The Usher Institute, The University of Edinburgh, Edinburgh, UK.
Department of Public Health NHS Lothian, Edinburgh, UK.
BMC Public Health. 2021 May 27;21(1):995. doi: 10.1186/s12889-021-10928-0.
As Scotland strives to become a country where children flourish in their early years, it is faced with the challenge of socio-economic health inequalities, which are at risk of widening amidst austerity policies. The aim of this study was to explore trends in infant mortality rates (IMR) and stillbirth rates by socio-economic position (SEP) in Scotland, between 2000 and 2018, inclusive.
Data for live births, infant deaths, and stillbirths between 2000 and 2018 were obtained from National Records of Scotland. Annual IMR and stillbirth rates were calculated and visualised for all of Scotland and when stratified by SEP. Negative binomial regression models were used to estimate the association between SEP and infant mortality and stillbirth events, and to assess for break points in trends over time. The slope (SII) and relative (RII) index of inequality compared absolute and relative socio-economic inequalities in IMR and stillbirth rates before and after 2010.
IMR fell from 5.7 to 3.2 deaths per 1000 live births between 2000 and 2018, with no change in trend identified. Stillbirth rates were relatively static between 2000 and 2008 but experienced accelerated reduction from 2009 onwards. When stratified by SEP, inequalities in IMR and stillbirth rates persisted throughout the study and were greatest amongst the sub-group of post-neonates. Although comparison of the SII and RII in IMR and stillbirths before and after 2010 suggested that inequalities remained stable, descriptive trends in mortality rates displayed a 3-year rise in the most deprived quintiles from 2016 onwards.
Whilst Scotland has experienced downward trends in IMR and stillbirth rates between 2000 and 2018, the persistence of socio-economic inequalities and suggestion that mortality rates amongst the most deprived groups may be worsening warrants further action to improve maternal health and strengthen support for families with young children.
随着苏格兰努力成为一个让儿童在早年茁壮成长的国家，它面临着社会经济健康不平等的挑战，而在紧缩政策下，这些不平等有可能会加剧。本研究的目的是探索 2000 年至 2018 年期间苏格兰按社会经济地位（SEP）划分的婴儿死亡率（IMR）和死产率的趋势。
从苏格兰国家记录中获取了 2000 年至 2018 年期间的活产、婴儿死亡和死产数据。计算了所有苏格兰地区以及按 SEP 分层的年度 IMR 和死产率，并进行了可视化。使用负二项回归模型来估计 SEP 与婴儿死亡和死产事件之间的关联，并评估随时间变化的趋势是否存在拐点。斜率（SII）和相对（RII）不平等指数用于比较 IMR 和死产率的绝对和相对社会经济不平等，比较的时间点分别为 2010 年之前和之后。
2000 年至 2018 年期间，IMR 从每 1000 例活产 5.7 例降至 3.2 例，但趋势没有变化。死产率在 2000 年至 2008 年期间相对稳定，但自 2009 年以来加速下降。按 SEP 分层，IMR 和死产率的不平等现象在整个研究期间持续存在，且在新生儿后亚组中最大。尽管比较 2010 年前后 IMR 和死产的 SII 和 RII 表明不平等状况保持稳定，但死亡率的描述性趋势显示，自 2016 年以来，最贫困五分之一的死亡率上升了 3 年。
尽管 2000 年至 2018 年期间苏格兰的 IMR 和死产率呈下降趋势，但社会经济不平等的持续存在，以及最贫困群体的死亡率可能恶化的迹象，需要采取进一步行动，改善产妇健康，加强对有幼儿家庭的支持。
