Infant mortality and diminished entelechy in three European countries

Individual-level research reports that adverse environmental conditions during infancy increase the risk of mortality later in life. Extending this model to populations implies what we call the “diminished entelechy” hypothesis in which birth cohorts subjected to virulent environmental insults early in life experience increased mortality at older ages and do not realize their otherwise expected lifespan. Controversy remains as to whether the individual-level findings generalize to populations. We test the “diminished entelechy” hypothesis by measuring the association between infant mortality and life expectancy at age one for males and females born in Sweden (1751–1912), Denmark (1835–1913), and England and Wales (1841–1912). Time-series methods control for trends and other forms of autocorrelation that could confound the associations. Results support diminished entelechy in Sweden and England and Wales, but not in Denmark, in that environmental insults during infancy appear associated with reduced cohort lifespan. We then explored when in the life course the sequelae of infancy appear most salient. We examined cohort associations between infant mortality and mortality during childhood (1–4 years), youth (5–19 years), adulthood (20–54 years), and old-age (55–79 years). We generally find that infant cohort effects appear to “program” the mortality experience in youth, but not in adulthood or old-age. These findings conflict with the notion that improved conditions during infancy shaped the historical decline of old-age mortality.     

Comparison of infant mortality among twins and singletons: United States 1960 and 1983

Infant mortality among US black and white twins and singletons was compared for 1960 and 1983 using the Linked Birth/Infant Death Data Sets from the National Center for Health Statistics. Both twin and singleton infant mortality rates showed impressive declines since 1960 but almost all of the improvement in survival for both twins and singletons was related to increased birth weight-specific survival rather than improved birth weight distribution. One-half of white twins and two-thirds of black twins weighed less than 2,500 g at birth, and 9% of white twin births and 16% of black twin births were in the very low (less than 1,500g) birth weight category. In 1983, twin infant mortality rates were still four to five times that of singletons. However, twins had a survival advantage in the 1,250-3,000 g range, which persisted after adjustment for gestational age. Cause-specific mortality among twins was considerably higher for every major cause of death: twin mortality risks due to newborn respiratory disease, maternal causes, neonatal hemorrhage, and short gestation/low birth weight were six to 15 times that of singletons. The lowest twin-to-singleton mortality ratios observed were for congenital anomalies and sudden infant death syndrome with relative risks twice that of singletons. The data underscore the need to develop effective strategies to decrease infant mortality among twins.     

Childhood malnutrition and its predictors in rural Malawi

We prospectively followed up a population-based cohort of 767 rural Malawian children from birth to 36 months to characterise the timing and predictors of malnutrition. Underweight and wasting incidence peaked between 6 and 18 months of age, whereas stunting incidence was highest during the first 6 months of age. After infancy about 40% of the children were underweight, 70% stunted, and about 4% wasted. Small size during the first 3 months of life predicted the incidence of severe underweight (relative risk [95% confidence interval], 1.8 [0.9, 3.4]), severe stunting ( 2.1 [1.3, 3.4]), and moderate wasting (2.0 [1.1, 3.5]). Children with many illness episodes in infancy had a twofold risk for the development of severe underweight and moderate wasting. Severe underweight was further predicted by residence far away from a health facility and moderate wasting by maternal HIV infection. Our conclusion is that the intrauterine period and first 6 months of life are critical for the development of stunting whereas the subsequent year is more critical for the development of underweight and wasting. Strategies combating intrauterine growth retardation, maternal HIV and infant morbidity are likely to reduce the burden of malnutrition in this population.     

Small size for gestational age and the risk for infant mortality in the subsequent pregnancy

PurposeTo examine the association between small for gestational age (SGA) in the first pregnancy and risk for infant mortality in the second pregnancy.MethodsThis is a population-based, retrospective cohort study in which we used the Missouri maternally linked cohort dataset for 1978–2005. Analyses were restricted to women who had two singleton pregnancies during the study period. The exposure was SGA in the first pregnancy, whereas the primary outcome was infant mortality in the second pregnancy. Kaplan-Meier Estimate and Cox proportional hazard regression were conducted.ResultsInfant mortality was significantly greater among mothers with previous SGA (P < .01). A persistent association of previous SGA with subsequent infant mortality was observed (adjusted hazard ratio [AHR] 1.35, 95% confidence interval [95% CI] 1.24–1.48). Race-specific data illustrated that black women with a previous SGA birth were 40% more likely to experience infant mortality (AHR 1.40, 95% CI 1.21–1.63) than their counterparts without a history of SGA, but white women with a previous SGA had an increased risk of 31% (AHR 1.31, 95% CI 1.17–1.46).ConclusionsWomen with previous SGA bear increased risks for subsequent infant mortality, which was greater among black mothers. Hence, SGA plays an important role in the black?white disparity in infant mortality. Women's previous childbearing experiences could serve as important criterion in determining appropriate interconception strategies to improve infant health and survival.     

Age at first birth,parity, and post-reproductive mortality among white and black women in the US, 1982–2002

We investigate the relationship between the timing of first birth, parity, and women's risk of post-reproductive mortality over twenty-one years (1982–2002), among representative samples of black and white women in the United States. Data are taken from the National Longitudinal Survey of Mature Women. We find early childbearing to be associated with higher mortality among whites, while later childbearing is associated with higher mortality among blacks. The effect of age at first birth on white women's mortality is explained by background and mediating social, economic, and health related factors, but this effect remains robust for black women. In addition, childless white women have a higher risk of post-reproductive mortality than those with 2–3 children. High parity (6+ children) has a significant protective effect for blacks, though the effect is reduced with age. A similar protective effect of high parity becomes apparent among whites only after controlling for background and mediating characteristics. Findings are interpreted in light of the weathering hypothesis and from a life course framework that views women's fertility as adaptive to particular social and historical contexts.     

Variation in state-specific infant mortality risks

Data from the National Infant Mortality Surveillance project were used to examine the State-specific variations in infant, neonatal, and postneonatal mortality and to examine some of the factors affecting the risks of death. The infant mortality risk, defined as the risk of death before 1 year of age to an infant born in the 1980 birth cohort, in the highest risk State was nearly three times that in the lowest risk State. Mortality risk ratios of two or greater were found when comparing high and low States for overall black infant mortality risks, overall neonatal mortality, neonatal mortality risks for black and white infants examined separately, neonatal mortality risks for low birth weight infants regardless of race, and overall postneonatal mortality and postneonatal mortality for white infants. The lowest State-specific black mortality risks were higher than the highest white risks for overall infant mortality and neonatal mortality. The differences between State extremes in mortality risks are greater than the differences between the United States and the Scandinavian countries with the lowest infant mortality.     

Contribution of birth defects to infant mortality among racial/ethnic minority groups, United States, 1983

Linked birth/infant death data from the National Center for Health Statistics (NCHS) for the 1983 U.S. birth cohort, the latest year for which linked data were available, were evaluated in order to assess the contribution of birth defects to infant mortality among racial/ethnic groups. Of the 34,566 singleton infant deaths with specified birth weight born to U.S. residents, birth defects were listed as an underlying cause of death for 7,678 (22.2%) infants and as a contributing cause of death for an additional 1,006 (2.9%) infants. Infant mortality rates due to birth defects were highest among American Indians (2.9 deaths/1,000 live births), followed by Asians and Hispanics (2.6), and blacks (2.5). Proportional mortality due to birth defects varied among racial/ethnic groups; it was greatest among Asians (27%), followed by whites (25%), Hispanics (24%), American Indians (18%), and blacks (13%). Also, infant mortality rates due to birth defects were high among minority infants of low birth weight, particularly among those born weighing between 1,500 and 2,499 g. Within this group of infants, proportional mortality due to birth defects ranged from 52% among Asians to 29% among blacks. These data indicated that birth defects were an important contributor to infant mortality among all racial/ethnic groups. Birth-defects surveillance systems should be used to evaluate whether racial/ethnic differences in infant mortality from birth defects are due to differences in incidence and/or survival among minority infants with birth defects.     

我国4种类型农村5岁以下儿童营养不良状况及其变化趋势

目的分析2002年我国农村5岁以下儿童营养不良状况及1992~2002年间的变化情况。方法利用“1992全国营养调查”和“2002年中国居民营养与健康调查”中的体格测量资料,采用1978年WHO推荐的身高标准体重参考值作为评价标准,应用SAS8.2软件进行统计分析。结果我国一类农村、二类农村、三类农村和四类农村的生长迟缓率分别为12.4%、15.4%、11.5%和29.3%,低体重率分别为7.4%、8.7%、5.4%和14.4%。我国农村5岁以下儿童中度迟缓率由1992年的20.5%降为2002年的12.0%,重度迟缓率由1992年的14.5%减至2002年的5.2%;2002年中度低体重率为8.0%,与1992年相比下降了47.7%,2002年重度低体重率仅为1.3%,比1992年下降了72.3%。     

Patterns of infant mortality and cancer death in Alabama, USA

Aim  To use recent information of infant and cancer mortality in Alabama counties of the USA to test their relationships with social, economic, and environmental conditions at a large scale to identify potential public health issues. Subjects and methods  The data of infant mortality rates and cancer deaths in the recent years, biodiversity, including species number of plants, fishes, reptiles, and amphibians, roadless areas, metropolitan areas, river basins, African-American and minority populations, and per person income for all 67 Alabama counties were obtained and organized by geographic information system. The relationships between infant mortality rates and cancer deaths and social, economic, and environmental conditions at a large scale were analyzed. Results  Infant mortality was significantly higher in African-American and other minority populations than in white populations, but cancer mortality was higher in white populations than in African-American and minority populations. There was no significant difference in infant mortality rate between populations in the urban areas and the rural areas, but the mortality rate of cancers was significantly higher in the rural population than in the urban population. Mortality rates for cancers in wealthy counties were lower than in poorer counties. The incidences of infant and cancer mortality were lower in counties with higher biodiversity. The emergent spatial pattern suggests that the incidences of infant and cancer mortality were higher in the Sipsey/Warrior River Basin, Coosa/Tallapoosa River Basin, and Conecuh River Basins. Conclusion  This study indicates that ethnic disparities in infant and cancer mortality still exist in Alabama. This study also suggests that pattern analyses at larger scales can provide new insight for understanding public health.     

Alcohol-related mortality in Italy

This study evaluated the impact of alcohol drinking habits on mortality in Italy during the 1980–1990 period. Alcohol Attributable Fractions for a list of Alcohol-Related Diseases were assessed from national and international medical literature and then applied to national mortality data according to 5 y age groups, sex, and place of residence for each year of the 1980–1990 period. Mortality rates and 95% Confidence Intervals were standardized with the direct method. Years of potential life lost (YPLL) were calculated for 1990. 18 033 Italian residents died during 1990 from causes related to alcohol drinking, representing 3.3% of general mortality (males 4.6%; females 2.0%) which corresponded to over 200 000 YPLL up to age 70 y. Chronic diseases account for 65% of alcohol-related mortality. Age-adjusted death rates declined in both genders during 1980–1990. Geographic differences in death rates are well evident. Alcohol drinking is a strong determinant of mortality in Italy. The variability of alcohol-related death rates across the country and the comparison with the results from other populations suggest that health consequences, mainly liver damage, of alcohol intake in Italy may be affected by other factors than alcohol itself. The need for further methodological efforts to improve alcohol attributable fraction estimates is recommended.     

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.     

Underweight, overweight and obesity as risk factors for mortality and hospitalization

AIMS: The prevalence of overweight and obesity is increasing in many countries. We aimed to investigate differences in mortality and severe morbidity between underweight people (body mass index (BMI)<18.5), overweight people (BMI 25 to <30), obese people (BMI> or =30), and those with normal weights (BMI 18.5 to <25). METHODS: Random samples of the Swedish population aged 16-74 years in 1980-81 and 1988-89 were followed for 12 years with regard to all-cause mortality and mortality from circulatory diseases, all inpatient care, and inpatient care for circulatory and musculoskeletal diseases. Relative risks (RRs) for different levels of BMI were adjusted for age, longstanding illness, smoking, and educational level at baseline. In addition, analyses were made with delayed entry until the fourth-year after interview. RESULTS: Obesity and underweight, but not overweight, was associated with higher all-cause mortality. Among underweight men, the adjusted RR for all-cause mortality was 2.4 (95% confidence interval 1.6-3.6), and among underweight women it was 2.0 (1.5-2.7), but population attributable risks (PARs) were small, at 1.2% and 2.7%, respectively. Overweight was associated with increased risks for inpatient care for circulatory diseases, with PARs being 13.4% among men and 8.1% among women, and musculoskeletal diseases (PARs were 12.7% and 12.9%, respectively). Obese men and women had about 50% higher risks of all-cause mortality than normal-weight people, PARs being 3.2% and 3.8% respectively. CONCLUSIONS: This study supports the findings of other studies, in that overweight seems to be an exaggerated risk factor for all-cause mortality, but is related to other chronic disease. Underweight and obesity generally implies greater increases of RRs, but avoidance of overweight may have greater effect on the population level with regard to reduced cardiovascular and locomotor disease.     

Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality

Objective

To compare the estimated prevalence of malnutrition using the World Health Organization’s (WHO) child growth standards versus the National Center for Health Statistics’ (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy.

Methods

A secondary analysis of data on 9424 mother–infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants’ weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards.

Findings

The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6–12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6–12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%).

Conclusion

Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.     

Influence of malnutrition on childhood mortality in a rural hospital in Rwanda

BackgroundRecent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda.MethodsA prospective cohort study included children aged 6–59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression.ResultsAt the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5–8.4) and 4.0 (IC95% 2.0–8.2) respectively.ConclusionThe study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition.     

Racial and ethnic disparities in infant mortality: risk in social context.

This article presents the multifaceted efforts of Syracuse Healthy Start, a federally funded initiative of the Onondaga County Health Department and over 20 partnering agencies to reduce racial and ethnic disparities in infant mortality. The analyses presented in this article demonstrate that many women--Caucasian, African American, and Hispanic--have serious risks for low birth weight and infant death. In many cases, multiple, simultaneous risks complicate a pregnant woman's situation and in other cases the longitudinal cumulative risks impact health across generations. Infant mortality decreased overall, and for both Caucasian and African American infants during the first 3 years of the project.     

Association of body mass index and weight change with all-cause mortality in the elderly

The authors explored the relation of body mass index (BMI; weight (kg)/height (m)(2)) and weight change to all-cause mortality in the elderly, using data from a large, population-based California cohort study, the Leisure World Cohort Study. They estimated relative risks of mortality associated with self-reported BMI at study entry, BMI at age 21 years, and weight change between age 21 and study entry. Participants were categorized as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), or obese (BMI >or=30). Of 13,451 participants aged 73 years (on average) at study entry (1981-1985), 11,203 died during 23 years of follow-up (1981-2004). Relative to normal weight, being underweight (relative risk (RR) = 1.51, 95% confidence interval (CI): 1.38, 1.65) or obese (RR = 1.25, 95% CI: 1.13, 1.38) at study entry was associated with increased mortality. People who were either overweight or obese at age 21 also had increased mortality (RR = 1.17, 95% CI: 1.09, 1.25). Participants who lost weight between age 21 and study entry had increased mortality regardless of their BMI category at age 21. Obesity was significantly associated with increased mortality only among persons under age 75 years and among never or past smokers. This study highlights the influence on older-age mortality risk of being overweight or obese in young adulthood and underweight or obese in later life.     

Short report: The mother-child health passport: Austria's successful weapon against infant mortality

The rapid decline in Austrian infant mortality is explained in terms of a new administrative program in that country entitled “The Mother-Child Health Passport.” The rationale and procedures involved in this plan are presented. Prenatal care was made more attractive to mothers by offering them a cash award payable upon completion of a specified number of examinations during pregnancy. One year after the program's commencement, the Austrian Health Department succeeded in linking a second set of examinations with further financial support contingent upon four checkups during an infant's first year of life. Approximately 95% of all pregnant women now participate in the Mother-Child Health Passport program. Infant mortality has declined by as much as 30% over the last five years.     

Infant mortality differences between whites and African Americans: the effect of maternal education.

OBJECTIVES: Despite decreasing infant mortality in North Carolina, the gap between African Americans and Whites persists. This study examined how racial differences in infant mortality vary by maternal education. METHODS: Data came from Linked Birth and Infant Death files for 1988 through 1993. Multiple logistic regression models adjusted for confounders. RESULTS: Infant mortality risk ratios comparing African Americans and Whites increased with higher levels of maternal education. Education beyond high school reduced risk of infant mortality by 20% among Whites but had little effect among African Americans. CONCLUSIONS: Higher education magnifies racial differences in infant mortality on a multiplicative scale. Possible reasons include greater stress, fewer economic resources, and poorer quality of prenatal care among African Americans.     

Young maternal age and infant mortality: the role of low birth weight

In 1980, there were 562,330 babies born in the United States to teenage mothers (19 years of age or younger). The offspring of teenage mothers have long been known to be at increased risk of infant mortality, largely because of their high prevalence of low birth weight (less than 2,500 grams). We used data from the National Infant Mortality Surveillance (NIMS) project to examine the effect of young maternal age and low birth weight on infant mortality among infants born in 1980 to U.S. residents. This analysis was restricted to single-delivery babies who were either black or white, who were born to mothers ages 10-29 years, and who were born in one of 48 States or the District of Columbia. Included were 2,527,813 births and 28,499 deaths (data from Maine and Texas were excluded for technical reasons). Direct standardization was used to calculate the relative risks, adjusted for birth weight, of neonatal mortality (less than 28 days of life) and postneonatal mortality (28 days to less than 1 year of life) by race and maternal age. There was a strong association between young maternal age and high infant mortality and between young maternal age and a high prevalence of low birth weight. Neonatal mortality declined steadily with increasing maternal age. After adjusting for birth weight, the race-specific relative risks for babies born to mothers less than 16 years of age were still elevated from 11 to 40 percent, compared with babies born to mothers 25-29 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)