Socioeconomic effects on child mortality in the United States.

Despite considerable reason for scholarly and policy interest in socioeconomic mortality differentials, socioeconomic effects on child and teenage mortality in the United States have been a neglected research topic because of several data limitations. Exploiting data obtained for other purposes, this paper reports socioeconomic effects on the mortality of children and teenagers. Socioeconomic mortality differentials among children are large--at least as large as those among adults. The major source of socioeconomic mortality differences among children is apparently differential risk to accidental death. Within the child population, the strength of socioeconomic effects varies directly with the relative importance of accidents as a component of overall mortality.     

Social differentials in the decline of child mortality in nineteenth century Stockholm

BACKGROUND: Mortality had declined dramatically by the end of the nineteenth century and the early twentieth century. Little is known about the development of social differentials in infant and child mortality in Stockholm at the turn of the century. This study investigates social differentials in child mortality during the years 1885, 1891 and 1910 in one parish in Stockholm. METHODS: Individual entries from computerised records originally collected for civil registration purposes in Stockholm for 1878-1925 (the Roteman Archives) were analysed with respect to social class of the head of household and marital status of the mother for 36,718 children aged 0-14 years. Age- and cause-specific mortality rates were calculated for each year of study. Cox' regression analysis was used to analyse the mortality risk (relative rates (RRs) of mortality) by socioeconomic group and by marital status of the mother. RESULTS: Child mortality rates were nearly halved between 1885 and 1910. Socioeconomic differentials in mortality between the four social classes emerged from 1891 as the overall mortality declined. The decline was sharpest in the upper and middle social classes. Children born out of wedlock had higher mortality rates than children of married mothers in all 3 years studied. CONCLUSION: The social differentials in child mortality risk were substantial and the gradient emerged sharper from 1891 to 1910. The results are in line with studies from England and Wales, Germany and the USA for the same time period. The differentials mostly increased because of a greater decline in mortality among higher socioeconomic groups.     

Health insurance and child mortality in Costa Rica

This study uses a natural experiment approach to evaluate the effect of health insurance on infant and child mortality. In the 1970s Costa Rica adopted national health insurance, which expanded children's insurance coverage from 42 percent in 1973 to 73 percent by 1984. Aggregate infant and child mortality rates dropped rapidly during this period, but this trend had begun prior to the insurance expansion, and may be related to other changes during this period. We use county-level vital statistics and census data to isolate the causal insurance effect on mortality using county fixed effects models. We find that insurance increases are strongly related to mortality decreases at the county level before controlling for other time-varying factors. However, after controlling for changes in other correlated maternal, household, and community characteristics, fixed effects models indicate that the insurance expansion could have explained only a small portion of the mortality change. These results question the proposition that health insurance can lead to large improvements in infant and child mortality, and that expanding insurance to the poor can substantially narrow socioeconomic differentials in mortality.     

Infant mortality in Costa Rica: explaining the recent decline

Costa Rica has undergone a dramatic reduction in its infant mortality rate from 68 per 1,000 live births in 1970 to 20 per 1,000 in 1980. In the present study, changes during this century, mortality differentials, and causes of death are analyzed, and multiple regression techniques are used to identify the determinants of the decline in Costa Rica's 79 cantons (counties). Although socioeconomic development and greatly reduced fertility contributed to the infant mortality decline, as much as three-fourths of the decline is attributable to public health programs implemented during the 1970s. The extension of primary health care--especially rural and community programs--seems to be responsible for 40 percent of the reduction. In addition, health services produced a notable decrease in the socioeconomic differentials related to children's risk of death. The unique achievements of this developing country offer a new strategy for public health improvement.     

Interventions for the control of diarrhoeal diseases among young children: prevention of low birth weight

The effect of low birth weight (LBW) on diarrhoea morbidity and mortality is analysed and interventions to increase birth weights are reviewed. Birth weight is a major determinant of infant mortality and, in developed countries at least, its effect on neonatal mortality is independent of socioeconomic status. We have located no satisfactory data on LBW as a determinant of diarrhoea mortality or morbidity. The strong association between LBW and mortality, however, makes it likely that there is an association between LBW and diarrhoea mortality in developing countries where diarrhoea is a major cause of infant death. Poor maternal nutrition, certain infections, pre-eclampsia, arduous work after mid-pregnancy, short birth intervals, and teenage pregnancy are likely to be causally associated with LBW in developing countries. Tobacco and alcohol consumption are additional risk factors.     

Population and nutrition; implications of sociodemographic trends and differentials for food and nutrition policy in Central America and Panama

This paper looks into some of the sociodemographic trends and differentials that may be influencing the lack of improvement in the food and nutrition situation in rural Central America. Evidence is presented that indicates that it is more difficult to reduce malnutrition and fertility than it was to reduce infant and child mortality initially. When sociostructural changes are not forthcoming after the initiation of the mortality decline, then resultant population growth, distribution and composition dynamics can hinder improvement in nutrition. In particular, changes in the social composition differentials as a result of selectivity in mortality, fertility and migration have apparently contributed to the increasing nutrition gap between the well-fed and the poorly-fed classes.     

关于我国婴幼儿死亡性别模式异常的研究

目的 婴幼儿死亡性别模式异常是中国人口发展中出现的最重要的问题之一，本文在于准确度量我国婴幼儿死亡性别差异常程度以及分析生存环境诸因素对其的影响。方法 应用ＫｅｎｅｒｔｈＨｉｌｌ与ＤａｗｎＭ．Ｕｐｃｈｕｒｃｈ提出的标准，度量了我国四普数据各我超出的女童死亡水平，并用线性回归法对可能影响因素进行了分析。结果 研究表明，过高的女孩死亡水平在我国的大部分省区普遍存在，在诸因素中，妇女地位的影响最为显著，     

Trends in infant and child mortality in Mozambique during and after a period of conflict

This study describes urban and rural trends of infant, child and under-five mortality in Mozambique (1973-1997) by mother's place of residence. A direct method of estimation was applied to the 1997 Mozambican Demographic and Health Survey data. The levels of infant, child and under-five mortality were considerably higher in rural than in urban areas. The difference in mortality between urban and rural areas increased over time until 1988-1992 and thereafter diminished. Possible causes of the different trends (e.g. the impact of civil war, drought, migration, adjustment programme and HIV/AIDS) are discussed. The increase in mortality in urban areas during the last few years before the survey may have been related to the immigration to urban areas of mothers whose children had high levels of mortality. Higher levels of infant, child and under-five mortality still prevail, particularly in rural areas. Further studies are needed to investigate the differentials of infant and child mortality by mother's place of residence.     

Effects of birth rank, maternal age, birth interval, and sibship size on infant and child mortality: evidence from 18th and 19th century reproductive histories.

There has been long-standing interest in the effects of maternal age, birth rank, and birth spacing on infant and child mortality. Contradictory inferences about the role of these factors have arisen on occasion because of the absence of adequate controls, the use of cross-sectional or incomplete reproductive histories, and inattention to the effect of family size goals and birth limitation practices. This study analyzes completed reproductive histories for German village populations in the 18th and 19th centuries, a period when deliberate fertility control was largely absent. Our results confirm previous studies of the association of infant mortality with maternal age, although in the present data these differentials are largely limited to neonatal mortality. They also confirm the importance of birth interval as a factor in infant mortality. Sibship size is positively related to infant mortality even when birth rank is controlled. However, once sibship size is controlled, there are no systematic differences in infant and child mortality by birth order. The mechanisms relating sibship size and mortality are explored.     

Sociocultural determinants of infant and child mortality in Turkey

This paper is an attempt to review and integrate international and Turkish research on infant and child mortality. Recent research and multivariate analyses in African, Latin American and Asian countries have revealed that in many countries mother's education is a powerful predictor of child survival. The present review of research in Turkey has indicated that urban/rural and regional differentials in infant mortality have been clearly established as by-products of fertility, contraception, and health surveys covering nationally representative samples. However, there are only a few multivariate explanatory models of infant/child mortality in Turkey to isolate and measure the effects of mother's education in relation to other variables. Nevertheless, existing studies in Turkey seem to suggest that mother's and father's education might link socio-economic, psychocultural, and biomedical variables with each other at community, household, and individual levels, providing clue for the formulation of future research designs and policy decisions.     

Socioeconomic correlates of mortality and hospital morbidity differentials by Local Government Area in Sydney 1985–1988

Abstract: Objective: To determine the magnitude of differentials in mortality and hospital morbidity by Local Government Area (LGA) in Sydney (1985–1988), and to correlate these with LGA indicators of socioeconomic status. Design: Cross-sectional group-based comparative study of mortality and hospital separations, and a group-based correlations analysis in relation to socioeconomic indicators. Outcome measures: Mortality—life expectancy at birth, infant mortality, 0- to 4-year mortality, age-standardised 15- to 64-year mortality (all-cause and various causes), sex-specific (except infant and 0- to 4-year mortality). Hospital morbidity rates—0- to 4-year hospital separations, age-standardised 15- to 64-year hospital separations (all-cause and various causes), sex-specific. Study factors: Census-derived LGA proportions of immigrants, Aborigines, professionals, unskilled workers, unemployed persons, those with a university degree and those having no qualifications, and the composite Ross Indicator. Results: Considerable differences in mortality and hospital morbidity by LGA in Sydney were found. Males had higher mortality and lower rates of hospital separation than females. LGA differentials were most obvious for adults, with little variation noted for infants or children. Most socioeconomic indicators were highly correlated with adult mortality and hospital morbidity in the expected direction, particularly indicators of low socioeconomic status. The unemployment rate, proportion Aboriginal, proportion unskilled, proportion unqualified, and the Ross Indicator were the most highly correlated variables. Conclusions: There are persistent differentials by LGA in mortality and hospital morbidity in Sydney which are strongly associated with socioeconomic status. The Ross Indicator was found to be a useful composite indicator. The high correlations of mortality and hospital morbidity with the unemployment rate raise the question of to what extent this is due to illness and premature mortality in the unemployed. Monitoring of health status differentials needs to continue if progress towards Health For All targets is to be evaluated.     

Socioeconomic mortality differentials in men and women according to own and spouse's characteristics in Finland

This paper compares the magnitude of differences in mortality according to own and spouse's socioeconomic characteristics and assesses the importance of cross-classifying these characteristics. The analysis covers all 35–64 year-old married Finnish men and women in the period 1981–85. Relative mortality rates were obtained from Poisson regression models. The analysis shows that socioeconomic mortality differentials within each sex are more or less equally large according to both own and spouse's education or occupational characteristics for a wide range of causes of death. Moreover, among both women and men cross-classifications between own and spouse's socioeconomic status do not indicate important mortality differentials over and above those already displayed by its two separate parts, i.e. there were no important interactions between own and spouse's socioeconomic characteristics. The results call into question the argument that the mortality of married women should be analysed on the basis of their husband's socioeconomic characteristics because these characteristics better describe both spouses' socioeconomic standing and are thus more powerful predictors of men's and women's mortality than women's socioeconomic characteristics. It is further concluded that the advantages of cross-classifying both spouses' socioeconomic characteristics in mortality analysis are very limited when these characteristics do not interact with each other. Moreover, cause-specific comparisons between men and women showed that married women's mortality differentials by own educational as well as occupational status were roughly as large as those obtained for men. The larger total mortality differentials among men than women are mainly due to cause of death structure.     

Identifying children with high mortality risk

This issue reports selected results from a comprehensive study of infant and child mortality based on the National Family Health Survey data. The analysis distinguishes between neonatal, postneonatal, infant and child mortality since mortality and its causes vary considerably among children of different ages. Hazard regression analysis was used to estimate the effects of each individual variable as the factors that affect infant and child mortality tend to be correlated with each other. The study involves adjusted effects of selected socioeconomic and demographic characteristics on neonatal, postneonatal, infant, and child mortality for children born during the survey. Short birth intervals have a great effect on infant and child mortality. A previous birth interval of less than 24 months increases child mortality by about 67%. Neonatal mortality is highest among children of very young mothers. Child mortality is higher for girls in all states except Tamil Nadu, Kerala, and Goa. Seven groups of children who are especially vulnerable to infant and child mortality were identified. Thus, intervention programs, such as efforts to provide supplemental nutrition and basic immunization to pregnant mothers, infants and young children need to focus on these high-risk groups. Results for many states show elevated mortality rates for girls after the neonatal period. Family health programs aimed at overall improvement in mortality levels should pay attention to providing basic health care and supplemental nutrition to girls.     

Birth rates and reproductive risk in adolescents in Chile, 1990-1999]

OBJECTIVE: For Chilean teenage mothers under 15 years old and from 15 to 19 years old, to evaluate the trends in birth rates and reproductive risk for the period of 1990-1999. METHODS: A database was constructed using data from the Demography Yearbook (Anuario de demografía) volumes published by Chile's National Institute of Statistics (Instituto Nacional de Estadísticas) for 1990-1999. From that database we calculated the trends in the number of live births and in the rates of maternal mortality, late fetal mortality, neonatal mortality, and infant mortality among the teenage mothers under 15 and from 15 to 19 years old. We calculated the risk odds ratio (OR) for both of those age groups in comparison with women from 20 to 34 years old. The groups were compared using Fisher's exact test or the chi-square test, and the analysis of trends in the period studied was carried out with Pearson's correlation, with an alpha level of 0.05. RESULTS: In the period studied, for the teenage mothers under age 15, the respective rates for maternal mortality, late fetal mortality, neonatal mortality, and infant mortality were 41.9 per 100 000 live births, 5.1 per 1 000 live births, 15.2 per 1 000 live births, and 27.4 per 1 000 live births. For the adolescents from 15 to 19 years, the corresponding rates were 19.3, 4.1, 8.1, and 16.6; for the women 20-34 years old, they were 26.8, 5.0, 6.7, and 12.1. The adolescents under 15 had higher risks of maternal mortality (OR = 1.56; 95% confidence interval (CI): 0.50 to 4.31; P = 0.372) and of fetal mortality (OR = 1.02; 95% CI: 0.76 to 1.36; P = 0.890), but those differences were not statistically significant. However, the younger adolescents did have significantly higher risks of neonatal mortality (OR = 2.27; 95% CI: 1.92-2.68; P < 0.0001) and of infant mortality (OR = 2.39; 95% CI: 2.04 to 2.62; P < 0.0001). In comparison to the women 20-34 years old, the teenage mothers from 15 to 19 years old had significantly lower risks of maternal mortality (OR = 0.72; 95% CI: 0.56 to 0.92; P < 0.008) and of fetal mortality (OR = 0.81; 95% CI: 0.77 to 0.86; P < 0.0001) but significantly higher risks of neonatal mortality (OR = 1.20; 95% CI: 1.16 to 1.25; P < 0.0001) and of infant mortality (OR = 1.38; 95% CI: 1.35 to 1.42; P < 0.0001). Among both the older teenage mothers and the mothers 20-34 years old there was a significant downward trend in maternal, fetal, neonatal, and infant mortality rates in the period studied; in the younger adolescents only neonatal mortality and infant mortality declined significantly. There was a rising trend in the number of live births among the two groups of teenage mothers, but that trend was statistically significant only for the mothers under 15; among mothers 20-34 years old there was a statistically significant downward trend. CONCLUSIONS: In the period studied, the Chilean teenage mothers faced greater reproductive risk than did the women 20-34 years old. The number of live births among teenage mothers tended to rise during the 1990-1999 period, but the change was significant only for the mothers under age 15. These results point to the need to develop programs that improve both sex education and birth control practices starting in early adolescence.     

Sociodemographic differences in the occurrence of teenage pregnancies in Finland in 1987-1998: a follow up study

STUDY OBJECTIVE: To analyse sociodemographic differences in the occurrence of pregnancies to 14 to 19 year olds and changes in these differences from 1987 to 1998. DESIGN: Follow up of adolescent survey respondents using registers. Setting and subjects: The dataset includes information on all registered pregnancies (abortions, births, and miscarriages, n=2743) of the female respondents (n=28 914) to the Adolescent Health and Lifestyle Survey (AHLS) from 1987 to 1998. In the AHLS, self administered questionnaires were mailed every second year to independent samples of 12, 14, 16, and 18 year olds representative for Finland. MAIN OUTCOME MEASURE: Relative risk (hazard) of becoming pregnant at teenage. Main results: Girls from lower socioeconomic background had a higher pregnancy risk. Girls who did not live with both parents at the baseline survey had higher pregnancy risk than those who did, and girls who lived in a stepfamily had a higher risk than those who lived in a one parent family. Swedish speaking girls had a lower pregnancy risk than the Finnish speaking girls. There was no systematic change from 1987 to 1998 in most sociodemographic differentials in the teenage pregnancy risk, however, there was some increase in the differences by family structure. Changes in the sociodemographic structure did not explain the levelling off of the downward trend in teenage pregnancy risk, nor did the regional socioeconomic differences explain regional differentials in teenage pregnancy risk. CONCLUSION: Although the reduction of socioeconomic and regional differences has been a general objective in Finnish social and health policies, the relative differences in teenage pregnancies have not decreased.     

Gender imbalance in infant mortality: a cross-national study of social structure and female infanticide

Sex differentials in infant mortality vary widely across nations. Because newborn girls are biologically advantaged in surviving to their first birthday, sex differentials in infant mortality typically arise from genetic factors that result in higher male infant mortality rates. Nonetheless, there are cases where mortality differentials arise from social or behavioral factors reflecting deliberate discrimination by adults in favor of boys over girls, resulting in atypical male to female infant mortality ratios. This cross-national study of 93 developed and developing countries uses such macro-social theories as modernization theory, gender perspectives, human ecology, and sociobiology/evolutionary psychology to predict gender differentials in infant mortality. We find strong evidence for modernization theory, human ecology, and the evolutionary psychology of group process, but mixed evidence for gender perspectives.     

Infant mortality trends and differentials in Nepal

Infant mortality trends and differentials are estimated from the 1981 Nepal Contraceptive Prevalence Survey (NCPS) and compared with similar estimates from the 1976 Nepal Fertility Survey (NFS) and the 1981 Census of Nepal. The analysis indicates that infant mortality rates derived directly from the NFS maternity histories are the most accurate. Infant mortality rates derived directly from the NCPS maternity histories are severely underestimated and yield a strongly biased trend that is the reverse of the true downward trend. Indirect estimates of infant mortality trends derived from child survivorship data do not result in a consistent pattern. Infant mortality differentials, when expressed in relative rather than absolute terms, are generally consistent with findings from earlier studies. Possible reasons for data quality differences among the three data sources are discussed.     

Child mortality,socioeconomic position,and one-parent families: independent associations and variation by age and cause of death

BACKGROUND: Although the association between child mortality and socioeconomic status is well established, it is unclear whether child mortality differences by socioeconomic position are present at all ages. The association of one-parent families with mortality, and whether any such association is due to associated low socioeconomic position, is also not clear. METHODS: In all, 480 of 693 (69%) 0-14 year old deaths during 1991-1994 were linked to 1991 census records. Analyses were weighted to adjust for potential linkage bias. RESULTS: There was approximately twofold higher mortality among the lowest compared with the highest socioeconomic categories of education, income, car access, and neighbourhood deprivation. Occupational class differences were weaker. These socioeconomic differences in mortality were strongest among infants (particularly sudden infant death syndrome [SIDS] mortality), but similar across other age groups (1-4, 5-9, and 10-14 years). The socioeconomic differences were of a similar magnitude for unintentional injury, cancer, congenital, and other deaths. Multivariable analyses demonstrated persistent independent associations of education, income, car access, and neighbourhood deprivation with mortality. Rate ratios (adjusted for age and ethnicity) for one-parent families compared with two-parent or other families were 1.2 (95% CI: 1.0, 1.5) and 1.8 (95% CI: 1.2, 2.5) for all-cause and unintentional injury mortality, respectively. Further adjustment for socioeconomic factors reduced these associations to 0.8 (95% CI: 0.6, 1.2) and 1.2 (95% CI: 0.7, 2.2), respectively. CONCLUSIONS: There does not appear to be notable variation in relative risk terms of socioeconomic differences in child mortality by age or cause of death. Any association of one-parent families with child mortality is due to associated low socioeconomic position.     

Economic status differences in infant mortality by cause of death

Infant mortality differentials in a metropolitan aggregate of eight Ohio cities were examined for the years 1979-81. The primary analytical unit was the census tract of mother's usual residence. The independent variable was defined as the percentage of low-income families in each tract at the 1980 census. Results of the analysis revealed that in spite of some very substantial declines in the overall level of infant mortality in recent decades, there continues to be a pronounced inverse association between the aggregate economic status of an area and the probability that a newborn infant will not survive the first year of life. This inverse association characterizes both males and females, whites as well as nonwhites, and it is observed during both the neonatal and postneonatal age intervals. Moreover, it is apparent that the adverse influence of a low economic status is reflected in the incidence of mortality from all major exogenous and endogenous causes. Since these two cause groups have such different underlying determinants, this finding has important implications for the development and implementation of specific maternal and child health care policies and programs.     

Does health intervention improve socioeconomic inequalities of neonatal,infant and child mortality? Evidence from Matlab,Bangladesh

Background  

Although there are wide variations in mortality between developed and developing countries, socioeconomic inequalities in health exist in both the societies. The study examined socioeconomic inequalities of neonatal, infant and child mortality using data from the Matlab Health and Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).