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Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000–2017: time trend analysis
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  • Published on:
    What is driving the increase in infant mortality?
    • Anna S Pease, Senior Research Associate Centre for Academic Child Health, Bristol Medical School, University of Bristol
    • Other Contributors:
      • Debbie Watson, Professor of Child and Family Welfare
      • Peter S Blair, Professor of Epidemiology and Statistics
      • Peter J Fleming, Professor of Infant Health & Developmental Physiology

    We read with interest this paper which asserts that recent increases in infant mortality have affected poorer areas of England disproportionately. In our analyses of largely post-neonatal unexplained infant deaths we too have found a proportional increase of poorer families; markers of deprivation including maternal age, education, parity and smoking status will all impact on infant mortality. (1-3) However, it is perhaps worth pointing out that this recent increase in infant mortality in England & Wales from 2014 to 2017 is limited to neonatal deaths, the rate of post-neonatal deaths (4 weeks to 1 year old) has flat-lined in these 4 years from 1.09 deaths per 1000 live births in 2014 to 1.08 deaths per 1000 live births in 2017. Furthermore, in the data release by the Office for National Statistics (ONS) for 2017, (4) they report a 23.5% reduction in infant mortality in the most deprived areas over the last 10 years, compared with a 10.0% reduction in the most affluent areas. Using the data provided in that release on age at death we can see that the increase in overall infant mortality is driven by very early neonatal deaths of infants under 1 day old, from 1.3 per 1000 live births in 2014 to 1.5 in 2015, and 1.6 in 2016 and 2017. Mortality in all other age groups within infancy from one day to one year show reductions over that time. (4) The major contributory causes to early neonatal mortality are prematurity, congenital anomalies and infections, with a small but...

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    Conflict of Interest:
    None declared.
  • Published on:
    Infant mortality in England
    • Rodney P Jones, Lecturer in Healthcare Management Coventry University

    The rise in infant mortality is concerning. As this paper points out around one-third of the extra deaths may be due to 'austerity'.

    On a very pragmatic level it would be useful to see an analysis of the cause of death for these infants.

    In this respect there have been a number of influenza epidemics in the UK in recent years , mainly involving influenza A(H3N2) [1]. Influenza is known to disproportionately affect the poorest parts of society [2], partly due to lower vaccination rates [3].

    From a policy viewpoint, it is important to separate cause and effect, and for this reason the effects of influenza need to be disentangled and the cause(s) of death identified in order to correctly target any intervention(s).


    1. Public Health England. National Influenza report. 2019. (accessed 5 October 2019)

    2. Okland H, Mamelund S-E. Race and 1918 influenza pandemic in the United States: A review of the literature. Int J Environ Res Public Health 2019; 16: 2487. doi: 10.3390/ijerph16142487

    3. Vukovic V, Lillini R, Lupi S, et al. Identifying people at risk for influenza with low vaccine uptake based on deprivation status: a systematic review. Eur J Public Health 2018; cky264,...

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    Conflict of Interest:
    None declared.