女性为 6·5%，黑人女性为 6·6% (p<0·0001)；FGR 的风险范围从白人女性的 1·4% 到南亚女性的 3·5% (p<0·0001)。11·7% 的死产 (95% CI 9·8–13·5)、1·2% 的早产 (0·8–1·6) 和 16·9% 的 FGR (16·1–17· 8) 可归因于种族不平等。对社会经济剥夺、吸烟和 BMI 的调整仅对这些种族群体归因分数有很小的影响（死产为 13·0%，早产为 2·6%，FGR 出生为 19·2%）。社会经济最贫困的南亚妇女和黑人妇女死产（南亚妇女 53·5%，黑人妇女 63·7%）和 FGR（南亚妇女 71·7%）的特定群体归因分数特别高黑人女性为 55·0%）。

解释

我们的结果表明，社会经济和种族不平等是造成英格兰相当大比例的死产、早产和 FGR 分娩的原因。在社会经济上最贫困的五分之一人口中，黑人和南亚女性的不平等现象最为严重。预防工作应针对整个人群以及处于不良妊娠结局高风险中的特定少数族裔群体，以解决风险因素和更广泛的健康决定因素。

资金

医疗保健质量改进伙伴关系。