Health disparities in preterm births in England, study finds

Press release issued: 3 October 2024

Preterm birth rates are lower than the national average for White women and higher for Black and Asian women, and women living in the most deprived areas according to a new University of Bristol-led study published in BMC Medicine.

The study analysed data from 1.3 million births across the 130 NHS Trusts in England and is the first to report ethnic and socioeconomic disparities in preterm birth rates.

In the UK, around one in every 13 births is a preterm birth, and over 50,000 cases occur annually. Despite the existence of preventive measures for women deemed to be at high risk, a persistent increase in preterm birth rates continues.

Until now, there has been a lack of evidence regarding how socioeconomic disparities affect preterm birth rates. To investigate this, the team at Tommy’s National Centre for Maternity Improvement used data from the National Maternity and Perinatal Audit data, for babies born in England between 2015 and 2017.

The study found that of the 1,174,047 births and 91,056 preterm births recorded between 2015 to 2017, the preterm birth rate ranged from 6.8/100 births for women living in the least deprived areas to 8.8/100 births for those living in the most deprived areas. Similarly, the preterm birth rate ranged from 7.8/100 births for White women, up to 8.6/100 births for Black women.

The findings also show the risk of preterm birth varied between and within NHS Trusts. Within the same Health Trust, preterm birth rate appears to be variable depending on the women’s ethnicity, with preterm birth rates lower than the national average in White women while being higher than the national average in Black and Asian women.

Dr Erik Lenguerrand, Senior Lecturer in Medical Statistics & Quantitative Epidemiologist in the Bristol Medical School: Translational Health Sciences (THS) at the University of Bristol, and a senior author on the paper, said: “The reasons for these disparities are not fully understood. Socioeconomic and/or ethnic inequalities are likely to be responsible for some of these inequalities in preterm birth in England, but the Health Trust of birth plays a leading role in the inequity of health care being delivered.

“Disparities in preterm birth could be reduced by targeting populations that have higher than average rates of preterm birth as early as possible in the antenatal care pathway. A strategy to reduce the number of preterm births by 25 per cent every year could result in 3,633 fewer preterm births in Black and Asian women, and 6,472 fewer preterm births in women living in the most deprived areas. Although reducing preterm birth numbers by 25 per cent will improve outcomes for all women, it will not narrow differences between different ethnic and socioeconomic groups.”

Kath Abrahams, Chief Executive of Tommy’s, said: “Premature birth can have life-changing consequences, leaving children at higher risk of long-term complications including learning disabilities, hearing problems and visual impairment.

“As this study shows very starkly, people from minoritised ethnic groups in the UK and those living in the most deprived areas are more likely to experience premature birth, contributing to a damaging cycle of health inequalities.

“We are determined to reduce those disparities through our research into the causes of preterm birth, and by translating our findings into treatments that will stop babies being born too soon.”

Dr Erik Lenguerrand, Amy Howell, Dr Christy Burden, Professor Andrew Judge and colleagues recommend the analysis is repeated when more recent data is available from the Maternity Services Dataset, so that any changes across NHS Trusts can be examined further.

The study was funded by Tommy’s baby charity, and was conducted as part of the Tommy's National Centre for Maternity Improvement led by the Royal College of Obstetricians & Gynaecologists (RCOG), and the Royal College of Midwives (RCM).

Paper

'Socioeconomic and ethnic disparities in preterm births in an English maternity setting: a population-based study of 1.3 million births’ by E. Lenguerrand et al. in BMC Medicine [open access]

Further information

Call to Action

The disparities in the preterm birth rate within the same maternity units involved in this study suggest that inequalities in access, and/or delivery of good quality antenatal care may be an important target for change and improvement by decision-makers. These findings should guide care and policy decision-makers in addressing this challenge and prioritising interventions to reduce this important public health issue.

The quality of antenatal care is key in reducing preterm births. There is a need for local community engagement to reduce barriers for women with social risk factors and to address equity issues in maternity care in the UK. Services should be closely monitored to ensure everyone has access to the same levels of care.

There is an urgent need to use methods for identifying those at risk of preterm birth, so that they can be referred to services designed specifically for the needs of those at risk of premature labour.

Using an initial early pregnancy risk assessment that includes ethnicity and socioeconomic deprivation may represent one of the most effective approaches towards preterm birth reduction, especially if targeted at the NHS Hospital Trusts in areas with the highest variability in preterm birth outcomes. Women identified with a higher chance of preterm birth can be offered specialist care that may delay birth so that the baby is born less premature. This can also help to reduce neonatal mortality and morbidity.

About the term disparity

The term disparity in this context is used to describe something that is unfair or unequal.

An ethnicity or ethnic group is a grouping of people who identify with each other because of shared attributes that distinguish them from other groups. Those attributes can include common sets of traditions, ancestry, language, history, society, nation, religion, or social treatment within their residing area.

Socioeconomic status is the position of an individual or group which is determined by a combination of social and economic factors such as income, amount and kind of education, type and prestige of occupation, and place of residence. In this study the data only allows for place of residence to be considered.

To understand how to reduce the number of preterm births, it is important to understand the differences in the preterm birth rate across all healthcare settings and across different groups of people cared for in these settings. Improving access to healthcare and reducing health disparities could reduce preterm birth, improve infant survival and improve infant quality of life.

The team now plans to conduct further observational work to better understand the risk factors for preterm birth among women pregnant for the first time, the largest group among those at risk of preterm birth, but who remained vastly understudied.