A large European study has found that children born with major congenital anomalies were more likely to die if they came from socioeconomically disadvantaged backgrounds. The difference was visible during infancy and became even larger between the ages of one and 10.

Researchers analysed information on 47,134 children recorded across 10 congenital anomaly registers in seven European countries. The study was part of the EUROlinkCAT collaboration and used securely linked health and administrative data.

The Gap Increased With Age

During the first year of life, children in the most disadvantaged groups had a 47% higher risk of death than those in the most affluent groups.

Between the ages of one and 10, the difference became greater: mortality in the most disadvantaged group was approximately twice as high.

The researchers stress that these results show an association between socioeconomic conditions and survival. They do not prove that poverty itself directly caused individual deaths.

Why Later Childhood Matters

Lead researcher Professor Sue Jordan of Swansea University noted that the differences became greater after the first year of life, when children generally depend less on acute hospital care and more on primary, community and continuing services.

This raises important questions about whether families facing financial and social disadvantage have equal access to follow-up care, specialist support and other resources needed by children with complex health conditions.

The pattern was not identical in every country. Consistent statistically significant differences across all comparisons were found particularly in Wales/

Denmark Shows the Gap Is Not Inevitable

One especially important finding was that the same clear socioeconomic mortality pattern was not observed in Denmark.

Researchers argue that this suggests inequalities in survival are not necessarily unavoidable. Differences in health systems, social protection and access to support may influence how strongly socioeconomic circumstances affect children with congenital conditions.

That makes cross-country comparisons valuable for policymakers looking for ways to reduce disparities.

Nationality Was Another Factor

Where nationality information was available, children born to mothers who were not EU nationals also showed higher mortality.

By contrast, researchers found no clear association between maternal marital status and childhood mortality.

These findings reinforce the idea that long-term outcomes may reflect a combination of medical, social and structural factors rather than diagnosis alone.

Why Linked Health Data Matters

The study also demonstrates the value of securely linking routine medical and administrative records.

Congenital anomalies are relatively uncommon individually, so very large datasets are needed to identify patterns reliably. Combining information from several countries allowed researchers to examine outcomes over many years while protecting patient privacy.

Professor Jordan and colleagues argue that the findings should encourage closer examination of how services and resources are distributed to families living with financial disadvantage.

What the Research Suggests

The study does not imply that socioeconomic status determines the future of an individual child. Diagnosis, severity of the condition, treatment and many other factors remain important.

What it does show is that survival differences can persist beyond infancy and may widen as children grow older.