Introduction

Infant mortality is an indicator of the general health of an entire population. It reflects the relationship between causes of infant mortality and upstream determinants of population health such as economic, social and environmental conditions. Deaths occurring during the first 28 days of life (the neonatal period) in particular, are considered to reflect the health and care of both mother and newborn (OHID Child and Maternal Health Profile, 2023).

Oldham's infant and child deaths have been significantly higher than England rates for a number of years. Infant and child mortality are key measures of the health of Oldham.

The National Child Mortality Database (NCMD) completed a review of child deaths in England between April 2019 and March 2020 and found the below as the most frequent modifiable factors contributing to the death of a child.


A study published by the BMJ explores the the effects of deprivation on infant and child mortality and found that there is a clear gradient of increasing child mortality across England as measures of deprivation increase; with a striking finding that this varied little by area, age or other demographic factor. Over one-fifth of all child deaths may be avoided if the most deprived half of the population had the same mortality as the least deprived. Children dying in more deprived areas may have a greater proportion of avoidable deaths. Adult employment, and improvements to housing, may be the most efficient place to target resources to reduce these inequalities[1].

Figure 1 below shows the number of deaths, in each deprivation decile with identified modifiable factors; and the relative risk of death for each increasing deprivation decile with, or without them; split by category of death. The link between deprivation and child mortality is clearly evident. Figures 2 and 3 demonstrate the link further, displaying the infant and child mortality rates by England deprivation deciles. Oldham has high levels of deprivation and many areas within Oldham fall within the highest deprivation deciles.

Figure 1: Number of deaths with modifiable factors identified, England
Source: What is the relationship between deprivation, modifiable factors and childhood deaths: a cohort study using the English National Child Mortality Database, BMJ [1] 
Source: ONS
Source: ONS

Data Overview

Infant Mortality

Infant mortality refers to deaths of babies under the age of 1 year.

Oldham's infant mortality rate has been above Greater Manchester, regional and national averages for more than 20 years. Latest data for 2019-21 reveals that Oldham has the second highest rate in England at 7.2 per 1,000 live births. Stoke-on-Trent is the only Local Authority with a higher rate at 7.5 per 1,000. Whilst improvements in rate have been seen across Greater Manchester (-16%), the North West (-23%) and England (-28%) over the period shown in figure 4, Oldham has not experienced this trend, with rates similar in 2001-03 to 2019-21.

Figure 4: Infant mortality trend
Source: ONS

Table 1: Infant mortality, crude rate per 1,000 live births
Year	Oldham	Greater Manchester	North West	England
2001 - 03	6.9	6.2	5.7	5.4
2002 - 04	7.8	6	5.6	5.2
2003 - 05	6.9	5.7	5.7	5.1
2004 - 06	6.8	5.6	5.6	5
2005 - 07	5.9	5.4	5.5	4.9
2006 - 08	6.1	5.5	5.3	4.8
2007 - 09	6.7	5.2	5	4.7
2008 - 10	7.1	5.1	4.9	4.6
2009 - 11	7.4	5	4.7	4.4
2010 - 12	6.3	4.7	4.6	4.3
2011 - 13	5.3	4.4	4.4	4.1
2012 - 14	5.2	4.2	4.3	4
2013 - 15	5.1	4.3	4.2	3.9
2014 - 16	6.2	4.7	4.5	3.9
2015 - 17	5.9	4.9	4.6	3.9
2016 - 18	5.5	4.9	4.6	3.9
2017 - 19	5.7	5	4.5	3.9
2018 - 20	6.2	4.9	4.3	3.9
2019 - 21	7.2	5.2	4.4	3.9
Source: ONS

Oldham's rate for 2019-21 is highest across Greater Manchester. Trafford has the lowest rate at 1.8 per 1,000 and is the only Greater Manchester Local Authority with a rate below the England average of 3.9 per 1,000 (figure 5).

Figure 5: Infant mortality rate across Greater Manchester
Source: ONS

The map below (figure 6) demonstrates the inequality within Oldham for infant mortality. The data is displayed over a ten year period and by quintile. Rates are highest in Waterhead (8.2 per 1,000 live births), Werneth (8.1), Chadderton Central (8.0) and St Mary’s (7.7) indicating these are the areas of highest need. Oldham’s overall average for this period is 5.8 (per 1,000 live births).

Figure 6: Infant mortality by Oldham ward

Source: Primary Care Mortality Database, Oldham Council Data Insight & Intelligence Team

Child Mortality

Child mortality refers to child deaths between 1 and 17 years.

Oldham's child mortality rate is 5th highest in England.

Oldham's latest child mortality rate for 2018-20 (DSR 16.5 per 100,000) is higher than the averages for both North West (11.5 per 100,000) and England (10.3 per 100,000). Whereas the rates have decreased over the last decade across the North West and England (by 19% and 18% respectively), the rate in Oldham has increased by 10% between 2010-12 and 2018-20 (figure 7).

Figure 7: Child mortality rate trend
Source: ONS

Table 2: Child mortality rates, DSR per 100,000
Year	Oldham	North West	England
2010 - 12	15	14.2	12.5
2011 - 13	13.1	13.5	11.9
2012 - 14	18.1	13.1	12
2013 - 15	20.5	14	11.9
2014 - 16	20	14.3	11.6
2015 - 17	16.9	14.1	11.2
2016 - 18	14.3	13.3	11
2017 - 19	17.7	12.6	10.8
2018 - 20	16.5	11.5	10.3
Source: ONS

Oldham's child mortality rate is highest in Greater Manchester. Salford is lowest at 8.7 per 100,000, almost half of the Oldham rate. Within Greater Manchester Salford, Stockport and Bolton all have rates below the national average (figure 8).

Figure 8: Child mortality rate across Greater Manchester
Source: ONS

Further Information & Resources

Oldham's latest Infant Mortality Intelligence Report
Oldham Council Data Insight and Intelligence Team produce an annual Infant Mortality intelligence Report. This report explores infant mortality in Oldham in comparison to other areas of Greater Manchester (GM), the North West region and England. This analysis also focuses on differences in infant mortality rates (per 1,000 live births) within Oldham by electoral ward areas and indices of multiple deprivation (IMD) 2019 rankings. Infant mortality rates act as one of the key indicators of health and well-being within our communities and can reveal incidence of preventable mortality with regards to lifestyle issues, consanguinity and other factors.

Oldham's latest Child Mortality Intelligence Report
Oldham Council Data Insight and Intelligence Team produce an annual Child Mortality intelligence Report. This report explores child mortality (1 to 17 year olds) in Oldham in comparison to other areas of Greater Manchester (GM), the North West region and England. This analysis also focuses on differences in child mortality rates (per 100,000 DSR) within Oldham by electoral ward areas and indices of multiple deprivation (IMD) 2019 rankings. Child mortality rates can act as a key indicator of health and well-being within our communities and can reveal incidence of preventable mortality with regards to lifestyle issues, consanguinity and other factors such as child safeguarding and mental health issues.

Oldham, Rochdale and Bury Child Death Overview Panel Annual Report 2021-22
This is an annual review of the Child Death Overview Panel (CDOP) data for Oldham, Rochdale and Bury, one of the four CDOP groupings in Greater Manchester. CDOPs review all child deaths under 18 years, apart from still births, late foetal loss, or termination of pregnancy. CDOPs are not responsible for establishing the cause of death, they explore all factors relating to the death of the child. The findings of the report will be used to inform future action and to generate recommendations.

National Child Mortality Database
The National Child Mortality Database (NCMD) is an NHS-funded programme delivered by the University of Bristol. It gathers information on all children who die in England, so that it can improve and save children’s lives in the future. NCMD has a range of resources for Child Death Overview Panels (CDOPs) and other health and social care professionals working in Child Death Review.

OHID Child and Maternal Health Profiles
For further data and information relating to infant and child mortality.

ONS: Child and infant mortality in England and Wales: 2021
ONS reporting on Stillbirths, infant and childhood deaths occurring annually in England and Wales, and associated risk factors.

References
[1] Odd D, Stoianova S, Williams T, et al
What is the relationship between deprivation, modifiable factors and childhood deaths: a cohort study using the English National Child Mortality Database BMJ Open 2022;12:e066214. doi: 10.1136/bmjopen-2022-066214