Researchers found 614 deaths per 100,000 of under-fives in UK compared with 328 in Sweden, with social inequalities partly to blame for difference

The death rate among preschool children in the UK is almost double that of Sweden, with social inequalities being partly to blame, according to researchers.

A study, published online in the Archives of Disease in Childhood, compared the UK with Sweden because the Scandinavian country has one of the lowest child death rates, a measure considered by Unicef to be a barometer of children’s health.

Sweden also has levels of economic and social development comparable with the UK, free healthcare at the point of access and spends the same proportion of GDP – about 8% – on healthcare.

The researchers found there were 614 deaths per 100,000 of the under-fives population in the UK, compared with 328 in Sweden. The primary causes of death in the UK were problems associated with premature birth, congenital abnormalities, and infections, with the mortality rate for the first of these factors being 13 times higher than in Sweden.

The study’s co-author Imti Choonara, emeritus professor at Nottingham University’s academic unit of child health, said: “The major cause of death is prematurity, and social economic inequalities are one of the causes [of prematurity]. A society with large inequalities inevitably results in worse health outcomes.”

The paper, published on Thursday, emphasised that the high mortality rate from prematurity in the UK – 138.5 per 100,000 preschool children compared with 10.1 in Sweden – was not a reflection of the quality of neonatal intensive care but of “the adverse social determinants of health in the UK that result in a large number of preterm births”. The premature birth rate has remained stable in Sweden while it has been rising in the UK.



The researchers used nationally collated data spanning the period 2006 to 2008, during which there were 2,295,964 live births in the UK and 315,884 in Sweden. The respective mortality rates for congenital abnormalities and infections in the UK were 112.1 and 63.9, compared with 88.6 and 34.8 in Sweden.

Both newborns and young children were significantly more likely to die of treatable infections such as pneumonia, meningitis and septicaemia in the UK than they were in Sweden.

That prompted the authors to suggest money would be better spent working out why children do not get prompt care with existing treatments rather than on evaluating new medicines. One suggestion was that, unlike in Sweden, many UK GPs do not have any training in paediatrics. The child death rate in the UK is not just higher than in Sweden but in many European countries, including France and Spain.

Choonara said: “If children are dying from a whole range of issues, then we need to identify what the reasons are. There’s a fault in the system somewhere.”

Neena Modi, president of the Royal College of Paediatrics and Child Health, said the wide variation in the mortality rates “strongly suggests the possibility that the differences identified may arise from variability in how cases are defined and coded, and how very pre-term babies who have lived for just a few minutes before passing away, are registered”.

She added: “The important message of this paper is that the NHS requires investment and commitment to ensure the availability of high quality reliable data and there must be consistency in analytical approaches so that apples are compared with apples and not with pears.”

The health minister Jane Ellison said: “This data is nearly 10 years old. Since then we have invested in the Each Baby Counts programme to prevent neonatal deaths and we are making sure women get consistent advice on things like a healthy diet, and reducing smoking and drinking. We have also increased the number of midwives and health visitors and invested in GP training so that every child gets a good start in life.

“While deaths in children in the UK are actually falling, we do recognise more needs to be done. We have a world-class national childhood immunisation programme in place which saves many lives each year and even more children will be protected when we roll out the world’s first national and publicly funded meningitis B immunisation programme from September 2015.”