Inequalities in Preterm Birth in England: A Retrospective National Cohort Study Focusing on Deprivation and Ethnicity, Using Routinely Collected Maternity Hospital Data

Abstract

Objective

To quantify the interplay between socioeconomic and ethnic inequalities in preterm birth rates in England from 2018 to 2021.

Design

A retrospective cohort study using electronic health data.

Setting

English hospitals.

Population

1537 595 women aged 13–55 with a singleton livebirth (April 2018–March 2021) at 24–42 gestational weeks were included.

Methods

Multivariate Poisson regression was used to estimate the rate of preterm birth in each ethnic and deprivation group, adjusted rate ratios between groups, and associations. A post hoc calculation identified the rate of preterm birth for each ethnic group at each level of deprivation.

Main Outcome Measures

Preterm birth (birth at less than 37 gestational weeks).

Results

The rate of preterm birth was 6.30% (95% CI: 6.22–6.37) in women living in the most deprived areas, compared to a rate of 5.05% (95% CI: 4.96–5.14) among women in the least deprived areas. White women had a preterm birth rate of 5.74% (95% CI: 5.70–5.78), whereas South Asian and Black women had higher rates of preterm birth at 6.09% (95% CI: 5.98–6.21) and 5.89% (95% CI: 5.70–6.09), respectively. Deprivation interacted with ethnicity and attenuated the differences in the rate of preterm birth across all ethnicity groups (p < 0.001). In areas of high deprivation, preterm birth rates were similar across ethnicity groups, whereas in the least deprived areas, South Asian and Black women had higher rates.

Conclusion

Deprivation and ethnicity remain key drivers of inequalities in preterm birth. Prevention strategies need to address socioenvironmental and structural determinants of preterm birth in areas of high deprivation and minority ethnicity groups.