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Odd DE, Stoianova S, Williams T, Odd D, Edi-osagie N, McClymont C, Fleming P, Luyt K. Race and Ethnicity, Deprivation, and Infant Mortality in England, 2019-2022. JAMA Netw Open 2024; 7:e2355403. [PMID: 38345821 PMCID: PMC10862146 DOI: 10.1001/jamanetworkopen.2023.55403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024] Open
Abstract
Importance England has one of the highest infant mortality rates in Europe. Much of the variation in infant mortality rates between races and ethnicities may be due to socioeconomic factors, but how deprivation and race and ethnicity are associated with infant mortality is unclear. Objectives To investigate the association of infant race and ethnicity with the infant mortality rate in England, adjusted for preterm birth and level of deprivation. Design, Setting, and Participants This cohort study included children who died younger than 1 year of age, born at or after 22 weeks' gestation, occurring from April 1, 2019, to March 31, 2022, in England. Characteristics of the infant were derived from death notifications. Exposures The racial and ethnic groups were derived from National Health Service data and were reported by the parents and characterized using the Office of National Statistics classification: Asian or Asian British (Bangladeshi, Chinese, Indian, Pakistani, or any other Asian background), Black or Black British (African, Caribbean, or any other Black background), multiracial (White and Asian, White and Black African, White and Black Caribbean, or any other multiracial background), White or White British (British, Irish, any other White background, or Gypsy or Irish Traveler), and other (Arab or any other racial or ethnic group). Main Outcomes and Measures Risk of death for all racial and ethnic groups and relative risk of death compared with the reference group (White) were calcuated. Analyses were repeated, adjusting for deprivation, gestational age of infants, and region of England. Results A total of 5621 infants who died younger than 1 year of age were reported to the National Child Mortality Database. A total of 2842 of 5130 infants (55.4%) were male; the median gestational age was 33 weeks (IQR, 25-38 weeks); of 5149 infants, 927 (18.0%) were Asian, 448 (8.7%) were Black, 3318 (64.4%) were White, 343 (6.7%) were multiracial, and 113 (2.2%) were from other racial and ethnic groups; and the median deprivation score was 4 (IQR, 3-5). In the unadjusted analysis, the relative risk of death compared with White infants was higher for Black (1.93 [95% CI, 1.75-2.13]) and Asian (1.67 [95% CI, 1.55-1.80]) infants. The population attributable risk fraction for all mortality rates among infants who were not White was 12.0% (95% CI, 10.3%-13.8%) (unadjusted), 9.8% (95% CI, 8.0%-11.7%) (adjusted for deprivation), 7.7% (95% CI, 5.9%-9.5%) (adjusted for gestational age at birth), and 12.8% (95% CI, 11.0%-14.5%) (adjusted for region of England). Conclusions and Relevance This cohort study suggests that the proportion of infants who died before 1 year of age is associated with race and ethnicity, with a population attributable risk fraction of 12.0%. An overconservative adjustment for deprivation did not explain the overall patterns seen. Approximately half the population attributable risk fraction may be due to increased risk of preterm birth in Asian and Black communities. Work is needed to identify what can be done to reduce this incidence of infant mortality.
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Affiliation(s)
- David E. Odd
- Division of Population Medicine, School of Medicine, University of Cardiff, Cardiff, United Kingdom
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Sylvia Stoianova
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Tom Williams
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Dawn Odd
- School of Health and Social Wellbeing, University of the West of England, Blackberry Hill, Bristol, United Kingdom
| | - Ngozi Edi-osagie
- Newborn Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Peter Fleming
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Karen Luyt
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Bond L, McNicholas F. The ethicality of the COVID-19 response in children and adolescents. Ir J Med Sci 2024; 193:321-327. [PMID: 37318749 DOI: 10.1007/s11845-023-03423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
Childhood and adolescence are critical periods of physiological growth as well as development in biological, emotional, and social domains. During the COVID-19 pandemic, children and adolescent's lives were drastically changed. Many countries including the United Kingdom and Ireland imposed strict universal lockdowns, which included the closing of creches, schools and universities as well as restricting peer interactions, social activities, and recreational pursuits. Evidence is emerging of a catastrophic impact on the younger generation, which leads the authors to explore the ethicality of the COVID-19 response in this population in relation to the four pillars of medical ethics: beneficence, nomaleficence, autonomy, and justice.
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Affiliation(s)
- Laura Bond
- University College Dublin School of Medicine, Dublin, Ireland.
| | - Fiona McNicholas
- University College Dublin School of Medicine, Dublin, Ireland
- Department of Psychiatry, Children's Hospital Ireland at Crumlin, Dublin, Ireland
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Odd D, Williams T, Stoianova S, Rossouw G, Fleming P, Luyt K. Newborn Health and Child Mortality Across England. JAMA Netw Open 2023; 6:e2338055. [PMID: 37847501 PMCID: PMC10582783 DOI: 10.1001/jamanetworkopen.2023.38055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/02/2023] [Indexed: 10/18/2023] Open
Abstract
Importance Although the immediate impact of neonatal illness is well recognized, its wider and longer term outcomes on childhood mortality and the role of specific illnesses across childhood are unclear. Objective To investigate how many deaths in childhood are associated with neonatal illness and the underlying conditions of the children who died. Design, Setting, and Participants This population-based cohort study of children who died before age 10 years in England between April 1, 2019, and March 31, 2021, used data from the National Child Mortality Database. Data analysis was performed from September 2022 to May 2023. Exposure Children who received care in a neonatal unit after birth plus those who died in the first day of life, before admission to a neonatal unit, were considered to have likely neonatal illness. Main Outcomes and Measures The primary outcome was the relative risk (RR) of dying, stratified by likely neonatal illness and specific neonatal conditions. Comparisons were made using the χ2 or likelihood ratio test, as appropriate. Results A total of 4829 children were included (median [IQR] age at death, 28 [2-274] days; 2606 boys [54.8%]; 2690 White children [64.0%]). Overall, 3456 children who died (71.6%) had evidence of likely neonatal illness. Children with neonatal illness were more likely to die before their tenth birthday than those without evidence of neonatal illness (RR, 13.82; 95% CI, 13.00-14.71). The estimated population-attributable risk fraction for neonatal illness among all deaths before age 10 years was 66.4% (95% CI, 64.9%-67.9%). Children with preceding neonatal illness who died were more likely to have underlying behavioral or developmental disorders (odds ratio [OR], 3.31; 95% CI, 2.47-4.42), chronic neurological disease (OR, 3.00; 95% CI, 2.51-3.58), and chronic respiratory disease (OR, 3.01; 95% CI, 2.43-3.73) than children without neonatal illness. Conclusions and Relevance In this cohort study, most children who died before age 10 years had some evidence of neonatal illness, and they died of a range of causes, including infections and sudden, unexpected, unexplained death. These findings suggest that improvements to perinatal morbidity, an area with an existing evidence base for improvement, may have important impacts on child health across the next decade.
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Affiliation(s)
- David Odd
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Medicine, Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Tom Williams
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sylvia Stoianova
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Grace Rossouw
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Fleming
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Karen Luyt
- National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neonatal Neurology, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
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Efendi F, Haryanto J, Has EMM, Makhfudli M, Indarwati R, Kuswanto H, Wahyuhadi J, Farabi MJA, Ho KHM, Susanti IA. Predictors of Mortality Among Children with Confirmed and Suspected Cases of COVID-19 in East Java, Indonesia. J Multidiscip Healthc 2023; 16:355-362. [PMID: 36785579 PMCID: PMC9921435 DOI: 10.2147/jmdh.s391917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) increases rapidly and causes mortality in all groups, including children. However, the predictive risk factors of mortality among children remain inconclusive. This study aimed to analyse the predictors related to mortality among children with COVID-19. Methods Secondary data analysis was conducted using provincial COVID-19 data from April 2020 to May 2021. We selected 6441 children under age 18 to be included in this study. Chi-square and binary logistic regression were used to evaluate the predictors of mortality in children with COVID-19. Results This study showed that the prevalence of children who died COVID-19 was 2.7%. Age, case definition, treatment status, severity of illness, and travel history had a significant relationship with survival status in children with COVID-19. As the increasing age, the risk of death with COVID-19 will decrease [AOR=0.94; CI 95%=0.91-0.97]. Otherwise, suspected status [AOR=2.12; 95% CI=1.48-3.04], hospitalization with ventilators [AOR=22.25; 95% CI=5.73-86.42], severe illness [AOR=46.76; 95% CI=21.69-100.80], and travel history [AOR=1.78; 95% CI=1.22-2.60] were significantly related with an increased risk of death in children with COVID-19. Discussion Severe illness in children was the strongest predictor of mortality. Disease prevention and health promotion programs are the key to preventing hospitalizations in children and decreasing the mortality rate.
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Affiliation(s)
- Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia,Correspondence: Ferry Efendi, Email
| | - Joni Haryanto
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Retno Indarwati
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Heri Kuswanto
- Department of Statistics, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia,Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Makhyan Jibril Al Farabi
- Dr. Soetomo General Hospital, Surabaya, Indonesia,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ken Hok Man Ho
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong
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Odd D, Stoianova S, Williams T, Fleming P, Luyt K. Child Mortality in England During the First 2 Years of the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2249191. [PMID: 36622676 PMCID: PMC9857017 DOI: 10.1001/jamanetworkopen.2022.49191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE During the first year of the COVID-19 pandemic, child mortality in England was the lowest on record, but if this trend will continue, or if unrecognized morbidity during the first year of the pandemic will manifest as increased deaths over the next few years is unclear. OBJECTIVE To examine the risks and patterns of childhood deaths before and during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study includes all child deaths in England from April 1, 2019, to March 31, 2022. EXPOSURES The year of death. MAIN OUTCOMES AND MEASURES The primary outcome measure is risk of death. RESULTS Of the 9983 child deaths reported during the study period, 9872 (98.8%) were linked to demographic and population data with 3409 deaths (34.5%) between April 2019 and March 2020, 3035 (30.7%) between April 2020 and March 2021, and 3428 (34.7%) between April 2021 and March 2022. Most deaths occurred in children who were younger than 1 year (6257 of 9872 [62.7%]), the majority were male (5534 of 9760 [56.7%]), and lived in an urban area (8766 of 9872 [88.8%]). The risk of death was lower between April 2020 and March 2021 (relative risk [RR], 0.89 [95% CI, 0.84-0.93]), but not between April 2021 and March 2022 (RR, 1.00 [95% CI, 0.95-1.05]) when compared with April 2019 to March 2020. A population attributable risk (PAF) of 4.0% (95% CI, 0.1%-6.8%) suggested fewer deaths occurred during the whole 3-year period than expected. Reductions were seen in risk of dying by infection (PAF, 22.8% [95% CI, 8.2%-37.0%]) and underlying disease (PAF, 13.3% [95% CI, 8.1%-18.8%]), but there was evidence of an increasing risk of death by trauma (PAF, 14.7% [95% CI, 2.9%-25.2%]). Any reduction in the risk of death was greater in rural areas than in urban areas (RR, 0.73 [95% CI, 0.63-0.85] vs RR, 0.91 [95% CI, 0.86-0.95]) and was not seen in children older than 9 years. CONCLUSIONS AND RELEVANCE In this cohort study, there was a significant reduction in all-cause child mortality during the first year of the COVID-19 pandemic (2020-2021), which returned to close to prepandemic levels the following year (2021-2022). However, there was a net reduction in deaths despite this, with 4% fewer deaths during the 3-year period than would have been expected from the 2019 to 2020 risks. The reductions were largest in rural areas and in children younger than 10 years.
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Affiliation(s)
- David Odd
- School of Medicine, Division of Population Medicine, Cardiff University, United Kingdom
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Sylvia Stoianova
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Tom Williams
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
| | - Peter Fleming
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Karen Luyt
- National Child Mortality Database, Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol, United Kingdom
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Sanmarchi F, Esposito F, Adorno E, De Dominicis F, Fantini MP, Golinelli D. The impact of the SARS-CoV-2 pandemic on cause-specific mortality patterns: a systematic literature review. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-19. [PMID: 36188447 PMCID: PMC9510758 DOI: 10.1007/s10389-022-01755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022]
Abstract
Background Understanding the effects of the COVID-19 pandemic on cause-specific mortality should be a priority, as this metric allows for a detailed analysis of the true burden of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon. Methods We searched MEDLINE, Scopus, and ProQuest for studies that reported cause-specific mortality during the COVID-19 pandemic, extracting relevant data. Results A total of 2413 articles were retrieved, and after screening 22 were selected for data extraction. Cause-specific mortality results were reported using different units of measurement. The most frequently analyzed cause of death was cardiovascular diseases (n = 16), followed by cancer (n = 14) and diabetes (n = 11). We reported heterogeneous patterns of cause-specific mortality, except for suicide and road accident. Conclusions Evidence on non-COVID-19 cause-specific deaths is not exhaustive. Reliable scientific evidence is needed by policymakers to make the best decisions in an unprecedented and extremely uncertain historical period. We advocate for the urgent need to find an international consensus to define reliable methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01755-7.
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Affiliation(s)
- Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Emanuele Adorno
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Francesco De Dominicis
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum—Università di Bologna, Via San Giacomo 12, 40126 Bologna, Italy
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Affiliation(s)
- Zachary Willis
- Division of Pediatric Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Annabelle de St Maurice
- University of California Los Angeles, Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
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