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Title: Socioeconomic inequalities in pregnancy outcome associated with Down Syndrome: a population based study
Authors: Budd, Judith L. S.
Draper, Elizabeth S.
Lotto, Robyn R.
Berry, Laura E.
Smith, Lucy K.
First Published: 12-Jun-2015
Publisher: BMJ Publishing Group
Citation: Archives of Disease in Childhood: Fetal and Neonatal Edition 2015;100:F400-F404
Abstract: Objective: To investigate socioeconomic inequalities in outcome of pregnancy associated with Down syndrome (DS) compared with other congenital anomalies screened for during pregnancy. Design & Setting: Retrospective population-based registry study (East Midlands & South Yorkshire in England). Participants: All registered cases of DS and nine selected congenital anomalies with poor prognostic outcome (FASP9) with an end of pregnancy date between 1 January 1998 and 31 December 2007. Main outcome measures: Poisson regression models were used to explore outcome measures including: socioeconomic variation in rates of anomaly; antenatal detection; pregnancy outcome; live birth incidence; and neonatal mortality. Deprivation was measured using the Index of Multiple Deprivation 2004 at super output area level. Results: There were 1151 cases of DS and 1572 cases of the nine severe anomalies combined. The overall rate of antenatal detection was 57% for DS, which decreased with increasing deprivation (Rate ratio comparing the most deprived tenth with the least deprived: 0.76 (0.60 to 0.97)). Antenatal detection rates were considerably higher for FASP9 anomalies (86%), with no evidence of a trend with deprivation (0.99 95% CI (0.84 to 1.17)). The termination of pregnancy rate following antenatal diagnosis was higher for Down syndrome (86%) than the FASP9 anomalies (70%). Both groups showed wide socioeconomic variation in the termination of pregnancy rate (Rate ratio: DS: 0.76, (0.58 to 0.99); FASP9 anomalies: 0.80 (0.65 to 0.97)). Consequently, socioeconomic inequalities in live birth and neonatal mortality rates associated with these anomalies arise that were not observed in utero. Conclusions: Socioeconomic inequalities exist in the antenatal detection of DS, and subsequent termination rates are much higher for DS than other anomalies. Termination rates for all anomalies are lower in more deprived areas leading to wide socioeconomic inequalities in live born infants with a congenital anomaly, particularly DS, and subsequent neonatal mortality.
DOI Link: 10.1136/archdischild-2014-306985
ISSN: 1359-2998
eISSN: 1468-2052
Version: Published version (Publisher PDF)
Status: Peer-reviewed
Type: Journal Article
Rights: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Description: Aggregated EMSYCAR data may be requested from BINOCAR
Appears in Collections:Published Articles, Dept. of Health Sciences

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