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.     

Trends in infant/child mortality and life expectancy in Indigenous populations in Yunnan Province, China

OBJECTIVE: The 2000 Census in China registered 55 groups of Indigenous population, including 104.49 million people, making up 8.1% of China's total population. Yunnan Province, located in Southwest China, is the only province where all 55 Indigenous nationalities are represented (14.15 million), making up 33.4% of Yunnan's total population. This study aimed to examine trends in infant and child mortality and life expectancy at birth of the 22 largest Indigenous nationalities and compared these trends with those of the majority Han Chinese in Yunnan and China as a whole. METHODS: Data sources of mortality and socioeconomic status came from the population censuses of China (1953, 1964, 1982, 1990, and 2000) and Yunnan (1990-2000) and from the Provincial Health Department (1990, 1995, 1996 and 2000). Weighted linear regression analysis was used to examine the associations between infant/child mortality and life expectancy at birth, socioeconomic indicators and the use of preventive health services. RESULTS: In 2000, the infant mortality rate was 26.90 for China and 53.64 for Han Chinese in Yunnan per 1,000 live birth versus 77.75 for the 22 largest minority nationalities in Yunnan, despite improvements in health status indicators since 1990. The inequalities in life expectancy at birth between China as a whole and some minority nationalities remained striking in 2000 (57.18 versus 71.40). Literacy, prenatal examination, hospital deliveries, economic development were important predictors of these health indicators. IMPLICATIONS: Efforts to continue to improve these intermediate proximate determinants and to target the most disadvantaged Indigenous groups are likely to further reduce health disparities between the Chinese and Indigenous populations.     

河南省2000--2010年婴儿死亡率变化趋势及孕产妇保健影响因素分析

目的 分析2000-2010年河南省婴儿死亡率变化趋势及孕产妇保健方面的影响因素.方法 采用描述性分析、Cox-Stuart检验和多元线性回归分析的方法,对2000-2010年河南省监测地区人群婴儿死亡率变化趋势及其孕产妇保健因素进行分析.结果 2000-2010年河南省及其城乡婴儿死亡率分别由30.91‰、10.05‰和33.99‰下降至712‰、5.51‰和8.03‰,年均下降分别为13.65％、5.83％和13.44％,下降趋势均有统计学意义(P＜0.05),农村下降幅度(25 96％)超过城市(4.54％),城乡间差异由23.49％逐年减少至2.52％.孕产妇建卡率、产后访视率、住院分娩率、新法接生率、低出生体重率与婴儿死亡率之间多元线性回归分析差异有统计学意义(F=229.738,P=0.004),影响强度依次为住院分娩率、低出生体重率、新法接生率、建卡率、产后访视率.结论 河南省及其城乡婴儿死亡率呈下降趋势,下降幅度农村超过城市,城乡间差异逐年减小;孕产妇建卡率、产后访视率、住院分娩率和新法接生率是影响婴儿死亡率 下降的重要因素,应进一步加强孕产妇住院分娩和产后访视工作.     

Trends and regional variations in infant mortality rates in Japan, 1973-1998

OBJECTIVE: The purpose of the study was to investigate the trends and regional variations in infant mortality rates in Japan. METHOD: The data from 1973 to 1998 analysed in this paper were from the Vital Statistics Division, Ministry of Health, Labor and Welfare of Japan. RESULTS: Infant mortality rates declined significantly between 1973 and 1998 in all regions. Statistically significant differences in infant mortality rates among the regions were observed in 1973, 1974, 1976, 1977 and 1978. However, the regional differences in infant mortality rates were insignificant thereafter, indicating elimination of regional variations in infant mortality in Japan. CONCLUSION: The results of this study indicated declines in infant mortality rates in all regions, with elimination of regional variations in infant mortality in Japan in the last two decades. This may be attributable to both qualitative and quantitative improvements in health and medical services in Japan.     

The role of medicine in the decline of post-War infant mortality in Japan

The infant mortality rate (IMR) in Japan declined dramatically in the immediate post-War period (1947-60) in Japan. We compared the time trends in Growth Domestic Product (GDP) in Japan against declines in IMR. We then conducted a prefecture-level ecological analysis of the rate of decline in IMR and post-neonatal mortality from 1947 to 1960, focusing on variations in medical resources and public health strategies. IMR in Japan started to decline after World War II, even before the era of rapid economic growth and the introduction of a universal health insurance system in the 1960s. The mortality rates per 1000 infants in 2009 were 2.38 for IMR, 1.17 for neonatal mortality and 1.21 for post-neonatal mortality. The rate of decline in IMR and preventable IMR (PIMR) during the post-War period was strongly correlated with prefectural variations in medical resources (per capita physicians, nurses, and proportion of in-hospital births). The correlation coefficients comparing the number of physicians in 1955 with the declines in IMR and PIMR from 1947 to 1960 were 0.46 [95% confidence interval (CI) 0.19, 0.66] and 0.39 [95% CI 0.11, 0.61], respectively. By contrast, indicators of public health strategies were not associated with IMR decline. The IMR in Japan has been decreasing and seems to be entering a new era characterised by lower neonatal compared with post-neonatal mortality. Furthermore, the post-War history of Japan illustrates that improvement in infant mortality is attributable to the influence of medical care, even in the absence of rapid economic development.     

Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates

OBJECTIVES: To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries. STUDY DESIGN AND SETTING: Data on ischemic heart disease (IHD) and stroke mortality in 1950-1999 in the Netherlands, England & Wales, France, and four Nordic countries were analyzed. We used Poisson regression to describe trends in mortality according to birth cohort, for the cohorts born between 1860 and 1939. Pearson correlation coefficients were calculated to determine associations between IMR and IHD, or stroke mortality. RESULTS: IHD mortality increased for successive cohorts up to 1900, and then started to decline. Stroke mortality levels were virtually stable among birth cohorts up to 1880, but declined rapidly among later cohorts. A strong positive association was found between cohort-specific IMR levels and stroke mortality rates. There were no strong cohort-wise associations between IMR and IHD mortality. CONCLUSION: These results support other studies in suggesting that living conditions in early childhood may influence population levels of stroke mortality. Future studies should determine the contribution of specific early life factors to the mortality decline in IHD and especially stroke.     

Separate and unequal: Structural racism and infant mortality in the US

We examined associations between state-level measures of structural racism and infant mortality among black and white populations across the US. Overall and race-specific infant mortality rates in each state were calculated from national linked birth and infant death records from 2010 to 2013. Structural racism in each state was characterized by racial inequity (ratio of black to white population estimates) in educational attainment, median household income, employment, imprisonment, and juvenile custody. Poisson regression with robust standard errors estimated infant mortality rate ratios (RR) and 95% confidence intervals (CI) associated with an IQR increase in indicators of structural racism overall and separately within black and white populations. Across all states, increasing racial inequity in unemployment was associated with a 5% increase in black infant mortality (RR=1.05, 95% CI=1.01, 1.10). Decreasing racial inequity in education was associated with an almost 10% reduction in the black infant mortality rate (RR=0.92, 95% CI=0.85, 0.99). None of the structural racism measures were significantly associated with infant mortality among whites. Structural racism may contribute to the persisting racial inequity in infant mortality.     

The use of logit models to investigate social and biological factors in infant mortality. III. Neonatal mortality

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper develops the methodology from an earlier paper by Murrells et al. to the analysis of the neonatal data.     

The main determinants of infant mortality in Nepal

Infant mortality has reached a low stable rate in developed countries while it is still high and on a slow decline in developing countries. There are many factors that contribute to the incidence of a high or low level of infant mortality. Although credit for contributing to the lowering of infant mortality has been given to health programs by public health personnel and to the improvement in socio-economic status by social scientists, in a traditional and agricultural country such as Nepal, both these factors are found to influence infant mortality. Data on infant mortality obtained by the 1991 Demographic Health Survey of Nepal are analyzed in this study. A logistic regression model is used for analyzing the data. Several hypotheses are tested to explain the incidence of infant mortality in Nepal. The various reasons for the persistence of high infant mortality and the difficulties in lowering it are discussed. The findings suggest that among all the variables analyzed in the study, parity, place of residence, immunization, and ethnicity influence infant mortality the most.     

ＡＲＩＭＡ 模型在婴儿死亡率预测中的应用

摘要：目的　探讨应用自回归滑动平均混合模型（ａｕｔｏｒｅｇｒｅｓｓｉｖｅｉｎｔｅｇｒａｔｅｄ ｍｏｖｉｎｇａｖｅｒａｇｅ,ＡＲＩＭＡ） 预
测婴儿死亡率的可行性。方法　运用ＳＰＳＳ１６．０ 对１９９１－２０１２ 年山西省妇幼卫生年报婴儿死亡率建立
ＡＲＩＭＡ 模型,用所建模型比较预测值与实际值差异,并预测２０１３－２０１５年山西省婴儿死亡率。结果　模
型ＡＲＩＭＡ （１,２,０）较好地拟合了既往时间段的婴儿死亡率的时间序列, 模型自回归参数ＡＲ１＝
－０．７５４,犘＜０．０１,有统计学意义, 赤池信息准则（ＡＩＣ） ＝６８．２１３, 许瓦兹贝叶斯准则（ＳＢＣ） ＝
７０．２０４,模型残差为白噪声（犘＞０．０５）, 模型数学函数式为＾ 犢狋＝０．０６７＋１．２４６犢狋－１ ＋０．５０８犢狋－２ －
０．７５４犢狋－３,利用模型预测２０１３－２０１５ 年婴儿死亡率分别为４．７７‰、４．３２‰、３．９６‰。结论　ＡＲＩＭＡ 模
型能够较好地拟合婴儿死亡率的时间变化趋势,并用于短期预测未来婴儿死亡率。
关键词：婴儿死亡率;时间序列;ＡＲＩＭＡ 模型
中图分类号：Ｒ１９５．１　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０３ ０２５６ ０４     

Effects of employment and education on preterm and full-term infant mortality in Korea

Objectives

The infant mortality rate is a sensitive and commonly used indicator of the socio-economic status of a population. Generally, studies investigating the relationship between infant mortality and socio-economic status have focused on full-term infants in Western populations. This study examined the effects of education level and employment status on full-term and preterm infant mortality in Korea. Data were collected from the National Birth Registration Database and merged with data from the National Death Certification Database.

Study design

Prospective cohort study.

Methods

In total, 1,316,184 singleton births registered in Korea's National Birth Registration Database between January 2004 and December 2006 were included in the study. Multivariate logistic regression analysis was performed.

Results

Paternal and maternal education levels were inversely related to infant mortality in preterm and full-term infants following multivariate adjusted logistic models. Parental employment status was not associated with infant mortality in full-term infants, but was associated with infant mortality in preterm infants, after adjusting for place of birth, gender, marital status, paternal age, maternal age and parity.

Conclusions

Low paternal and maternal education levels were found to be associated with infant mortality in both full-term and preterm infants. Low parental employment status was found to be associated with infant mortality in preterm infants but not in full-term infants. In order to reduce inequalities in infant mortality, public health interventions should focus on providing equal access to education.     

我国婴儿死亡率影响因素的定性分析

目的:了解影响我国婴儿死亡率(infantmortality rate,IMR)水平和变化趋势的主要因素。方法:严格培训的访谈人员围绕"三率"的主要影响因素,按照针对相关部门的领导和人员的访谈提纲,在沿海、内地和边远地区按照分层抽样抽取15个全国妇幼卫生监测点,进行了93次个人深入访谈(包括小组访谈)。结果:经济发展较好的地区影响和制约IMR的主要因素是卫生经费的投入、卫生服务的利用和流动人口管理,而经济发展较差的地区主要的制约因素是经济发展状况、居民收入和教育宣传。结论:IMR的影响因素纷繁复杂,各种因素的影响程度、方式、途径不尽相同。为进一步控制和降低我国的IMR,应抓住各地存在的主要问题,制定具有针对性的政策和措施。     

Ecological analysis of the relationship between infant mortality and cardiovascular disease mortality at ages 45-69 in the Brazilian 1935 birth cohort

Background

International ecological studies have shown a positive association between infant mortality as a proxy for low birth weight and cardiovascular disease mortality in adult life.

Methods

Mortality rates due to Cardiovascular Diseases (CVDMR) standardised by age in adults between 45 and 69 years of age and by place of birth (pob) and residence (res) were related to Infant Mortality Rates (IMR) in the Brazilian 1935 birth cohort.

Results

Two relationship patterns were noted between IMR and CVDMR: for the Southeast, South and Centre-West group of regions (r_pob = 0.46; r_res = 0.29) and for the North and Northeast group of regions (r_pob = 0.21; r_res = 0.33). For the latter pattern, two states were identified (Rio Grande do Norte and Paraíba) as atypical areas, whose exclusion strengthened the association (r_pob = 0.73; r_res = 0.91).

Conclusions

The direction of the associations changed after the analysis by group of Brazilian regions (indirect control of socio-economic levels, coverage and quality of the information). There is a positive, although weak association between IMR and CVDMR. Attempts to control or minimise the interference of migratory movements, cohort effects and socio-economic levels represented methodological progress in ecological analyses of foetal programming in Brazil.     

Income inequality and infant mortality in New York City

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6–29.6/1,000 live births: range in income inequality: 12.7–27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P<.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions. Data collection and initial analyses for this project were supported in part by an Investigator Award in Health Policy Research from The Robert Wood Johnson Foundation. The views expressed are those of the authors and do not imply endorsement by The Robert Wood Johnson Foundation.     

Socioeconomic inequalities in perinatal and infant mortality from 1854 to 1990 in Amsterdam, the Netherlands

Trends in socioeconomic differences in infant and perinatalmortality in Amsterdam were studied for the period 1854–1990,using published and unpublished material, at the aggregate andat the individual level. Absolute and relative socioeconomicmortality differences (SEMD) per data-set were calculated usinginequality indices developed by Pamuk. The results show a decreaseof the absolute differences in both infant and perinatal mortality.For infant mortality, this is mainly due to the overall declineof the infant mortality rate. Relative differences in infantmortality did not decrease during the study period. This isthe result of separate developments in 3 time periods. Fromapproximately 1850 to approximately 1910 an increase in relativedifferences can be seen, a trend which is reversed from approximately1910 to the end of World War II. After World War II relativedifferences seem to stabilize at the same level. For perinatalmortality, for which only data from the post-World War II periodare available, the decrease in the absolute differences is dueboth to the overall decline of the perinatal mortality rateand to a decline of relative differences between socioeconomicgroups. It is conduded that although SEMD in infant and perinatalmortality have declined in an absolute sense, they still existand that the relative position of deprived groups concerninginfant mortality was not ameliorated during the study period.     

Measuring progress in meeting healthy people goals for low birth weight and infant mortality among the 100 largest cities and their suburbs

We examined the progress of the nation's 100 largest cities and their surrounding suburban areas toward achieving Healthy People 2000/2010 goals for two measures of infant health: low birth weight (LBW) and infant mortality (IM). Using data from the National Center for Health Statistics, we compared 1990 and 2000 urban and suburban LBW and IM rates to target rates for Healthy People 2000 and 2010 objectives. Although the 2000 LBW weight rate for the 100 largest cities was higher than the average for the suburbs (8.9% vs. 7.1%), the increase in LBW rates for the suburbs was nearly four times that of the cities (15.7% vs. 4.1%). Suburban and urban white infants led the increases in LBW rates; urban and suburban black infants showed a slight decrease or no change in LBW rates. Neither cities nor suburbs, on average, met the 2000 target rate of 5%. It appears unlikely that most of the 100 largest cities and suburbs will meet the Healthy People 2010 goal, which remains at 5%, without reductions in preterm births, nationally on the rise. The IM rate declined across most cities and suburbs between 1990 and 2000. However, the 100 largest cities on average did not meet the 2000 IM rate target of 7 infant deaths per 1000 live births; their suburbs did (8.5 vs. 6.4, respectively). The cities and suburbs that did not meet the 2000 target may be especially challenged to meet the 2010 goal for IM unless rates of preterm births are reduced. With the continuing black-white disparities in LBW and IM rates and the overall differences in the racial composition of the largest cities and suburbs, strategies for meeting Healthy People goals will likely need to be targeted to the specific populations they serve.     

The use of logit models to investigate social and biological factors in infant mortality. IV: Post-neonatal mortality

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper describes the application of logit models using the methodology presented by Murrells et al. to investigate post-neonatal deaths.     

广州市2001-2010年婴儿死亡率趋势分析及预测

婴儿死亡率(IMR)是衡量一个国家或地区国民健康和经济发展水平的重要指标.本文通过趋势分析探讨广州市2001 -2010年IMR的变化趋势并预测未来10年的水平,旨在为制定进一步降低IMR的政策措施提供依据.     

1996-2010年全国孕产妇死亡率变化趋势

目的 了解1996-2010年全国孕产妇死亡率和主要死亡原因的变化趋势及地区的差异变化。方法 采用以人群为基础的全国孕产妇死亡监测网的数据,1996-2005年覆盖了内地31个省、自治区、直辖市的176个监测区（县）,2006年后扩大至336个区（县）,统计1996-2010年全国不同时间、不同地区孕产妇死亡率、死因别死亡率、下降幅度和年平均下降速率。应用Cochran-Armitage趋势检验及Poisson检验,对1996-2010年的孕产妇死亡率、死因构成及地区间差异的变化趋势进行分析。结果 全国孕产妇死亡率从1996年的64.7/10万下降到2010年的30.0/10万,下降53.2％;2010年农村孕产妇死亡率（30.1/10万）高于城市（29.7/10万）,西部（46.1/10万）高于中部（29.1/10万）及东部地区（17.8/10万）。东、中、西部地区孕产妇死亡率下降幅度分别为37.76％、57.02％和66.27％。地区间差异在逐渐减少,2006-2010年间,农村孕产妇死亡率下降为城市的1.82倍,西部地区为东部地区的3.0倍。产科出血死亡的构成比从1996年的47.9％下降到2010年的27.8％,但仍是导致全国孕产妇死亡的首要因素。结论 全国孕产妇死亡率呈下降趋势,地区间孕产妇死亡率仍存在差异,但差异逐年减小,农村和西部地区仍是孕产妇死亡干预的重点;产科出血仍是各地区的主要死亡原因。     

Fiscal decentralisation and infant mortality rate: the Colombian case

There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998–2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to −0.06). However, this effect was stronger in non-poor municipalities (−0.12) than poor ones (−0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised.