University of Liverpool

Hugh Greenwood Legacy for Children’s Health Research Fund University of LiverpoolUniversity of Liverpool

No

6205-1AD8-95E1-28E2-B6E3-40C7

There has been a rise in infant mortality rates since 2014, especially in disadvantaged areas such as Liverpool. One of the main drivers of this rise is due to an increase of deaths of babies within 28 days of life (neonatal period). However, even within in the North West of England, there are variations in the neonatal mortality rate. Previous studies that have investigated potential factors that may affect the relationship between geographical region and neonatal mortality has been limited. As a result, local service providers and policy makers have identified a need to understand to what extent the observed trends can be explained by maternal and pregnancy-related characteristics and wider societal circumstances of the population. At the University of Liverpool, in collaboration with a wider project team that includes clinical experts, we will use individual level data from the National Neonatal Research Database to assess the inequalities in neonatal mortality by calculating and comparing neonatal mortality rates for each neonatal network in England and Wales and by deprivation levels, over time. In the North West of England specifically, we will compare rates between neonatal units within the network. We will also account for other factors, which may affect the relationship between deprivation and risk of neonatal death. The data we will receive will not include any identifiable variables and will not be accessed until all ethical approval has been received. At this point the data will be stored on a secured server that only key contributors to the project who will be involved in analysis will have access to. It is hoped that we can raise awareness of any key results, and engage with service providers and local communities.

There has been an unprecedented rise in infant mortality rates since 2014, especially in disadvantaged areas such as Liverpool. This rise is primarily due to an increase in the proportion of babies that die within the neonatal period; most of these deaths occur in hospital neonatal care units. Neonatal mortality rates in the North West are above the UK average. The recent report from the National Neonatal Audit Programme showed that in 2019 rates of mortality prior to discharge from a neonatal unit or 44weeks post-menstrual age in very preterm infants in the North West was the second highest compared to all Neonatal Operational Delivery networks in the UK. Local analyses have shown that even within the North West there are large variations; the proportion of babies that die at Liverpool Women’s Hospital is higher than at comparable units for example in Manchester. The reasons for this are unclear as the number of variables used to adjust for differences in case-mix between networks and units in both, national and local analyses, has been limited. Local service providers and policy makers have highlighted the need to understand to what extent the observed trends can be explained by adverse maternal and pregnancy-related characteristics and wider societal circumstances of the population. We will use individual level data to assess the pathways to geographic inequalities in neonatal mortality rates. No unit-level comparisons will be made, except in the North-West where we are particularly interested in the extent to which variation between units can be explained by case-mix.

01/06/2022

31/10/2024

11/10/2023

(f) processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child.

(i) processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy;

Not applicable

One-off

15/01/2025

Release

In scenarios where values presented n<10, values may either be suppressed in tables and totals updated as a result, or imputation may be applied if appropriate. Care will be taken to not plot individual level data on any graphs and ensure it is clear no individuals can be identified from the results. Any summary statistics plotted will only be provided where n >=10.