Social inequality and infant health in the UK: systematic review and meta-analyses
- Alison L Weightman1,
- Helen E Morgan1,
- Michael A Shepherd2,
- Hilary Kitcher1,
- Chris Roberts3,
- Frank D Dunstan4
- 1Support Unit for Research Evidence (SURE), Information Services, Cardiff University, Cardiff, UK
- 2Freelance public health researcher, Somerset, UK
- 3Health, Social Services and Children Analytical Team, Welsh Government, Cardiff, UK
- 4Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
- Correspondence to Dr Alison Lesley Weightman;
- Received 2 February 2012
- Accepted 10 April 2012
- Published 14 June 2012
Objectives To determine the association between area and individual measures of social disadvantage and infant health in the UK.
Design Systematic review and meta-analyses.
Data sources 26 databases and websites, reference lists, experts in the field and hand-searching.
Study selection 36 prospective and retrospective observational studies with socioeconomic data and health outcomes for infants in the UK, published from 1994 to May 2011.
Data extraction and synthesis 2 independent reviewers assessed the methodological quality of the studies and abstracted data. Where possible, study outcomes were reported as ORs for the highest versus the lowest deprivation quintile.
Results In relation to the highest versus lowest area deprivation quintiles, the odds of adverse birth outcomes were 1.81 (95% CI 1.71 to 1.92) for low birth weight, 1.67 (95% CI 1.42 to 1.96) for premature birth and 1.54 (95% CI 1.39 to 1.72) for stillbirth. For infant mortality rates, the ORs were 1.72 (95% CI 1.37 to 2.15) overall, 1.61 (95% CI 1.08 to 2.39) for neonatal and 2.31 (95% CI 2.03 to 2.64) for post-neonatal mortality. For lowest versus highest social class, the odds were 1.79 (95% CI 1.43 to 2.24) for low birth weight, 1.52 (95% CI 1.44 to 1.61) for overall infant mortality, 1.42 (95% CI 1.33 to1.51) for neonatal and 1.69 (95% CI 1.53 to 1.87) for post-neonatal mortality. There are similar patterns for other infant health outcomes with the possible exception of failure to thrive, where there is no clear association.
Conclusions This review quantifies the influence of social disadvantage on infant outcomes in the UK. The magnitude of effect is similar across a range of area and individual deprivation measures and birth and mortality outcomes. Further research should explore the factors that are more proximal to mothers and infants, to help throw light on the most appropriate times to provide support and the form(s) that this support should take.
To cite: Weightman AL, Morgan HE, Shepherd MA, et al. Social inequality and infant health in the UK: systematic review and meta-analyses. BMJ Open 2012;2:e000964. doi:10.1136/bmjopen-2012-000964
Contributors HK, HEM and ALW carried out the literature searching and selected relevant papers. FDD, HEM, MAS and ALW completed critical appraisal, data extraction and summary of the included studies. FDD carried out statistical analyses including meta-analyses of studies where feasible. The author from the Welsh Government (CR) contributed to the conception of the study, drafted and revised sections on the policy context. He had no role in the searching, analysis or interpretation of data. Each author's contribution to the paper meets the three ICMJE guidelines for authorship. All were responsible for drafting sections of the article, revising it critically for important intellectual content and approving the final version for publication.
Funding Funding from the Welsh Government was received in partial support of preparation and publication costs. No grant number is available. All authors completed the unified competing interest form. FDD does consultancy for Jacob, Medinger and Finnegan and MAS does consultancy for the Welsh Government. There are no other relationships or activities that could appear to have influenced the submitted work. The researchers operated independently from the funders and views expressed in the paper are those of the authors, based on the evidence reviewed, and are not necessarily those of the Welsh government.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All original data extraction and critical appraisal forms are available from the corresponding author. Dryad doi is 10.5061/dryad.35db6.
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