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

英国儿童的死亡率高于许多其他发达国家。我将调查为什么会发生这种情况，从而为提高英国儿童存活率的政策提供信息。在20世纪70年代，英国的儿童死亡率（每10万人中儿童死亡人数）与可比的富裕国家相似，在许多领域，英国表现良好。然而，尽管从那时起英国儿童死亡率一直在下降，但下降的速度比其他国家慢，英国现在是欧洲儿童死亡率最高的国家之一。如果英国的死亡率与瑞典（表现最好的国家）相似，那么每年的儿童死亡人数将减少约2000人，即每天减少5人。我将建立一份最新的儿童死亡率与类似富裕国家的对比图，然后调查英国表现不佳的地方——即确定哪些死亡原因和年龄组表现出最大的差异。我将使用的比较组是EU15+，即2004年之前的欧盟国家加上加拿大、澳大利亚和挪威。先前的研究表明，英国人在出生前后死亡的风险很高，这可以用早产率高和出生体重低来解释。我的项目将集中研究新生儿期后的死亡原因，英国在这方面也表现不佳，但人们对这方面知之甚少。先前的研究表明，在英国，哮喘、糖尿病和癌症等长期疾病（也称为非传染性疾病（NCDs））的许多结果（包括死亡率）比其他富裕国家更糟糕。我将比以前更详细地研究这些死亡原因，以确定导致英国儿童死亡率高的原因。由于这些疾病中有许多影响到青少年和年轻人，因此该项目将重点关注24岁以下年轻人以及更年幼的儿童的死亡情况。我还将调查英国儿童更容易死亡的地方。我将研究一些高儿童死亡率是否是由于高度贫困、社会排斥和其他已知会影响儿童健康的剥夺标志。先前的研究表明，与其他欧洲国家相比，英国的贫困更多地集中在儿童身上，而不是成年人身上。我将探讨这是否是英国儿童死亡率高的一个因素。该项目的这一部分着眼于健康的社会决定因素，将有助于确定在降低儿童死亡率方面需要特别关注哪些群体，并确定在卫生以外的特定政策领域，在这些领域进行干预可以挽救生命。最后，我将看看英国儿童死亡前几年的医疗服务是如何使用的。先前的研究表明，在全国不同地区，儿童接受的常见疾病护理存在很大差异。我将探讨是否获得和使用医疗保健服务，如门诊诊所，到急诊科的人数，以及在死亡前错过预约的比率，以及这些在英格兰各地的不同方式，可能与更大的死亡风险有关。我将使用英格兰、威尔士、北爱尔兰和苏格兰国家统计局例行收集的死亡原因数据。这些组织还为我的分析提供了贫困和不平等程度的数据。这一信息可与医院收集的儿童入院、门诊预约或急诊科就诊的数据联系起来，以描述儿童在死亡前使用卫生服务的情况。我将详细描述英国儿童死亡率的模式，并确定哪些群体的风险最大，以及与这种风险相关的剥夺和医疗保健因素有多大。我的发现可能有助于制定有效的政策，以减少英国的儿童死亡，这是一个关键的医疗保健优先事项。

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.