Spatial analysis of the association between area deprivation and neonatal outcomes in an ethnically diverse maternal cohort in England: a retrospective cross-sectional study

Abstract

Background Maternal socioeconomic disadvantage and ethnic minority status are linked to increased risk of adverse neonatal outcomes. Neighbourhoods are structural and contextual conditions in which babies are born, but associations between area deprivation and neonatal outcomes in ethnically diverse areas are seldom examined. We examined spatial variations in neonatal outcomes using area deprivation at small-area levels in an ethnically diverse maternal cohort in the east of England. Methods This was a retrospective cross-sectional study using routinely collected anonymous data of singleton births between April 1, 2015, and Feb 28, 2022, in a UK National Health Service maternity unit. Primary outcomes were low birthweight (ie, under 2500g) and preterm birth (ie, before 37 weeks of gestation). We did geospatial analyses of maternal residence postcode areas to understand associations between primary outcomes and area deprivation based on 2019 Indices of Multiple Deprivation using generalised linear regression, optimised hotspot, and spatial autocorrelation (Global Moran's I) in ArcGIS Pro 3.0.2. Findings Of 36 359 singleton births, 12 491 (34·4%) were to mothers from Black Caribbean, Black African, Indian, Pakistani, or Bangladeshi backgrounds. The prevalence of low birthweight (3319 [9·1%] of 36 359) and preterm birth (3147 [8·7%] of 36 359) was higher than the national average (6·8% and 7·4%, respectively). Low birthweight varied across Indices of Multiple Deprivation deciles, from 4 (3·9%) of 103 in the least deprived areas to 48 (10·5%) of 456 in the most deprived areas, with significant clustering in the most deprived areas (Moran's I 0·061; p<0·0001). Mean birthweight differed by 228g between the least (3402g) and most (3174g) deprived areas. An inverse linear association between birthweight and area deprivation was evident (R2 0·18). Preterm birth varied from 7 (6·8%) of 103 in the least deprived areas to 45 (9·9%) of 456 in the most deprived areas, but showed no significant association with area deprivation (R2 0·06). Interpretation Neonates born to mothers in the most deprived areas of ethnically diverse neighbourhoods are more likely to have adverse outcomes, particularly low birthweight, highlighting the need for targeted primary and secondary interventions. Spatial analysis of routine data can be used to examine health inequalities at the small-area level to inform spatially targeted resources. Funding Wellbeing of Women, in partnership with the Burdett Trust for Nursing (grant reference RG2245). Contributors SP conceptualised and designed the study, coordinated and supervised data extraction and analysis, interpreted the findings, and drafted the abstract. CP contributed to literature review, data analysis and interpretation, and drafting the abstract. EA led the data analysis and contributed to the interpretation of the findings and drafting of the abstract. P-CT and TP contributed to the literature review, data analysis, and interpretation. All authors read and approved the final abstract. Declaration of interests We declare no competing interests.