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Qual Saf Health Care 13:238 doi:10.1136/qhc.13.3.238
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Risk of infant death or stillbirth does not change with distance to hospital

A link between infant death or stillbirth and journey time to the nearest hospital has been refuted by statistics in northwest England covering more than four decades when used in a model providing a more realistic estimate of time travelled.

The data included all 287 993 births in the whole of Cumbria, northwest England, for 1950–93, among which there were 4889 infant deaths and 4325 stillbirths. The deaths were grouped according to when they occurred after birth, and journey times to the nearest hospital at that time were computed with a geographical information system from grid references based on the postcodes of birth and hospital and data on the road network and location of built up areas between the two.

Over the entire period the odds of infant death were similar for early neonatal (0–6 days), neonatal (0–27 days), and postneonatal (28 days–1 year) deaths and all categories of journey times, from 0–17 to over 35 minutes, after correction for demographic risk factors—birth year, birth order, and multiple births. The same was true for decade by decade analysis. Stillbirths also showed no significant difference according to journey time. Median journey time to hospital was 12 (range <1–70) minutes.

There is little known in the UK about whether risk of infant death is affected by distance to nearest hospital. This large dataset confirms the results of a smaller study in West Cumbria a few years ago.

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