This annual report - Taranaki District Health Board

Socioeconomic DeprivationDefinitions and New Zealand DistributionSocioeconomic status, measured by indicators such as level of income, education, wealth,housing, occupation, neighbourhood deprivation and access to resources, is a keydeterminant of health, including the health and life chances of unborn and new born babies[136,149]. In economically developed countries such as New Zealand, deprivation is amatter of relative disadvantage, or inequalities [8]. Income inequality increased significantlyin New Zealand from 1990 to 2011 [8]. There is also a significant disparity in thedistribution of deprivation in New Zealand. The proportion of Māori living in very deprivedareas is significantly higher than the proportion for non-Māori, and the proportion of Māoriand Pacific babies born in the most deprived areas is consistently higher than for otherethnic groups [150,151].Associations between socioeconomic deprivation and pregnancy outcomesChildren born into poverty are at increased risk of IUGR, neonatal or infant death, delayedcognitive development and poor school performance [152]. In common with othercountries, perinatal mortality and other adverse pregnancy outcomes in New Zealand arelinked to socioeconomic disadvantage. Women, babies and whānau/families in the mostsocioeconomically deprived circumstances consistently experience the worst outcomes[138,141]. In 2010 rates of stillbirth and neonatal death (see box 1 above for definitions)were significantly higher for mothers living in the most socioeconomically deprived areas(NZDep quintile 5: perinatal related death rate 13.26 per 1000) compared to those in theleast deprived areas (NZDep quintile 1: 8.34 per 1000) [138]. Stillbirths and neonataldeaths were also more common among Māori and Pacific women and women undertwenty years, compared to those aged 20 to 39 years [8]. Rates of SUDI also demonstratea social gradient [153]. For example, during 2004 to 2008, the rate of SUDI among those inthe most deprived areas (NZDep quintile 5) was 202.5 per 100,000, compared to 27.4 per100,000 for those in the least deprived areas (NZDep quintile 5) (RR 7.4, 95% CI 4.21 to13.01).While a higher proportion of Pacific and Māori babies than European babies are born intothe most deprived NZDep areas, their higher perinatal mortality rates may also reflectdiffering distributions of more proximal risk factors such as maternal smoking [151].Stillbirth rates are higher for Pacific women (8.48 per 1000 births) than for Europeanwomen (4.84 per 1000 births in 2007–2010) but a recent case control study found thisdisparity was explained by confounding factors such as high parity and maternal obesity[154]. Māori babies experience much higher rates of SUDI (223.8 per 100,000 in 2004–2008) than NZ European babies (45.1 per 100,000, RR 4.96, 95% CI 3.77–6.53) [153].Differences in the distribution of proximal risk factors such as maternal smoking inpregnancy and bed-sharing practices may account for some of the differences seen [155].A report published by Whakawhetu National SUDI Prevention for Māori(http://www.whakawhetu.co.nz/) found that Māori mothers were on average younger, lesslikely to access antenatal education, more likely to book late for antenatal care and morelikely to receive fewer antenatal visits [156]. Understanding these different pathways toSUDI is essential in developing culturally appropriate prevention strategies.Internationally, several studies have examined the relationship between deprivation andadverse birth outcomes. A recent meta-analysis of 28 studies found that women who livedin low income neighbourhoods had significantly higher odds of having a low birthweightinfant (pooled OR 1.11, 95% CI 1.02 to 1.20) [157]. Similarly, Weightman et al. foundconsistent links between social deprivation and adverse birth outcomes and infant mortalityin the UK [149]. This systematic review and meta-analysis of 36 prospective andretrospective observational studies with socioeconomic data and health outcomesidentified an OR of 1.81 (95% CI 1.71 to 1.92) for adverse birth outcomes in the highestversus lowest area deprivation quintiles. For infant mortality, the ORs were 1.72 (95% CI1.37 to 2.15) overall, 1.61 (95% CI 1.08 to 2.39) for neonatal mortality and 2.31 (95% CI2.03 to 2.64) for post neonatal mortality. Significantly increased odds were also identifiedfor stillbirth, low birthweight and prematurity. While prematurity has been linked toIn-Depth Topic: Adversity in Pregnancy - 279