Infant Mortality Analysis Update

13th October 2008

Helen BrownAssistant Director – Intelligence & Analysis

Contents

Population

Births

Infant Mortality Trends

Deprivation

Gender and Cause of Death

Social Marketing

Future Predications

Mortality Definitions

Infant mortality rate – number of deaths under one year per 1000 live births

Stillbirth rate – Birth of a dead baby at 24 or more completed weeks of gestation expressed as a rate this is the number per 1000 live and stillbirths

Neonatal mortality rate – number of deaths under 4 weeks per 1000 live births

Post neonatal mortality rate – number of deaths aged between 4 weeks and under one year per 1000 live births

Population 2006, Bradford and England and Wales

10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10%

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 plus

Male Female England & Wales

Births & Gestation

Age of Mother

Ethnicity

Birthweight

Gestation

Age of Mother, 2005

40.0% 30.0% 20.0% 10.0% 0.0% 10.0% 20.0% 30.0% 40.0%

<20

20-24

25-29

30-34

35-39

40 & over

Ag

e o

f m

oth

er

Bradford England and Wales

Percentage of Live Births by Ethnicity

52.9%53.2%52.8%54.7%57.0%58.5%59.3%

53.6%

0%

10%

20%

30%

40%

50%

60%

70%

White Ist Generation Pakistani 2nd Generation Pakistani Bangladeshi

33.7

35.7% 36.7 38.8% 40.2% 41.4%

1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005

40.7% 40.3%

Live Births 1996 - 2005

Birthweight

8%

6%

90%

92%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Bradford

England and Wales

Very low birthweight Low birthweight Not low birthweight

Summary Births

Since last analysis to 2003:

Similar distribution of mothers ages

Similar proportions of low birthweight babies

The increase in the proportion of births to south Asian mothers seems to be levelling off

Gestation

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005

Pre

ma

ture

Birt

h R

ate

pe

r 1

00

Birt

hs Most deprived

2nd mostdeprived

3rd mostdeprived

2nd leastdeprived

Least deprived

Since 1996 the percentage of pre-term births in Bradford has increased by approximately 20%

Premature Birth Rates by deprivation quintile and ethnicity, 1996-2005

No clear difference by ethnic group within deprivation quintiles for preterm births

0.0

5.0

10.0

15.0

20.0

25.0

Most deprived 2nd most deprived 3rd most deprived 2nd least deprived Least deprived

Rat

e pe

r 10

00

White

Pakistani 1st generation

Pakistani 2nd generation

Total Pakistani

Other

Smoking in Pregnancy

An average of 16.5% of mothers were reported to be smokers at time of delivery in 2006/07

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Q1 Q2 Q3 Q4

2006/07

% S

mo

kers

Infant Mortality

Infant Mortality Rate

Neonatal Mortality Rate

Postneonatal Mortality Rate

Stillbirth Rate

Annual Infant Mortality Rate in Bradford and England and Wales, 1974 - 2006

0.0

5.0

10.0

15.0

20.0

25.0

30.0

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

Rat

e pe

r 1

000

live

birt

hs

Bradford England and Wales

Infant Mortality Rate in 3 year rolling periods

0

1

2

3

4

5

6

7

8

9

10

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

Rat

e pe

r 100

0 liv

e bi

rths

Bradford England & Wales

Neonatal mortality rate in 3 year rolling periods

0

1

2

3

4

5

6

7

8

9

10

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

Rat

e pe

r 100

0 liv

e bi

rths

Bradford England & Wales

Postneonatal mortality rate in 3 year rolling periods

0

1

2

3

4

5

6

7

8

9

10

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

Rat

e pe

r 100

0 liv

e bi

rths

Bradford England & Wales

Stillbirth rate in 3 year rolling periods

0

1

2

3

4

5

6

7

8

9

10

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

Rat

e pe

r 100

0 to

tal l

ive

and

still

birth

s

Bradford England & Wales

Summary Infant, Neonatal, Postneonatal Deaths & Stillbirths

Infant Mortality - Rate between Bradford and E&W appears to be reducing

Neonatal Mortality - Bradford's recent rates are barely significantly more that E&W

Postneonatal Mortality - Recent trends show Bradford rates coming down but still significantly higher than E&W

Stillbirth Rate - Bradford's rates are significantly higher than E&W and seem to be increasing

Deprivation and IMD2007

Studies have shown links between infant mortality and deprivation

Deprivation is a lack of the resources or environment that are considered to be necessary for well being

The Indices of Multiple Deprivation 2007 (IMD2007) provides measures of deprivation and is often grouped into quintiles

Deprivation in Bradford by IMD 2007 Quintiles

Percentage Livebirths by Quintiles of Deprivation in Bradford

1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007

Quintile 1 32.8% 33.4% 33.4% 33.6% 33.1% 32.6% 32.1% 32.4% 32.4% 32.3%

Quintile 2 25.6% 24.9% 24.8% 25.0% 25.7% 26.1% 26.0% 25.8% 25.8% 26.0%

Quintile 3 16.1% 15.9% 15.8% 15.7% 15.4% 15.5% 15.7% 16.1% 16.3% 16.4%

Quintile 4 14.0% 14.1% 14.2% 13.9% 13.9% 13.9% 14.4% 14.5% 14.5% 14.4%

Quintile 5 11.5% 11.6% 11.8% 11.7% 11.9% 11.9% 11.8% 11.3% 11.0% 10.9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007

Per

cent

age

Live

birt

hs

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5

Infant Mortality Rate by Quintiles of Deprivation in Bradford

0

2

4

6

8

10

12

14

1993

-199

7

1994

-199

8

1995

-199

9

1996

-200

0

1997

-200

1

1998

-200

2

1999

-200

3

2000

-200

4

2001

-200

5

2002

-200

6

2003

-200

7

Rat

e pe

r 10

00 li

ve b

irths

Most deprived

2nd most deprived

3rd most deprived

2nd least deprived

Least deprived

Stillbirth Rate by Quintiles of Deprivation in Bradford

0.0

2.0

4.0

6.0

8.0

10.0

12.0

1993-1997 1994-1998 1995-1999 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006 2003-2007

Stil

lbirt

h R

ate

per

1000

live

and

stil

lbirt

hs

Most deprived

2nd most deprived

3rd most deprived

4th most deprived

Least Deprived

Infant mortality rate by deprivation quintile and ethnicity, 1996 - 2005

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Most deprived 2nd most deprived 3rd most deprived 2nd least deprived

Rat

e pe

r 100

0

White Pakistani 1st generation Pakistani 2nd generation Total Pakistani Other

Summary Deprivation

Deprived areas have increased levels of infant deaths & stillbirths

More robust numbers in the more deprived areas

In deprived areas trends show slight reduction in infant deaths but possible increases in stillbirths

Decreasing deprivation appears to reduce likelihood of an infant death for white mothers

Preliminary Social Marketing Analysis

Live Births

Low Birthweight

Infant Deaths

Stillbirths

Ranked Births, Low Birthweights, Infant Deaths and Stillbirths by Acorn Category

More detailed categories ranked on Infant Death (where 1 is worst).

‘Crowded Asian Terraces’ is ranked 1 for infant deaths, Stillbirths, Low Birthweight and proportion of Live Births

R ank Number R ank Number R ank Number R ank Number R ank Number

4.K .37 C rowded As ian Terraces 1 22,303 1 2229 8 386 1 277 1 239

5.N.49 L arge F am ilies and S ing le P arents , Many C hildren 3 3,036 6 279 23 50 2 42 7 28

4.K .38 Low Income As ian F amilies 2 10,753 2 1055 9 188 3 117 5 93

2.F .20 S tudent F lats and C os mopolitan S harers 29 190 13 19 45 * 4 * 40 *

5.O .51 S ing le P arents and P ens ioners , C ouncil Terraces 8 2,512 5 236 21 42 5 28 42 13

5.Q.55 Multi-E thnic P urpos e B uilt E s tates 14 455 15 41 1 15 6 6 2 10

3.H.31 Home Owning A s ian F amily A reas 15 1,669 22 126 14 31 7 8 23 11

5.P .54 S ingles and S ingle P arents , High R is e E s tates 9 1,379 3 146 4 33 8 15 11 *

5.Q.56 Multi-E thnic , C rowded F lats 6 924 9 83 13 18 9 9 29 *

3.I.34 L ower Inc omes , O lder P eople, S emis 49 963 25 70 34 14 10 9 39 *

Acorn Analys is of Infant B irths and Deaths (1993-2005) - R anked on z -s core

L ive birthsLow B irthweight (1.5-

2.5 kg)Very Low B irthweight

(<1.5kg) Infant death S tillbirth* This figure is les s than or equal to 5 and has

been s uppres s ed.

Low Income Asian Families

Mainly young Asian Families

Terraced streets in major towns and cities

Areas will often be ethnically divers with a high number of students living in these areas

Housing is low cost and ownership is split evenly between mortgages owned outright and those renting from social housing

High levels of unemployment

Low educational attainment

Incomes are low

Employment is generally in manufacturing or retail sectors

High numbers of single parents

More reliant on public transport and walking

Large Families and Single Parents Many Children

Some of the poorest families in the country

Exceptionally high numbers of children coupled with a young age profile

Three times more likely to be a single parent

Generally council houses

Larger families may be overcrowded

Unemployment is high – with a significant number of young people never worked

High levels of debt

Single Parents and Pensioners, Council Terraces

High numbers of single pensioners

High number of single parents

Housing is either council owned or housing associations

Small terraced houses and flats found in urban estates

High levels of unemployment

Very low levels of educational attainment

Reliant on public transport

Crowded Asian Terraces

70% of the people will be of Asian Origin

Older terraced housing in major cities and towns

Can be a high number of student shares

Housing is some of the highest crowded in the country

High unemployment

Low levels of qualifications

Low Income

Employment tends to be in the manual or retail sectors

High numbers of children under 5

Religion is a very important to the residents

Acorn Category Characteristics

Ranked Births, Low Birthweights, Infant Deaths and Stillbirths by Health Acorn Category

Z-Score Count Z-Score Count Z-Score Count Z-Score Count Z-Score Count

3.5 Low income families with some smokers 48 20923 6 1877 -1 335 3 210 4 191

1.3 Vulnerable disadvantaged, smokers with high levels of obesity -1 507 0 42 1 10 3 10 -1 *

4.1 Young mobile population with good health and diet 12 5274 2 456 2 102 3 62 1 43

2.4 Deprived multi- ethnic estates, smokers and overweight 33 8763 5 828 2 171 2 88 2 75

2.3 Urban estates with sedentary lifestyle & low fruit & veg consumption 11 4358 0 352 1 76 2 47 1 39

2.2 Multi- ethnic, high smoking, high fast food consumption 23 3650 3 347 1 71 2 40 0 28

2.1 Poor single parent families with lifestyle related illnesses 26 3257 4 325 -1 48 2 36 0 25

2.5 Disadvantaged multi- ethnic yngr adults, with high levels of smoking 50 10996 4 990 2 201 1 104 3 106

1.4 Post industrial pensioners with long term illness -6 1080 2 105 1 20 1 11 -2 *

1.6 Elderly with associated health issues -14 1200 -1 87 -2 11 1 12 -2 *

3.1 Less affluent neighbourhoods, high fast food, sedentary lifestyles -12 3965 -2 290 1 70 0 35 0 29

4.3 Students and young professionals, living well -1 88 0 7 -1 * 0 * 0 *

1.8 Disadvantaged neighbourhoods with poor diet & severe health issues 3 3244 2 298 0 55 0 27 0 22

1.7 Home owning pensioners, traditional diets -17 495 -2 26 -1 * 0 * -2 *

1.2 Disadvantaged elderly, poor diet, chronic health -8 237 0 21 -1 * -1 * -1 *

1.5 Deprived neighbourhoods with poor diet, smokers -3 1441 2 138 0 24 -1 9 -1 7

1.1 Older couples, traditional diets, cardiac issues -13 180 0 14 -2 * -1 * -1 *

4.2 Younger affluent, healthy professionals -7 2108 -3 130 0 32 -2 11 -1 11

3.6 Affluent families with some dietary concerns -6 1528 -4 75 -2 16 -2 6 -2 6

4.5 Mixed communities with better than average health -25 5451 -5 340 1 95 -2 33 -2 30

4.4 Towns and villages with average health and diet -10 8998 -4 624 -1 137 -3 54 -2 53

3.2 Affluent healthy pensioners dining out -31 1277 -6 40 -1 18 -3 * -2 *

3.3 Home owning older couples, high levels of fat & confectionery -38 4029 -4 255 0 64 -3 18 -3 14

3.4 Affluent professionals, high alcohol consumption, dining out -34 3818 -7 183 -2 49 -3 15 -2 15

4.6 Affluent towns and villages with excellent health and diet -26 5787 -6 344 -2 77 -4 24 -1 35

* This figure is les s than or equal to 5 and has been s uppres s ed.

Still BirthsHealth Acorn Code

Health Acorn CategoryLive Births

Low Birth Weight

Very Low Birth Weight

Infant Deaths

3.5 – Low income families with some smoking

Age tends to be young with mixtures of families and single parents

Higher than average numbers of smokers

Slightly more than average people with weight issues

High levels of asthma and depression

Diet similar to national picture though there is slightly more fast food and crisps and not enough fruit and veg.

1.3 – Vulnerable disadvantaged smokers with high levels of obesity

Mixed age groups

High levels of family break-up

High levels of single parents

High levels of depression

High levels of smoking

High levels of obesity

Generally favour fried or grilled food and a high level of snacks and fatty foods

Eat less than one portion of fresh fruit and veg a day

4.1 – Young Mobile population with good health and diet

High proportions of students and single people

Typically aged 20-30

Physically active

Slight tendency to suffer from migraines or depression

May not be taking care of what they are eating, though generally eat well

Some smokers

2.5 – Disadvantaged multi-ethnic younger adults, with high levels of smoking

Relatively Mobile young population

Low cost rented accommodation

Higher than normal single parents

Some depression and asthma

High levels of smoking

High consumption of sugary and energy drinks

Higher than normal overweight population

Health Acorn Category Characteristics

2.2 – Multi-ethnic, high smoking high fast food consumption

High levels of single parents

Low income areas

High consumption of fast food

Low levels of fruit and veg

High levels of asthma and depression

2.4 Deprived multi-ethnic estates, smokers and overweight

Some incidence of depression

High proportion of smokers

High proportion of overweight people

High levels of fried food

Low fruit and veg consumption

Generally have a low consumption of high fat and high sugar foods

2.3 – Urban estates with sedentary lifestyles and low fruit and vegetable consumption

Mainly council estates

High levels of smoking

Low levels of physical exercise

High fat diet with little in take of fruit and veg