Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/32839
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dc.contributor.authorSmith, Lucy K.-
dc.contributor.authorBudd, Judith L. S.-
dc.contributor.authorField, David J.-
dc.contributor.authorDraper, Elizabeth S.-
dc.date.accessioned2015-07-29T13:22:27Z-
dc.date.available2015-07-29T13:22:27Z-
dc.date.issued2011-07-19-
dc.identifier.citationBMJ, 2011, 343, d4306en
dc.identifier.issn0959-8138-
dc.identifier.urihttp://www.bmj.com/content/343/bmj.d4306.shorten
dc.identifier.urihttp://hdl.handle.net/2381/32839-
dc.description.abstractOBJECTIVES: To investigate socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies. DESIGN: Retrospective population based registry study. SETTING: East Midlands and South Yorkshire regions of England (representing about 10% of births in England and Wales). PARTICIPANTS: All registered cases of nine selected congenital anomalies with poor prognostic outcome audited as part of the United Kingdom's fetal anomaly screening programme with an end of pregnancy date between 1 January 1998 and 31 December 2007. MAIN OUTCOME MEASURES: Socioeconomic variation in the risk of selected congenital anomalies; outcome of pregnancy; incidence of live birth and neonatal mortality over time. Deprivation measured with the index of multiple deprivation 2004 at super output area level. RESULTS: There were 1579 fetuses registered with one of the nine selected congenital anomalies. There was no evidence of variation in the overall risk of these anomalies with deprivation (rate ratio for the most deprived 10th with the least deprived 10th: 1.05, 95% confidence interval 0.89 to 1.23). The rate ratio varied with type of anomaly and maternal age (deprivation rate ratio adjusted for maternal age: 1.43 (1.17 to 1.74) for non-chromosomal anomalies; 0.85 (0.63 to 1.15) for chromosomal anomalies). Of the nine anomalies, 86% were detected in the antenatal period, and there was no evidence that this varied with deprivation (rate ratio 0.99, 0.84 to 1.17). The rate of termination after antenatal diagnosis of a congenital anomaly was lower in the most deprived areas compared with the least deprived areas (63% v 79%; rate ratio 0.80, 0.65 to 0.97). Consequently there were significant socioeconomic inequalities in the rate of live birth and neonatal mortality associated with the presence of any of these nine anomalies. Compared with the least deprived areas, the most deprived areas had a 61% higher rate of live births (1.61, 1.21 to 2.15) and a 98% higher neonatal mortality rate (1.98, 1.20 to 3.27) associated with a congenital anomaly. CONCLUSIONS: Antenatal screening for congenital anomalies has reduced neonatal mortality through termination of pregnancy. Socioeconomic variation in decisions regarding termination of pregnancy after antenatal detection, however, has resulted in wide socioeconomic inequalities in liveborn infants with a congenital anomaly and subsequent neonatal mortality.en
dc.language.isoenen
dc.publisherBMJ Publishing Group: BMJen
dc.relation.replaceshttp://hdl.handle.net/2381/23733en
dc.relation.replaces2381/23733en
dc.relation.urihttp://www.ncbi.nlm.nih.gov/pubmed/21771825-
dc.rightsCopyright © the authors, 2011. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.en
dc.sourceWeb of Science-
dc.source.urihttp://webofknowledge.com-
dc.subjectAbortion, Induceden
dc.subjectCongenital Abnormalitiesen
dc.subjectEnglanden
dc.subjectFemaleen
dc.subjectHealthcare Disparitiesen
dc.subjectHumansen
dc.subjectInfanten
dc.subjectInfant Mortalityen
dc.subjectPregnancyen
dc.subjectPregnancy Outcomeen
dc.subjectPrenatal Diagnosisen
dc.subjectRetrospective Studiesen
dc.subjectSocioeconomic Factorsen
dc.titleSocioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies: population based studyen
dc.typeJournal Articleen
dc.identifier.doi10.1136/bmj.d4306-
dc.identifier.eissn1756-1833-
dc.description.statusPeer-revieweden
dc.description.versionPublisher Versionen
dc.type.subtypeJournal Article;Research Support, Non-U.S. Gov't-
pubs.organisational-group/Organisationen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGYen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicineen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciencesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themes/Populationen
dc.description.irispid76172-
dc.dateaccepted2011-05-16-
Appears in Collections:Published Articles, Dept. of Health Sciences



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