Understanding excess child and adolescent mortality in the United Kingdom compared with EU15+ countries

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The rate at which children die in the United Kingdom is higher than in many other developed countries. I will investigate why this occurs, and thus inform policies to improve UK child survival.In the 1970s UK child mortality rates (the number of child deaths per 100,00 population) were similar to those in comparable wealthy nations, and in many areas the UK performed well. However, although UK child mortality has been falling since then, the rate of decline has been slower than in other countries, and the UK now has one of the highest child mortality rates in Europe. If the UK had a mortality rate similar to Sweden (the best performing country), about 2000 fewer children would die each year, or 5 fewer a day. I will establish an up to date picture of child mortality compared with similar wealthy nations, and then investigate where the UK performs badly - i.e. identify which causes of death and age groups show the greatest difference. The comparator group I will use is the EU15+ - meaning the countries of the EU before 2004 plus Canada, Australia and Norway. Previous studies have shown a high risk of dying around the time of birth in the UK, which has been explained by high rates of early delivery and low birth weights. My project will concentrate on causes of death after the newborn period, where the UK also performs poorly but about which little is known. Previous studies have shown that many outcomes (including mortality) for long-term conditions (also known as non-communicable diseases (NCDs)) such as asthma, diabetes and cancer, are worse in the UK than other wealthy nations. I will look at these causes of death in much greater detail than has been done previously, to identify which causes contribute to the high rates of child mortality in the UK. Because many of these conditions affect teenagers and young adults, the project will focus on deaths in young people to age 24 years as well as in younger children.I will also examine where in the UK children are more likely to die. I will examine whether some of the high child death rates are due to high levels of poverty, social exclusion, and other markers of deprivation which are known to affect child health. Previous research has shown that poverty in the UK is more concentrated among children than adults, in contrast to other European countries, and I will explore if this a factor in high UK child mortality rates. This part of the project looking at social determinants of health will help identify which groups will need particular attention to reduce child mortality, and identify particular policy areas outside of health where intervention could save lives.Finally, I will look at how health services are used in the years before children die in the UK. Previous studies have shown wide variation in the care that children receive for common illnesses in different parts of the country. I will explore whether access to and use of health care services such as outpatient clinics, attendances to Accident and Emergency departments, and rates of missed appointments prior to death, and the way these vary across England, may be related to greater risk of dying. I will use data on causes of death collected routinely by national statistics offices in England, Wales, Northern Ireland and Scotland. These organisations also provide data on levels of poverty and inequality needed for my analysis. This information can be linked with data collected by hospitals on which children were admitted, had clinic appointments, or attended emergency department, to describe use of health services before death.I will describe patterns of UK child mortality in detail and identify which groups are at greatest risk and how much deprivation and healthcare factors are related to this risk. My findings may enable effective policies to be developed to reduce child deaths in the UK, a key healthcare priority.