201 The unexplored effects of social and health inequality on adverse outcomes to children born with Spina Bifida: 2010–2020

Objectives

The incidence of Spina Bifida in the United Kingdom (UK) is 5.80 out of every 10,000 babies born.¹ A diagnosis of Spina Bifida often leads to profoundly complex, lifelong and life changing multi-system co-morbidities. Often, children can require intensive follow up with multiple medical and surgical interventions. To describe differences in severe adverse health outcomes across socioeconomic status for children born with Spina Bifida in West Yorkshire and Humber region.

Methods

This is a retrospective cohort study using routinely collected data. We identified children diagnosed with Spina Bifida from 2010–2020 and admitted to the Leeds centre for new born care. We followed up their healthcare needs in the first two years of life using routine data sources.

Our primary outcomes were

admission to paediatric intensive care unit (PICU) and mortality before the age of two years. We compared the number of babies with Spina Bifida and the outcomes across groups of deprivation using the Index of Multiple Deprivation.

Results

[ Figure 1: Distribution of deprivation for Spina Bifida cohort] There were 91 neonates with a diagnosis of Spina Bifida. Overall 2- year mortality was 7.7% (7), with 4.4% (4) children being admitted to PICU, all due to complications of Spina Bifida. of the 4 children admitted to PICU, 2 died (50%). The cumulative population level risk of been admitted to Leeds PICU over the 10- year period was 2.1% for those children aged under 2, compared to 0.6% across all UK PICUs. It was observed that 70.3% (64) of families with a child with Spina Bifida were ranked in the three most deprived deciles as described by the Index of Multiple Deprivation index. For those 2 cases that died on PICU, both resided in the most deprived deciles.

Conclusions

Little is described in the literature about the impact of social equity and health inequality on the severe adverse health outcomes for children born with Spina Bifida in the UK. We have shown that higher numbers of children are born with Spina Bifida in the most deprived groups – this may relate to differences in termination practices. Those children with spina bifida that are admitted to PICU or experience mortality within the first 2 years of life reside exclusively in the 3 most deprived deciles for England. Future national and international research is needed to explore the impact of deprivation on outcomes for children born with Spina Bifida.

Reference

Peake JN, Knowles RL, Shawe J, Rankin J, Copp AJ. Maternal ethnicity and the prevalence of British pregnancies affected by neural tube defects. Birth Defects Res. 2021 Jul 15;113(12):968–980. doi: 10.1002/bdr2.1893. Epub 2021 Mar 23. PMID: 33754462; PMCID: PMC7611580.