Comment on “Inequalities in Neonatal Unit Mortality in England and Wales Between 2012 and 2022: A Retrospective Cohort Study”

In England, progress in reducing infant deaths has stalled, and inequalities between different groups have widened. The highest risk of neonatal mortality is in babies admitted to neonatal units due to preterm birth, severe illness, or congenital anomalies. Higher mortality rates also persist among Black or Asian babies versus White babies, while ethic differences have increased with social deprivation. Yet, the reasons behind the ethnic and socioeconomic inequalities remain unclear. The aim of this study was to examine the association between socioeconomic and ethnic inequalities on neonatal mortality in England and Wales. This was a retrospective cohort study, using data from the National Neonatal Research Database, which includes all admissions to neonatal units in the UK. Included were babies born at 22 weeks of gestation and above that were admitted to neonatal units in England and Wales between January 2012 and December 2022. Excluded were babies whose first admission was at >7 days old or who did not receive any neonatal care. The primary outcome was in-unit mortality, or death before final discharge from a neonatal unit. The exposures were maternal socioeconomic status derived from the Index of Multiple Deprivation (IMD) and maternal ethnicity. A total of 561,621 babies were included in the complete case analysis, with 15.1% born to mothers living in the most deprived decile and 6.5% born to those in the least deprived decile. For infants in the most deprived decile, the in-unit mortality was 21.0 per 1000 babies (95% CI, 18.2-24.1) in 2012 and 35.9 per 1000 babies (95% CI, 22.4-29.6) in 2022. For those in the least deprived decile, the in-unit mortality was 13.5 per 1000 babies (95% CI, 10.2 to 17.5) in 2012 and 12.8 per 1000 babies (95% CI, 0.3-17.2) in 2022. The odds ratio (OR) of in-unit mortality was for babies born to mothers in the most deprived decile than the least deprived decile (OR, 1.63; 95% CI, 1.48-1.18). Adjusting for race/ethnicity, the odds ratio decreased to 1.52 (95% CI, 1.38-1.69). Adjusting for race/ethnicity and all case-mix variables on admission, the OR was 1.23 (95% CI, 1.10-1.37). Among White babies, the lowest rate of deaths was in 2019 (13.4 per 1000; 95% CI, 12.2-14.9) and the highest rate was in 2012 (16.9 per 1000; 95% CI, 15.8-18.1). Among Black babies, the lowest rate was in 2020 (18.6 per 1000; 95% CI, 13.8-24.5) and the highest rate was in 2021 (29.7 per 1000; 95% CI, 23.4-27.1). Among Asian babies, the lowest rate was in 2020 (16.4 per 1000; 95% CI, 13.3-20.2) and the highest rate in 2012 (24.1 per 1000; 95% CI, 20.7-27.9). The odds of in-unit mortality were higher among Black babies than White babies (OR, 1.81; 95% CI, 1.67-1.95). Adjusting for social deprivation, the odds ratio was 1.68 (95% CI, 1.55-1.81). Adjusting for social deprivation and and all case-mix variables on admission, the OR was 1.14 (95% CI, 1.05 to 1.24). The odds also were higher among Asian babies compared with White babies (OR, 1.48; 95% CI, 1.39-1.57). The odds ratio was 1.40 (95% CI, 1.32 to 1.49) after adjusting for social deprivation and 1.36 (95% CI, 1.27-1.45) adjusting for social deprivation and all case-mix variables. In conclusion, the mortality rate of babies cared for in neonatal units in England and Wales has increased since 2012 and socioeconomic and ethnic inequities persist and remained high in 2022. (Summarized from Saberian S, Gale C, Subhedar N et al. Inequalities in neonatal unit mortality in England and Wales between 2012 and 2022: a retrospective cohort study. Lancet Child Adolesc Health. 2025;9:857–67. doi: 10.1016/S2352-4642(25)00243-3).