Changing patterns of childhood mortality in Wolverhampton

Abstract

Objectives: To review the incidence and characteristics of preventable childhood deaths in an urban population in the UK and to determine whether the excess of preventable deaths seen previously in Asian girls still exists.

Design: A retrospective survey of childhood deaths from 1996-2002 classified in terms of preventability and compared with a previous study conducted 20 years earlier from 1976-82.

Setting: The city of Wolverhampton in the UK.

Main outcome measures: Deaths from all causes in children under the age of 5 years.

Results: There has been a reduction in the number of deaths in all age groups and from all causes. The postneonatal mortality rate fell from 6.5/1000 in 1976 to 3.1/1000 live births in 2002 largely because of the fall in the numbers of deaths caused by sudden infant death syndrome (SIDS). Preventable deaths are still associated with low birth weight (p<0.001) and poverty (unemployment and overcrowding in the earlier study (p<0.05) and with the Townsend score in this study (p<0.02)). There were fewer deaths among Asians and no female excess. There was a new category not seen in the previous study, deaths caused by homicide. The death rate for homicide in the first year of life was much higher in Wolverhampton (18.7/100,000) than in England and Wales (4.6/100,000).

Conclusions: Low birth weight and adverse socioeconomic conditions remain important factors associated with preventable deaths. There is no longer an increased risk of preventable death in Asian girls. The number of non-accidental deaths is a major cause for concern.

Figure 1

Sudden infant death syndrome as a proportion of postneonatal mortality for Wolverhampton and England and Wales (three year rolling averages).

Figure 2

Relation between Townsend Score and preventable deaths (r = 0.544, p<0.02).