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Premature births are blamed for high death rate in UK’s under 5s compared with Sweden

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4406 (Published 14 August 2015) Cite this as: BMJ 2015;351:h4406
  1. Ingrid Torjesen
  1. 1London

The death rate in preschool children in the United Kingdom is almost twice as high as in Sweden, and the most common causes are complications after premature birth, congenital abnormality, and infection, says a study published online by the Archives of Disease in Childhood.1

The findings raised “important questions” about the delivery of children’s health services in the UK and training in paediatrics among the country’s general practitioners, said the researchers, from the University of Nottingham.

To compare causes of death in under 5s in the two countries over a three year period (2006-08) researchers used data from the UK Office for National Statistics and the Swedish National Board of Health and Welfare.

Sweden was chosen as the comparator country because it has one of the lowest child death rates in Europe, has comparable economic and social development to the UK, has healthcare free at the point of access, and spends the same proportion of its gross domestic product (about 8%) on healthcare.

From 2006 to 2008 the total number of live births was 2 295 964 in the UK and 315 884 in Sweden. The death rate among under 5s in the UK was almost double that in Sweden, at 614 in 100 000 compared with 328 in 100 000.

The primary causes of death in the UK were problems associated with premature birth (138.5/100 000 population), congenital abnormalities (112.1/100 000), and infections (63.9/100 000). The mortality rates for the same three conditions in Sweden were far lower at 10.1/100 000, 88.6/100 000, and 34.8/100 000, respectively. The three main causes of death among under 5s in Sweden were congenital abnormalities, complications of pregnancy and labour, and infections.

“To reduce the mortality rate in the UK, we need to try and reduce the causes of prematurity,” the researchers said. The death rate from premature birth in the UK was 13 times higher than that in Sweden. And, while the rate of premature births in Sweden was stable, the UK’s rate was rising.

The researchers said, “The high mortality rate from prematurity in the UK is not a reflection on the quality of neonatal intensive care. It is, however, a reflection on the adverse social determinants of health in the UK that result in a large number of preterm births.” They warned that socioeconomic factors and inequalities have a major influence on premature birth.

They added, “The differences in mortality rates for a wide variety of clinical conditions, including respiratory disorders in both young children and neonates, cardiovascular, gastrointestinal, and neurological disorders raise important questions about the organisation and delivery of services for young children in the UK.”

Treatable infections such as pneumonia, meningitis, and septicaemia, in neonates and in young children, also had significantly higher mortality rates in the UK than in Sweden (P<0.001).

In contrast with Sweden, many GPs in the UK have no training in paediatrics. “It is of concern that within the UK a significantly higher number of young children do not receive timely treatment for life threatening infections,” the researchers said. “Our findings suggest that it would be more appropriate to fund research into service delivery to examine reasons why children do not receive existing treatment in a timely manner, rather than evaluating new medicines. The former is more likely to result in a significant reduction in mortality than the latter.”

Notes

Cite this as: BMJ 2015;351:h4406

References

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