infant mortality and mother’s country of birth- what information is currently available? nicola...

Infant mortality and mother’s country of birth- what information is currently available?

Nicola Dennis- Knowledge Transfer Facilitator, KIT(WM), PHE

Infant mortality and ethnicityTopics to be covered

• The West Midlands has significantly higher infant mortality rates than the rest of England

• Infant mortality has been shown to be higher in non-UK born mothers than UK born mothers

• Maternal death rates are also higher in non-UK born mothers

• Numbers of non-UK born mothers vary across the WM local authorities

2 Infant mortality and ethnicity

Long term trend


0

1

2

3

4

5

6

7

8R

ate

per

1,0

00 l

ive

bir

ths

West Midlands England

Source: PHOF

West Midlands infant mortality rates

Source: ChiMat infant mortality profiles


3.23.5 3.5 3.6 3.8

4.1

4.8 4.8 55.6

5.9

6.87.1 7.1

7.4 7.5

0

2

4

6

8

Rate of infant deaths under one year per 1,000live births (2011-2013)


England

Local authority rate

Further breakdownsAs well as examining infant mortality as a whole, we can also look at

• Stillbirths

• Perinatal mortality rates (under 7 days)

• Neonatal mortality rates (under 28 days)

• Post neonatal mortality rates (28 days-1 year)


West Midlands stillbirth rates



3.5 3.74.1 4.2 4.3 4.5 4.6 4.7 4.7 4.8 4.8 4.9

5.3 5.4 5.5

6.5

0

2

4

6

8

The rate of still births per 1,000 total births (2011-13)

West Midlands perinatal mortality rates



5.7 5.7 5.9 6.3 6.6 6.9 7.1 7.1 7.38 8.3 8.5 8.7 8.7

10.1

11.2

0

2

4

6

8

10

12

Stillbirths plus early neonatal deaths (deaths at under 7 completed days of life) per 1,000 births (2011-13)

West Midlands neonatal mortality rates



2.4 2.52.8 2.9 3 3.1 3.1 3.2

3.5 3.5

4.1

4.8 4.9 5.15.4 5.4

0

1

2

3

4

5

6

Rate of deaths of babies aged less than 28 days old per 1,000 live births (2009-2013)

West Midlands post neonatal mortality



0.60.7

11.1

1.2 1.21.3

1.51.6 1.6

1.81.9

22.2 2.2

2.3

0

0.5

1

1.5

2

2.5

Rate of deaths of babies aged between 28 days and 1 year old per 1,000 live births (2009-13)

Non-UK born mothers: What information is available?• There are many potential risk factors for stillbirth, infant mortality and

maternal mortality

• Rates of all of these have been shown to be higher in non-UK born mothers

• However, because of (overall) small numbers, the information available is currently limited


Country of birth, 2012


United Kingdom‚ Isle of Man and Channel Islands 4.5 6.6 2.7 1.1 3.8

Total outside the United Kingdom 5.8 8.1 3.0 1.3 4.2

Total 4.9 7.0 2.7 1.2 3.9

Stillbirths Perinatal Neonatal Post-neonatal Infant

RatesCountry of birth

Rates:

Stillbirths and perinatal deaths per 1,000 live births and stillbirths.Neonatal, postneonatal and infant deaths per 1,000 live births.

Source:

Child Mortality Statistics: Childhood, Infant and Perinatal, 2012

http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-332784





Total 4.9 7.0 2.7 1.2 3.9


RatesCountry of birth

Rates:


Information currently not available for the WM

Live births: country of birth of mother, 2013


Birmingham 60.9 39.1

Coventry 63 37

Sandwell 67.7 32.3

Wolverhampton 72.6 27.4

West Midlands 76.5 23.5

Stoke-on-Trent 79.7 20.3

Walsall 80.8 19.2

Herefordshire 84.2 15.8

Warwickshire 84.5 15.5

Telford and Wrekin 84.7 15.3

Worcestershire 86 14

Dudley 86.1 13.9

Solihull 88.7 11.3

Staffordshire 90.4 9.6

Shropshire 91.7 8.3

ENGLAND 72.7 27.3

2013

Names UK Outside UK

Source: ONS: Parents' Country of Birth, England and Wales 2013




Coventry 63 37

Sandwell 67.7 32.3




Walsall 80.8 19.2





Dudley 86.1 13.9

Solihull 88.7 11.3


Shropshire 91.7 8.3

ENGLAND 72.7 27.3

2013

Names UK Outside UK





Coventry 63 37

Sandwell 67.7 32.3




Walsall 80.8 19.2





Dudley 86.1 13.9

Solihull 88.7 11.3


Shropshire 91.7 8.3

ENGLAND 72.7 27.3

2013

Names UK Outside UK


Coventry 64.2 35.8

Sandwell 70.1 29.9



Walsall 80.6 19.4

Stoke-on-Trent 81 19




Worcestershire 87.2 12.8

Dudley 87.8 12.2

Solihull 89 11


Shropshire 91.4 8.6

ENGLAND 73.3 26.7

Names UK Outside UK

2012

Source: ONS: Parents' Country of Birth, England and Wales 2012, 2013

What does this mean?• We do not have WM specific rates for mortality and country of birth

• However, the numbers of UK born and non-UK born mothers across LAs may indicate areas of greater need

• What else do we know about the higher risks for non-UK mothers?




Rates:




EU 4.7 6.5 2.5 0.8 3.3

Rest of Europe (non EU) 4.2 5.2 1.1 0.9 2.0

Africa 7.4 10.1 3.4 1.8 5.2

The Americas and the Caribbean 4.7 7.8 3.7 1.1 4.9

Middle East and Asia 6.2 8.7 3.2 1.5 4.7

Antartica and Oceania 4.0 5.8 2.6 0.9 3.5

Other/Not stated 206.9 275.9 : - :

Total 4.9 7.0 2.7 1.2 3.9

Neonatal Post-neonatal InfantCountry of birth

Rates

Stillbirths Perinatal



England and Wales 4.5 6.5 2.7 1.1 3.8

Scotland 4.6 7.1 2.7 1.2 3.9

Northern Ireland 5.9 7.7 2.3 : 3.2

New EU 5.0 6.8 2.4 0.7 3.1

Irish Republic 6.7 8.7 3.0 : 3.7

North Africa 4.6 6.0 1.4 1.1 2.6

Western Africa 8.2 11.3 4.0 2.3 6.4

Central Africa 8.8 10.9 2.5 3.4 5.9

Eastern Africa 8.5 11.8 3.9 1.6 5.5

Southern Africa 2.9 4.3 1.6 0.7 2.3

North America and Central America 2.2 4.7 3.3 0.8 4.1

South America 3.6 5.2 2.4 1.2 3.7

Caribbean 9.8 15.6 5.8 1.6 7.4

Middle East and Central Asia 6.7 8.1 2.0 1.3 3.2

Eastern Asia 2.9 3.5 0.8 0.5 1.2

Southern Asia 6.8 9.8 3.8 1.7 5.5

India 7.8 10.7 3.6 1.4 4.9

Pakistan 7.3 10.6 4.0 2.0 6.1

Bangladesh 4.8 7.7 4.1 2.3 6.4

South East Asia 3.9 6.3 3.0 0.9 3.9

Total 4.9 7.0 2.7 1.2 3.9

Country of birth

Rates


Changes over time


0.0

1.0

2.0

3.0

% o

f al

l liv

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irth

s

* Note: Where a country has a blank space for one or more year groups, this indicates that country was not in the top ten

2004 2012 2013

Countries Total %Pakistan 15,736 2.5India 9,146 1.4Bangladesh 8,857 1.4Somalia 4,880 0.8Germany 4,615 0.7Nigeria 4,039 0.6Ireland 3,597 0.6South Africa 3,559 0.6Ghana 3,165 0.5United States 2,916 0.5Total non-UK 124,563 19.5

10 most common countries of birth for non-UK mothers (England and Wales, 2004)

Countries Total %Poland 21,156 2.9Pakistan 19,091 2.6India 14,621 2.0Bangladesh 8,224 1.1Nigeria 7,685 1.1Somalia 5,300 0.7Germany 5,064 0.7Lithuania 4,535 0.6Romania 4,406 0.6South Africa 4,231 0.6Total non-UK 189,079 25.9


Countries Total %Poland 21,275 3.0Pakistan 18,578 2.7India 14,044 2.0Bangladesh 7,982 1.1Nigeria 7,267 1.0Romania 4,956 0.7Somalia 4,897 0.7Germany 4,838 0.7Lithuania 4,595 0.7South Africa 3,824 0.5Total non-UK 185,075 26.5


Changes over time


0.0

1.0

2.0

3.0

% o

f al

l liv

e b

irth

s


2004 2012 2013







Distribution by region, 2013


60.9 63.067.7

72.679.7 80.8

84.2 84.5 84.7 86.0 86.1 88.7 90.4 91.7

76.55.7

10.98.0

7.8

5.4 4.1

12.28.2 7.3

7.82.8

3.14.7 4.5

6.423.313.8

17.913.1

11.8 12.3

4.1 4.63.7

8.45.4

3.6

11.6

7.9 10.64.1 4.7 3.9

50%

60%

70%

80%

90%

100%

UK EU (exc. UK) Europe (exc. EU) Middle East/ Asia Africa Elsewhere


Maternal deathsNon-UK born mothers are also at higher risk of maternal death


Maternal deaths by country


Source: CMACE, MBRRACE-UK

https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf

UK 2458671 211 8.6 7.5-9.8 1 (Ref)Outside UK 724229 110 15.2 12.5-18.3 1.77 1.39-2.24

Bangladesh 33299 3 9 1.9-26.3 1.05 0.21-3.11India 55203 8 14.5 6.3-28.6 1.69 0.72-3.39Pakistan 73523 8 10.9 4.7-21.4 1.27 0.54-2.54Sri Lanka 13630 4 29.4 8-75.1 3.42 0.92-8.89Ghana 13650 3 22 4.5-64.2 2.56 0.52-7.59Nigeria 29235 10 34.2 16.4-62.9 3.99 1.88-7.48Somalia 22512 4 17.8 4.8-45.5 2.07 0.56-5.38Poland 78889 7 8.9 3.6-18.3 1.03 0.41-2.17

Specific countries

Woman's country of birthMaternities 2009-2012

Total deathsRate per 100,000

maternities95% CI

Relative risk (RR)

95% CI

Maternal deaths

“Women born outside the UK were significantly more likely to die than those born in the UK (RR 1.77, 95% CI 1.39-2.24). Women born in Nigeria had the highest maternal mortality rate (34.2 per 100,000 maternities, 95% CI 16.4- 62.9). Three of the ten women from Nigeria who died, died from cardiac disease (30%). Most (70%) were long-term migrants (>5 years of residence). Nine of the ten women received antenatal care, but only one of them received the NICE recommended level of care (booking at less than 10 weeks and no antenatal appointments missed).”

Saving Lives, Improving Mothers’ Care Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012, Page 19

https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf


Further informationNicola Dennis: [email protected]

ChiMat infant mortality information:

http://atlas.chimat.org.uk/IAS/dataviews/infantmortalityprofile


mailto:[email protected]

infant mortality and mother’s country of birth- what information is currently available? nicola...

Documents

higher infant mortality

neonatal mortality source

maternal mortality rates

ethnicity slide

infant deaths

ethnicity rates

days neonatal mortality

ethnicity source