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Comparative Study
. 2013 Mar;98(2):F103-7.
doi: 10.1136/fetalneonatal-2011-301359. Epub 2012 Jun 9.

Comparing regional infant death rates: the influence of preterm births <24 weeks of gestation

Lucy Smith  1 , Elizabeth S Draper, Bradley N Manktelow, Catherine Pritchard, David John Field
Affiliations
Free PMC article
Comparative Study

Comparing regional infant death rates: the influence of preterm births <24 weeks of gestation

Lucy Smith et al. Arch Dis Child Fetal Neonatal Ed. 2013 Mar.
Free PMC article

Abstract

Objective: To investigate regional variation in the registration of preterm births <24 weeks of gestation and the impact on infant death rates for English Primary Care Trusts (PCTs).

Design: Cohort study.

Setting: England.

Participants: All registered births (1 January 2005-31 December 2008) by gestational age and PCT (147 trusts) linked to infant deaths (up to 1 year of life). Late-fetal deaths at 22 and 23 weeks gestation (1 January 2005-31 December 2006).

Main outcome measures: Extremely preterm (<24 weeks) birth rate per 1000 live births and percentage of births registered as live born by PCT. Infant death rate and rank of mortality for (1) all live births and (2) live births over 24 weeks gestation by PCT.

Results: Wide between-PCT variation existed in extremely preterm birth (<24 weeks) rates (per 1000 births) (90% central range (0.31, 1.91)) and percentages of births <24 weeks of gestation registered as live born (median 52.6%, 90% central range (26.3%, 79.5%)). Consequently, the percentage of infant deaths arising from these births varied (90% central range (6.7%, 31.9%)). Excluding births <24 weeks, led to significant changes in infant mortality rankings of PCTs, with a median worsening of 12 places for PCTs with low rates of live born preterm births <24 weeks of gestation compared with a median improvement of four ranks for those with higher live birth registration rates.

Conclusions: Infant death rates in PCTs in England are influenced by variation in the registration of births where viability is uncertain. It is vital that this variation is minimised before infant mortality is used as indicator for monitoring health and performance and targeting interventions.

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Conflict of interest statement

Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: all authors had financial support from UK Department of Health's National Institute of Health Research for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Median, IQR and 90% centile range of rate of preterm birth (live births and all births) by gestational age for Primary Care Trusts (log scale).
Figure 2
Figure 2
Median, IQR and 90% centile range for the percentage of preterm births registered as live born by gestational age for Primary Care Trusts (log scale).
Figure 3
Figure 3
Overall infant death rate versus infant death rate excluding infants less than 24 weeks gestation for Primary Care Trusts by percentage of births less than 24 weeks gestation registered as live born. Lines indicate an absolute difference of one death and two deaths per 1000 live births.
Figure 4
Figure 4
Rank of overall infant death rate versus rank of infant mortality excluding infants less than 24 weeks gestation for Primary Care Trusts by percentage of births less than 24 weeks registered as live born. Lines refer to an absolute increase and decrease of 20 places in rankings, 1=lowest death rate, 147=highest death rate.
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Comment in

References

    1. EURO-PERISTAT project with SCPE & Eurocat & Euroneostat. European Perinatal Health Report, 2008
    1. OECD Health data Statistics and indicators. Paris, 2010
    1. Draper ES. Evaluating and comparing neonatal outcomes. Arch Dis Child Fetal Neonatal Ed 2010;95:F158–9 - PubMed
    1. Kramer MS, Platt RW, Yang H, et al. Registration artifacts in international comparisons of infant mortality. Paediatr Perinat Epidemiol 2002;16:16–22 - PubMed
    1. Field DJ, Dorling JS, Manktelow BN, et al. Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994–9 compared with 2000-5. BMJ 2008;336:1221–3 - PMC - PubMed

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