Socioeconomic and ethnic disparities in preterm births in an English maternity setting: a population-based study of 1.3 million births

Abstract

Background: Preterm birth is a major cause of infant mortality and morbidity and accounts for 7-8% of births in the UK. It is more common in women from socially deprived areas and from minority ethnic groups, but the reasons for this disparity are poorly understood. To inform interventions to improve child survival and their quality of life, this study examined the socioeconomic and ethnic inequalities in preterm births (< 37 weeks of gestation at birth) within Health Trusts in England.

Methods: This study investigated socioeconomic and ethnic inequalities in preterm birth rates across the National Health Service (NHS) in England. The NHS in England can be split into different units known as Trusts. We visualised between-Trust differences in preterm birth rates. Health Trusts were classified into five groups based on their standard deviation (SD) variation from the average national preterm birth rate. We used modified Poisson regression to compute risk ratios (RR) and 95% confidence intervals (95% CI) with generalised estimating equations.

Results: The preterm birth rate ranged from 6.8/100 births for women living in the least deprived areas to 8.8/100 births for those living in the most deprived areas. Similarly, the preterm birth rate ranged from 7.8/100 births for white women, up to 8.6/100 births for black women. Some Health Trusts had lower than average preterm birth rates in white women whilst concurrently having higher than average preterm birth rates in black and Asian women. The risk of preterm birth was higher for women living in the most deprived areas and ethnicity (Asian).

Conclusions: There was evidence of variation in rates of preterm birth by ethnic group, with some Trusts reporting below average rates in white ethnic groups whilst concurrently reporting well above average rates for women from Asian or black ethnic groups. The risk of preterm birth varied substantially at the intersectionality of maternal ethnicity and the level of socioeconomic deprivation of their residency. In the absence of other explanations, these findings suggest that even within the same Health Trust, maternity care may vary depending on the women's ethnicity and/or whether she lives in an area of high socioeconomic deprivation. Thus, social factors are likely key determinants of inequality in preterm birth rather than provision of maternity care alone.

Keywords: Disparity; Ethnicity; Health inequalities; Preterm birth.

Fig. 1

Preterm birth (< 37 weeks of gestation) rates across the 130 Health Trusts between April 2015 and March 2017

Fig. 2

Preterm birth (< 37 weeks of gestation) rates by ethnicity across the 130 Health Trusts according to the national ethnic group preterm birth rates between April 2015 and March 2017

Fig. 3

Preterm birth (< 37 weeks of gestation) rates by ethnicity across the 130 Health Trusts according to the overall national preterm birth rate between April 2015 and March 2017

Fig. 4

a Preterm birth (< 37 weeks of gestation) rates by ethnicity across the 130 Health Trusts according to the national ethnic group preterm birth rate within mums living in the most deprived areas (Index of Multiple Deprivation (IMD) 1) between April 2015 and March 2017. b Preterm birth (< 37 weeks of gestation) rates by ethnicity across the 130 Health Trusts according to the national ethnic group preterm birth rate within mums living in the least deprived areas (Index of Multiple Deprivation (IMD) 5) between April 2015 and March 2017