{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:03:35Z","timestamp":1788390215231,"version":"build-2803163510"},"reference-count":27,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007421","name":"Li Ka Shing Foundation","doi-asserted-by":"publisher","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/100007421","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR303806"],"award-info":[{"award-number":["NIHR303806"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Policy Research Programme","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]},{"name":"Policy Research Unit","award":["PR-PRU-1217-21202"],"award-info":[{"award-number":["PR-PRU-1217-21202"]}]},{"name":"Oxford Biomedical Research","award":["NIHR203311"],"award-info":[{"award-number":["NIHR203311"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2024,4,28]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In the United Kingdom, pregnant women who live in the most deprived areas have two times the risk of dying than those who live in the least deprived areas. There are even greater disparities between women from different ethnic groups. The aim of this study was to investigate the role of area-based deprivation and ethnicity in the increased risk of severe maternal morbidity (SMM), in primiparous women in England.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective nationwide population study was conducted using English National Hospital Episode Statistics Admitted Patient Care database. All primiparous women were included if they gave birth in an National Healthcare Service (NHS) hospital in England between 1 January 2016 and 31 December 2021. Logistic regression was used to examine the relative odds of SMM by Index of Multiple Deprivation and ethnicity, adjusting for age and health behaviours, medical and psychological factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study population comprised 1\u2009178\u2009756 primiparous women. Neighbourhood deprivation increased the risk of SMM at the time of childbirth. In the fully adjusted model, there was a linear trend (p=0.001) between deprivation quintile and the odds of SMM. Being from a minoritised ethnic group also independently increased the risk of SMM, with black or black British African women having the highest risk, adjusted OR 1.84 (95% CI 1.70 to 2.00) compared with white women. There was no interaction between deprivation and ethnicity (p=0.49).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study has highlighted that neighbourhood deprivation and ethnicity are important, independently associated risk factors for SMM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2024-222060","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T16:07:42Z","timestamp":1717517262000},"page":"500-507","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Associations between neighbourhood deprivation, ethnicity and maternal health outcomes in England: a nationwide cohort study using routinely collected healthcare data"],"prefix":"10.1136","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0081-7670","authenticated-orcid":false,"given":"Dorothea","family":"Geddes-Barton","sequence":"first","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rema","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Knight","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raph","family":"Goldacre","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"key":"2025100302402378000_78.8.500.1","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2023.10.013","article-title":"Society for maternal-fetal medicine. social determinants of health and obstetric outcomes: a report and recommendations of the workshop of the society for maternal-fetal medicine","volume":"230","author":"Grobman","year":"2024","journal-title":"Am J Obstet Gynecol"},{"key":"2025100302402378000_78.8.500.2","unstructured":"Knight M , Bunch K , Patel R , et al . On Behalf of MBRRACE-UK. Saving Lives, Improving Mothers\u2019 Care \u2013 Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018\u20132020. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2022."},{"key":"2025100302402378000_78.8.500.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-046174","article-title":"Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada","volume":"11","author":"Snelgrove","year":"2021","journal-title":"BMJ Open"},{"key":"2025100302402378000_78.8.500.4","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2008.080408"},{"key":"2025100302402378000_78.8.500.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-007903","article-title":"Risk factors for maternal morbidity in Victoria, Australia: a population-based study","volume":"5","author":"Lindquist","year":"2015","journal-title":"BMJ Open"},{"key":"2025100302402378000_78.8.500.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0095086","article-title":"Ethnic variations in severe maternal morbidity in the UK\u2013a case control study","volume":"9","author":"Nair","year":"2014","journal-title":"PLoS One"},{"key":"2025100302402378000_78.8.500.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b542","article-title":"Inequalities in maternal health: national cohort study of ethnic variation in severe maternal morbidities","volume":"338","author":"Knight","year":"2009","journal-title":"BMJ"},{"key":"2025100302402378000_78.8.500.8","unstructured":"Draper E , Manktelow B , Smith P , et al . MBRRACE-UK Perinatal Mortality Surveillance Report: UK Perinatal Deaths for Births from January to December 2020. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2022."},{"key":"2025100302402378000_78.8.500.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017898","article-title":"Linkage of maternity hospital episode statistics data to birth registration and notification records for births in England 2005\u20132014: quality assurance of linkage of routine data for Singleton and multiple births","volume":"8","author":"Harper","year":"2018","journal-title":"BMJ Open"},{"key":"2025100302402378000_78.8.500.10","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyx015"},{"key":"2025100302402378000_78.8.500.11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"2025100302402378000_78.8.500.12","unstructured":"McLennan D , Noble S , Noble M , et al . The English indices of deprivation 2019: technical report."},{"key":"2025100302402378000_78.8.500.13","unstructured":"Ethnic category. Available: https:\/\/www.datadictionary.nhs.uk\/data_elements\/ethnic_category.html [Accessed 02 Jun 2022]."},{"key":"2025100302402378000_78.8.500.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0153370","article-title":"Establishing a national maternal morbidity outcome indicator in England: a population-based study using routine hospital data","volume":"11","author":"Nair","year":"2016","journal-title":"PLoS One"},{"key":"2025100302402378000_78.8.500.15","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"key":"2025100302402378000_78.8.500.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(01)00214-3"},{"key":"2025100302402378000_78.8.500.17","unstructured":"Jones I , Green E , Whittard D , et al . Re-thinking the English indices of multiple deprivation: a review and exploration of alternative and complementary area-based indicator systems. 2018."},{"key":"2025100302402378000_78.8.500.18","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/ppe.12370","article-title":"Variation in maternal co\u2010morbidities and obstetric interventions across area\u2010level socio\u2010economic status: a cross\u2010sectional study","volume":"31","author":"Adhikari Dahal","year":"2017","journal-title":"Paediatr Perinat Epidemiol"},{"key":"2025100302402378000_78.8.500.19","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181a819a1"},{"key":"2025100302402378000_78.8.500.20","doi-asserted-by":"crossref","DOI":"10.1177\/17455065221075913","article-title":"Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand","volume":"18","author":"Dawson","year":"2022","journal-title":"Womens Health (Lond)"},{"key":"2025100302402378000_78.8.500.21","unstructured":"NMPA Project Team . 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