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187: Temporal changes in health inequalities in perinatal and infant mortality in Scotland, between 1985 and 2004

      Objective

      To determine whether population trends in rates of perinatal and infant death differed in relation to socioeconomic deprivation.

      Study Design

      We studied 1,138,864 singleton births between 28 and 43 weeks with birthweight greater than 500g, in Scotland between 1985 and 2004 using data from national registries of births and perinatal deaths. Socioeconomic status was estimated using Carstairs socioeconomic deprivation categories (1=least through to 7=most deprived) which is derived from census data within postcode sectors of residence. Analysis was by multivariable logistic regression.

      Results

      All types of perinatal and infant death declined over the period 1985 and 2004. The reductions were most marked for neonatal death following preterm birth (75%, 95% CI 67-81%) and infant deaths (73%, 95% CI 68-77), less marked for explained stillbirth (51%, 95% CI 39-60%) and delivery-related perinatal death at term (39%, 95% CI 20-53), and smallest for unexplained stillbirth (31%, 95% CI 20-41%). The magnitude of decline did not significantly differ in relation to socioeconomic deprivation for all categories of death (p>0.05 for interaction) except for infant death due to SIDS (p<0.001 for interaction). The improvement was greater among less deprived women (Figure).

      Conclusion

      There have been population-wide improvements in the incidence of perinatal and infant mortality across the whole range of socioeconomic deprivation. However there is evidence of increasing health inequality in the incidence of SIDS.