Social inequalities in access to care at birth and neonatal mortality: an observational study

This manuscript examines all live births in France from 2012 - 2014 to assess the association between socioeconomic status and delivery of preterm infants in the appropriate level of maternity and neonatal care. The authors found such an association, as well as a higher risk of neonatal mortality. Objective To look at the association of socioeconomic status (SES) with the suitability of the maternity where children are born and its association with mortality. Design Retrospective analysis of a prospective cohort constituted using hospital discharge databases. Setting France Population Live births in 2012-2014 in maternity hospitals in mainland France followed until discharge from the hospital. Main outcome measure Unsuitability of the maternity to newborns' needs based on birth weight and gestational age, early transfers (within 24 hours of birth) and in-hospital mortality. Results 2 149 454 births were included, among which 155 646 (7.2%) were preterm. Preterm newborns with low SES were less frequently born in level III maternities than those with high SES. They had higher odds of being born in an unsuitable maternity (OR=1.174, 95% CI 1.114 to 1.238 in the lowest SES quintile compared with the highest), and no increase in the odds of an early transfer (OR=0.966, 95% CI 0.849 to 1.099 in the lowest SES quintile compared with the highest). Overall, newborns from the lowest SES quintile had a 40% increase in their odds of dying compared with the highest (OR=1.399, 95% CI 1.235 to 1.584). Conclusions Newborns with the lowest SES were less likely to be born in level III maternity hospitals compared with those with the highest SES, despite having higher prematurity rates. This was associated with a significantly higher mortality in newborns with the lowest SES. Strategies must be developed to increase health equity among mothers and newborns.

Automated summary

This study found that preterm infants with lower socioeconomic status were less likely to be born in level III maternity hospitals, had a higher risk of mortality, and were more likely to be born in unsuitable maternity hospitals. Newborns from the lowest socioeconomic status had a 40% increase in mortality compared to those from the highest socioeconomic status.