Comprehensive Assessment of Risk Factors of Cause-Specific Infant Deaths in Japan.

Naho Morisaki,Hideto Takahashi,Haruko Noguchi,Nanako Tamiya,Yui Yamaoka

doi:10.2188/jea.je20160188

Abstract

BackgroundPublic attention is given to infants with socially high risks of child abuse and neglect, while clinical attention is provided to infants with a biologically high risk of diseases. However, few studies have systematically evaluated how biological or social factors cross over and affect cause-specific infant mortality.MethodsWe linked birth data with death data from the Japanese national vital statistics database for all infants born from 2003–2010. Using multivariate logistic regression, we examined the association between biological and social factors and infant mortality due to medical causes (internal causes), abuse (intentional external causes), and accidents (unintentional external causes).ResultsOf 8,941,501 births, 23,400 (0.26%) infants died by 1 year of age, with 21,884 (93.5%) due to internal causes, 175 (0.75%) due to intentional external causes, and 1,194 (5.1%) due to unintentional external causes. Infants with high social risk (teenage mothers, non-Japanese mothers, single mothers, unemployed household, four or more children in the household, or birth outside of health care facility) had higher risk of death by intentional, unintentional, and internal causes. Infant born with small for gestational age and preterm had higher risks of deaths by internal and unintentional causes, but not by intentional causes.ConclusionsBoth biological as well as social factors were associated with infant deaths due to internal and external causes. Interdisciplinary support from both public health and clinical-care professionals is needed for infants with high social or biological risk to prevent disease and injury.

Highlights

Infant death, in many cases, is not due to one single cause but to an unfortunate complex assembly of risk factors.[1]
Of the 8,941,501 infants born in the period from 2003 through 2010, 23,400 (0.26%) died before their first birthday, with an average infant mortality rate (IMR) of 2.62 per 1,000 live births
Internal causes accounted for 93.5% of total infant deaths (n = 21,884, 2.45=1,000 live births); unintentional injury covered 78.8% of external causes (n = 1,194, 0.13=1,000 live births); intentional injury (n = 175) accounted for 11.5% of external causes and 0.75% of all infant deaths, and a small number of external deaths related to medical treatments or medications (n = 29) accounted for the remaining deaths due to external causes (Table 1)

Summary

Introduction

In many cases, is not due to one single cause but to an unfortunate complex assembly of risk factors.[1] Many studies on infant mortality have focused on either social factors and their relation to child abuse and neglect,[2,3,4] or on biological risk factors, such as low birth weight, preterm birth, congenital abnormalities, or other perinatal medical complications, and their association with death due to medical causes.[5,6]. Public attention is given to infants with socially high risks of child abuse and neglect, while clinical attention is provided to infants with a biologically high risk of diseases. Few studies have systematically evaluated how biological or social factors cross over and affect cause-specific infant mortality

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