Impact of socioeconomic circumstances on risks and life-course consequences of preterm birth: studies into differential exposure and susceptibility

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Relevance:Preterm birth is a significant public health problem. Affecting almost one in ten births, children born preterm are significantly more likely to face developmental problems, health and behavioural issues, and poorer educational outcomes. Preterm birth is a leading cause of mortality, morbidity and healthcare use among children globally, and to further exacerbate the issue, pregnant women who are of a lower socioeconomic status are significantly more likely to give birth preterm than more affluent women. Considering that health and educational outcomes are worse for children who grow up more disadvantaged socioeconomic conditions, and they are more likely to be born preterm, it evident that preterm birth is an important contributor to the generation of health inequalities. Reducing health inequalities is a key area of policy interest. However, there are currently no policies or interventions to support children born preterm in the UK beyond the health services they may require. Children born preterm have worse outcomes even when they do not have an early life health problem. Thus, there is a cohort of children that needs support but do not receive it. A challenge for this situation is that we do not fully understand the complex pathways from maternal socioeconomic status to preterm birth, or the relationships between preterm birth and childhood socioeconomic conditions, and their influence on outcomes in later life. This limits the ability to intervene effectively through policy action.Hypotheses:This research is founded on two hypotheses. First, we can better explain inequalities in the distribution of preterm birth through understanding of how maternal risk factors, such as maternal behaviours (smoking while pregnant), or maternal health status, influence the pathway from maternal socioeconomic status to preterm birth. Second is that the impacts that preterm birth have on later life health and education outcomes is dependent on the childhood socioeconomic circumstances.Aims:To test my hypotheses, I have three aims for this research:- Identify the complex pathways that lead to inequalities in the distribution of preterm birth.- Understand how preterm birth and childhood socioeconomic conditions interact to lead to inequalities in later life. - Evaluate the potential impact of policies and interventions at these two policy entry points on health inequalities in later life. To do this, I will use two rich UK datasets. The UK Millennium Cohort Study is a large follow-up study of children from birth, between 2000 and 2001, through to age seventeen. The SAIL databank is a world leading data linkage capturing data on the entire population of Wales covering health, education and social circumstances. I will apply state of the art statistical techniques to these data to meet my aims.Outcomes and Benefits: My research will increase understanding of pathways to inequalities in preterm birth, and how preterm birth interacts with socioeconomic conditions to influence later life inequalities. It will identify children who are most at risk of negative later life outcomes related to preterm birth and socioeconomic conditions. It will also show the potential benefits of intervening at select policy points associated with preterm birth on reducing inequalities in later life. I will work with local policymakers and clinicians to ensure this research is translated into effective action to reduce the negative impacts of preterm birth. The knowledge generated by my research has the potential to reduce inequalities, improve the health of the population, and have wider social and economic benefits.