6262 Intersecting ethnic and socio-economic inequalities in infant mortality in England using office of national statistics (ONS) data, 2007–2019

Objectives There are stark socio-economic and ethnic inequalities in infant mortality rates (deaths less than 1 year of age – IMR) in the United Kingdom (UK). 1 Recent estimates show stagnation in improvements in IMR and increasing inequalities over the last decade in UK nations. 2 However, there is limited evidence on the impact of the intersection of socio-economic deprivation and ethnicity on infant mortality. This study investigates the relationship between IMR and maternal ethnicity and whether social patterning is consistent across ethnic categories. Methods We used publicly available data on births, deaths, and Index of Multiple Deprivation (IMD) deciles (collapsed to quintiles) from 2007 to 2019 for England as published by ONS. 3 The maternal ethnicity was derived by ONS through the linkage of NHS birth notifications to births and death registrations. In keeping with ONS methodology, we used births registered within each year as the numerator and deaths registered within each year as the denominator. We calculated IMR by IMD quintile for broad ethnic categories of Black (Black African, Black Caribbean, Any other Black background), Asian (Bangladeshi, Pakistani, Indian, Any other Asian background), Mixed background, White (White British, White Other) and any Other ethnic background. 3 ONS published IMD deciles were collapsed to IMD-quintiles due to small numbers for some ethnic groups. Results There was a clear deprivation gradient and rising inequalities over time across Asian, Mixed and White ethnic categories except for the Black ethnic category for each of the year groups, with the highest IMR observed amongst those living in the most deprived quintile (figure 1). For the most recent period (2016–2019), the IMR for the Black ethnic group across all IMD quintiles was nearly double the England rate (average of 7. 1 per 1, 000 births vs. 4. 3 per 1, 000 births) although with large confidence intervalsfor the most affluent groups (figure 2). Conclusion Inequalities in IMR in England intersect on socio-economic and ethnic axes, particularly affecting Black mothers. Urgent action is needed for a deeper understanding of these inequalities within and across ethnic groups. Clinical teams, integrated care boards, and public health teams must work together to address these inequalities to improve outcomes for children and families. 4 References Child and infant mortality in England and Wales – Office for National Statistics Internet. cited 2023 Oct 12. Available from: https: //www. ons. gov. uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2021 INQ000280060 – Expert report titled 'Child health inequalities' by Professor David Taylor-Robinson. dated 21 September 2023 UK Covid-19 Inquiry Archives Internet. UK Covid-19 Inquiry. cited 2023 Oct 23. Available from: https: //covid19. public-inquiry. uk/documents/inq000280060-expert-report-titled-child-health-inequalities-by-professor-david-taylor-robinson-dated-21-september-2023/ Births and infant mortality by ethnicity in England and Wales – Office for National Statistics Internet. cited 2023 Oct 12. Available from: https: //www. ons. gov. uk/peoplepopulationandcommunity/healthandsocialcare/childhealth/articles/birthsandinfantmortalitybyethnicityinenglandandwales/2007to2019 Esan O, Adjei NK, Saberian S, Christianson L, McHale P, Pennington A, et al. Mapping existing policy interventions to tackle ethnic health inequalities in maternal and neonatal health in England: A systematic scoping review with stakeholder engagement Internet. 2022 Dec cited 2023 Feb 8. Available from: https: //www. nhsrho. org/wp-content/uploads/2022/12/RHO-Mapping-existing-policy-interventionsDecember-2022. pdf