Social deprivation and the causes of stillbirth and infant mortality

Aims-To investigate the relation between social deprivation and causes of s tillbirth and infant mortality. Methods-Stillbirths and infant deaths in 6347 enumeration districts in Wale s were linked with the Townsend score of social deprivation. In 1993-98 the re were 211 072 live births, 1147 stillbirths, and 1223 infant deaths. Pois son regression analysis was used to estimate the magnitude of effect for as sociations between the Townsend score and categories of death by age and th e causes of death. The relative risk of death between most and least depriv ed enumeration districts was derived. Results-Relative risk of combined stillbirth and infant death was 1.53 (95% CI 1.35 to 1.74) in the most deprived compared with the least deprived enu meration districts. The early neonatal mortality rate was not significantly associated with deprivation. Sudden infant death syndrome showed a 307% (9 5% CI 197% to 456%) increase in mortality across the range of deprivation. Deaths caused by specific conditions and infection were also associated wit h deprivation, but there was no evidence of a significant association with deaths caused by placental abruption, intrapartum asphyxia, and prematurity . Conclusions-Collaborative public health action at national and local level to target resources in deprived communities and reduce these inequalities i n child health is required. Early neonatal mortality rates and deaths fi om intrapartum asphyxia and prematurity are not significantly associated with deprivation and may be more appropriate quality of clinical care indicator s than stillbirth, perinatal, and neonatal mortality rates.