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Press releases Saturday 22 April 2006

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(2) Measures of health inequalities are misleading

(1) Concern over rising preterm births
(Editorial: Why should preterm births be rising?)
http://bmj.com/cgi/content/full/332/7547/924

Doctors in this week±s BMJ express concern over the apparent increase in preterm births.

Research from Denmark, published on bmj.com in February, found that preterm deliveries increased by 22% from 1995 to 2004. Even among low risk women aged 20-40, there was a 51% increase in early delivery.

The study also showed that assisted conceptions, multiple pregnancies, and elective deliveries increased during this time and were associated with early birth.

Now doctors in the UK warn that, if these trends are real, the impact for society is considerable.

Preterm deliveries account for fewer than 1 in 10 births but result in 75% of neonatal deaths and most neonatal intensive care admissions, write Andrew Shennan and Susan Bewley of St Thomas± Hospital, London.

Preterm birth also has considerable impact on long term future health. For instance, 1 in 4 survivors born less than 25 weeks± gestation have severe mental or physical disability. Even beyond 32 weeks, 1 in 3 children have educational and behavioural problems by the age of 7.

Possible reasons for the findings from Denmark are numerous and difficult to explain, say the authors, but they may include extremes of maternal weight, smoking, ethnic origin, and social class. A trend towards earlier ultrasound for dating and screening might also play a role.

Untangling the underlying causative factors may be difficult, but general public health measures to do with smoking, teenage and middle age pregnancy, prevention of sexually transmitted diseases, obesity, and social inequities are a good start, they write.

Obstetricians should re-evaluate the risks and benefits of delivering babies earlier. If these findings from Denmark are true, the implications for neonatologists, health economists, teachers, parents, and children themselves are worrying, they conclude.

Contact:
Andrew Shennan, Professor of Obstetrics, King±s College London School of Medicine, St Thomas± Hospital, London, UK Email: andrew.shennan@kcl.ac.uk

(2) Measures of health inequalities are misleading
(Importance of relative measures in policy on health inequalities)
http://bmj.com/cgi/content/full/332/7547/967

UK targets to reduce health inequalities could end up improving the health of the richest fastest, warn researchers in this week±s BMJ.

The UK government±s health inequalities policy aims to improve the health of the poorest fastest. But the way health gaps are currently measured gives a misleading impression of progress, argue health economist Allan Low and Director of public health, Anne Low.

They explain how national targets for reducing health inequalities are set using different measures of gaps in health. For example, the targets for infant deaths and life expectancy at birth use relative gaps, whereas the targets for deaths from cancer and circulatory diseases use absolute gaps.

Using data on cancer deaths, they show that measuring absolute gaps between the most deprived and most affluent areas of England gives a misleading impression of progress. Relative gaps should therefore be used to measure progress, they write.

Relative gaps can also be used to compare health inequalities with inequalities in provision of health services, they add. For example, if a minority ethnic group has a greater rate of ill health than the rest of the population, comparison of this health gap with the equivalent gap in service provision can be used to assess the need for greater access to relevant services.

±Most descriptions of the national inequality targets do not specify whether the reductions required are relative or absolute, as if it does not matter,± say the authors. ±We have shown why it does matter.±

±Lack of transparency in this regard has led to the inconsistent use of relative and absolute gaps in government targets going unquestioned. It has also resulted in confusion over how to establish local health improvement targets that are consistent with national policy on reducing health inequalities,± they conclude.

Contact:
Allan Low, Health Economist, Newcastle upon Tyne, UK Email: alow@btinternet.com

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