Social class differences in health and survival during the first two years of life; the results of a national survey

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Abstract
This paper compares social class differences in mortality and morbidity in a national sample of 5380 children born in March 1946 and followed up when they were 2 years old. There are significant social class differences in mortality during the first year but not during the second. If all classes had the same mortality rates as the well-to-do, some 4000 lives would be saved in the first month of life and 6300 in the rest of the first year. A considerable part of social class differences in mortality during the first month is explained by the higher proportion of light-weight babies born to poor mothers; between 4 weeks and I year they are explained by deaths from pneumonia and gastro-enteritis, which are most frequent in the least prosperous classes. Evidence, considered elsewhere and summarized here, suggests that the high proportion of light-weight births in the poorer classes may be in part attributed to early childbearing, close spacing of births, and excessive work (either inside or outside the home) during the last months of pregnancy. Marked social class differences in the incidence of both upper and lower respiratory infections are shown. The poorer children are both more likely to be affected, and are attacked at an earlier age. There is some inconclusive evidence that both case mortality rates for lower respiratory infection and the proportion of untreated patients increase with falling social class. These findings do not support Prof. Grundy's hypothesis that in certain prosperous towns, such as Luton, there is a favourable level of environment beyond which improvements have little or no effect on the amount of infant sickness. The reasons for this disagreement are discussed.