Differences In Infant Mortality Research Articles

Differential infant and child mortality in three Dutch regions, 1812–19091

New micro‐level data have recently become available for three provinces of The Netherlands for the period 1812–1912, which allow the study of the evolution of socio‐economic differentials in infant and childhood mortality. The authors found significant differences in the levels of infant mortality by social group between the three provinces, and a wide variety in the pattern of social inequality. This showed the importance of the regional environment for the level of infant mortality in the nineteenth century. Contrary to expectations, strong social differences were also observed in neonatal mortality. Being born in an urban environment did not have a strong effect on survival during the first year of birth.

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

The purpose of the study was to investigate the trends and regional variations in infant mortality rates in Japan. The data from 1973 to 1998 analysed in this paper were from the Vital Statistics Division, Ministry of Health, Labor and Welfare of Japan. 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. 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.

Education, infant mortality, and low birth weight in Sweden 1973—1990: Emergence of the low birth weight paradox

Educational differences in infant mortality, birth weight, and birth weight-specific infant mortality in Sweden were analysed. The "low birth weight paradox", where low birth weight infants have a lower mortality risk if born to women of lower rather than higher social strata, was addressed. The study includes about a million single births 1973-90 to women born 1946-60. There were 6,544 infant deaths and 35,334 low birth weight infants. Analysis conducted on six-year time periods was restricted to 652,859 births to women aged 25-32 at the time of delivery. Odds ratios and 95% CI were estimated by logistic regression. Birth weight-specific infant mortality rates were calculated by education. Infants of women with low/low intermediate education had significantly higher odds ratios than those of highly educated women of being of low birth weight or of dying. If one compares only the infants of women with low and high education, these differences were accentuated over time. The low birth weight paradox appears over time. The widening differences in infant mortality and low birth weight over time may be caused by the decrease in women with low education, signifying increased selection and growing social disadvantage in this group. The emergence of the low birth weight paradox suggests that the distribution of causes of low birth weight differs between educational groups, and further that these causes are differently related to infant mortality. To disentangle these two groups of causes and their effects on infant mortality seems highly relevant.

Free-standing midwife-led maternity units: a safe and effective alternative to hospital delivery for low-risk women?

The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal. Few have attempted to synthesise findings.To compare maternal and perinatal outcomes from different places of birth via a systematic review of high-quality research, and meta-analysis of appropriate data (Prospero registration CRD42016042291).Reviewers searched CINAHL, Embase, Maternity and Infant Care, Medline and PsycINFO databases to identify studies comparing selected outcomes by place of birth among women with low-risk pregnancies in high-income countries. They critically appraised identified studies using an instrument specific to birth place research and then combined outcome data via meta-analysis, using RevMan software.Twenty-eight articles met inclusion criteria, yielding comparative data on perinatal mortality, mode of birth, maternal morbidity and/or NICU admissions. Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation.High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies.

Treatment and mortality of aboriginal and Caucasian babies in 17 Canadian neonatal care units

In Canada, population-based studies report higher perinatal morbidity and mortality among Aboriginal infants than among Caucasians. The aim of this study was to compare baseline characteristics, treatment intensity, and mortality of Aboriginal versus Caucasian babies in neonatal intensive care units (NICU). We examined 12,564 infants with information on ethnicity from 17 tertiary care NICUs across Canada from January 1996 to October 1997. Patient information included demographic variables, health status of infant and problems at birth, and standardized measures on illness severity (Score for Neonatal Acute Physiology Version II), and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System, or NTISS). Patients were tracked until death or discharge home. Bivariate analyses and multiple linear regression analyses were conducted. Multiple births and babies with other ethnicities than Aboriginal and Caucasian were excluded. Aboriginal ( n = 709) and Caucasian ( n = 8333) babies did not differ in terms of Apgar score, gestational age, and intrauterine growth restriction. The mean birth weight (g) was higher among Aboriginals (2674, SD = 1.08) than among Caucasians (2535, SD = 1.04). The mean severity of illness score was higher among Caucasians (7.6, SD = 10.8 vs. 6.7, SD = 11.7). The mean treatment intensity score was higher for Caucasian infants (12.4, SD = 7.5 vs. 11.5, SD = 8.7). After adjustment for birth weight and illness severity, there were no ethnic differences in treatment score. There were no differences in mortality rate (odds ratio = 0.99, 95% confidence interval = 0.90–1.09). Contrary to population-based samples, in this highly selected sample there were no ethnic differences in infant mortality. Treatment intensity did not differ between Aboriginal and Caucasian babies, if adjusted for confounders. Further studies should examine whether increased access to tertiary care may help to reduce infant mortality rates in the Aboriginal population.

Narrowing of sex differences in infant mortality in Massachusetts.

To examine whether the improved survival of preterm infants has influenced the known male excess in infant mortality. We analyzed sex-specific infant mortality using linked birth and death certificates for all 619,811 live born infants in Massachusetts between 1989 and 1995. Between 1989 and 1995 the male excess in infant mortality decreased by 50%, from 1.6/1000 to 0.8/1000 live births (LB). This narrowing resulted primarily from a more rapid decline in neonatal mortality among male infants (1.5/1000 LB) than among female infants (0.9/1000 LB). The largest declines in the male excess in neonatal mortality occurred among very premature infants (GA < or = 30 weeks) and resulted primarily from a more rapid decrease in male deaths from respiratory distress syndrome. The narrowing of the sex difference in mortality between 1989 and 1995 suggests that newer treatments like antenatal steroids, and surfactants may have differentially benefited male infants.

Annual summary of vital statistics--2002.

The crude birth rate in 2002 was 13.9 births per 1000 population, the lowest ever reported for the United States. The number of births, the crude birth rate, and the fertility rate (64.8) all declined slightly (by 1% or less) from 2001 to 2002. Fertility rates were highest for Hispanic women (94.0), followed by black (65.4), Asian or Pacific Islander (63.9), Native American (58.0), and non-Hispanic white women (57.5). Fertility rates declined slightly for all race/ethnic groups from 2001 to 2002. The birth rate for teen mothers continued to fall, dropping 5% from 2001 to 2002 to 42.9 births per 1000 women aged 15 to 19 years, another record low. The teen birth rate has fallen 31% since 1991; declines were more rapid for younger teens aged 15 to 17 (40%) than for older teens aged 18 to 19 (23%). The proportion of all births to unmarried women remained approximately the same at one third. Smoking during pregnancy continued to decline; smoking rates were highest among teen mothers. In 2002, 26.1% of births were delivered by cesarean section, up 7% since 2001 and 26% since 1996. The primary cesarean rate has risen 23% since 1996, whereas the rate of vaginal birth after a previous cesarean delivery has fallen 55%. The use of timely prenatal care increased slightly to 83.8% in 2002. From 1990 to 2002, the use of timely prenatal care increased by 6% (to 88.7%) for non-Hispanic white women, by 24% (to 75.2%) for black women, and by 28% (to 76.8%) for Hispanic women, thus narrowing racial disparities. The percentage of preterm births rose to 12.0% in 2002, from 10.6% in 1990 and 9.4% in 1981. Increases were largest for non-Hispanic white women. The percentage of low birth weight (LBW) births also increased to 7.8% in 2002, up from 6.7% in 1984. Twin and triplet/+ birth rates both increased by 3% from 2000 to 2001. Multiple births accounted for 3.2% of all births in 2001. The infant mortality rate (IMR) was 6.9 per 1000 live births (provisional data) in 2002 compared with 6.8 in 2001 (final data). The ratio of the IMR among black infants to that for white infants was 2.5 in 2001, the same as in 2000. Racial differences in infant mortality remain a major public health concern. The role of LBW in infant mortality remains a major issue. New Hampshire, Utah, and Massachusetts had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage of LBW, and birth weight-specific neonatal mortality rates for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 77.2 years for all sex and race groups combined in 2001. Death rates in the United States continue to decline. Between 2000 and 2001, death rates declined for the 3 leading causes of death: diseases of the heart, malignant neoplasms, and cerebrovascular diseases. Death rates for children ages 1 to 19 years decreased for unintentional injuries by 3.3% in 2001; the death rate for chronic lower respiratory diseases decreased by 25% in 2001. Cancer and suicide levels did not change for children ages 1 to 19. A large proportion of childhood deaths continue to occur as a result of preventable injuries.

Living conditions and infant mortality: intra-urban differentials in Recife, Pernambuco State, Brazil

The objective of this study was to show infant mortality differentials in different areas of Recife, analyzing the relationship between living conditions and mortality risk. An ecological study design compared infant mortality coefficients in 1995 with living conditions indicators obtained from the 1991 National Demographic Census. Information on the 770 infant deaths and 27,965 live births were collected from death and birth certificates. Information on water supply, sanitation, garbage collection, literacy, schooling, income, and overcrowding were used to establish a compound indicator for living conditions, constructed through factor analysis. The neighborhoods were then ordered according to the level of living conditions and grouped in 4 clusters, through hierarchical cluster analysis. Infant, neonatal, and post-neonatal mortality coefficients were 23.94, 17.66, and 6.28, respectively, for cluster I; and 32.04, 20.24, and 11.80 for cluster IV. In general, an inverse relationship was found between infant mortality and living conditions in clusters from Recife, revealing inequalities that are disguised when coefficients are expressed as averages for the entire city.

Infant mortality in Zambia: Socioeconomic and demographic correlates

Trends in infant mortality in Zambia suggest a reversal of the decline experienced between the 1960s and the late 1970s. From a high of about 140, infant mortality rate declined to about 90 in the late 1970s only to rise again to 100 by 1996. Data on 5,600 births born between 1987 and 1992, and 6,630 births between 1991 and 1996 from the Zambian DHS are analyzed to identify socioeconomic and demographic correlates of infant mortality. Demographic factors such as small size at birth and short birth intervals are associated with higher neonatal mortality. In the post-neonatal period, urban children from poorer households had the highest mortality between 1991-1996. Also, differences in infant mortality rates between provinces narrowed. Children born in the most developed province of Lusaka had as high of risk of dying as those from Luapula, a province with a history of extremely high mortality rates in Zambia.

Social Differences in Infant Mortality in the Norwegian Parish Asker and Bærum 1814–1878

The electronic journal Hygiea Internationalis is the official journal of the International Network for the History of Public Health. The publication has been made possible by the generosity of the Swedish Research Council (VR) and Swedish Council for Working Life and Social Research (FAS).

Infant Mortality and Low Birth Weight Among Black and White Infants--United States, 1980-2000

Despite substantial reductions in U.S. infant mortality during the past several decades, black-white disparities in infant mortality rates persist. One of the Healthy People 2010 national objectives for maternal and infant health is to reduce deaths among infants aged < 1 year to < or = 4.5 per 1,000 live births among all racial/ethnic groups (objective 16-1c). Important determinants of racial/ethnic differences in infant mortality are low birth weight (LBW), defined as < 2500 grams, and very low birth weight (VLBW), defined as < 1500 grams. High birth weight-specific mortality rates (BWSMRs) occur at these low birth weights. Healthy People 2010 goals include reducing LBW to 5% and VLBW to 0.9% of live births (objectives 16-10a and 16-10b, respectively). To assess progress toward meeting these national objectives, CDC analyzed birth and death certificate data from the National Center for Health Statistics. This report describes trends in mortality and birth weight among black and white infants, which indicate persistent black-white disparities and underscore the need for prevention strategies that reduce preterm delivery and specific medical conditions that lead to infant death.

Registration Artifacts in International Comparisons of Infant Mortality

Although nearly all countries have noted a marked drop in infant mortality in recent decades, there are still large disparities between countries, particularly between developed and developing nations but also among industrialized countries. Nations employ different gestational age and/or birth-weight cutoff points for reporting fetal deaths and live births. Interpretations of signs of life, which classify deaths as fetal or infant, may vary widely despite attempts at standardization by the World Health Organization. There also may be differences in registering tiny preterm infants as live births or fetal deaths. The authors analyzed data on six national groups from the Internal Collaborative Effort on Perinatal and Infant Mortality (whites and blacks in the United States, Israeli Jews and non-Jews, Norwegians, and Swedes) for the years 1987 and 1988. In particular, two major potential artifacts that might help explain intercountry differences in infant mortality were examined: classification as fetal or infant death (especially at very low birth weights) and underregistration of borderline-viable infants as either fetal deaths or live births. Crude infant mortality rates (infant deaths per 1000 live births) were lowest in Sweden, where they were 25% below those for Norway, US whites, and Israeli Jews. Rates were twice as high for US blacks and Israeli non-Jews. Mortality risk was reduced in both US groups and Israeli non-Jews after adjusting for maternal age, parity, and multiple births. Excluding Sweden (because of insufficient data), stillbirths of 20 weeks' or more gestation as a proportion of all perinatal deaths were highest in Norway and lowest in US blacks. Differences were most marked when birth weight was less than 500 g. Live births of less than 500 g varied more than 50-fold between Sweden and both Israeli groups at the low end and US blacks at the high end. US whites had a 15-fold higher proportion of live births less than 500 g than did Swedes. Rates for live births at 500 to 749 g varied 7-fold among the various groups, but again were lowest in Sweden and highest in US blacks. Live births less than 750 g were much likelier to be registered in the United States than in the other countries, and this was not simply a reflection of differential classification of live births and stillbirths. Excluding births less than 750 g, the relative risk of infant mortality was somewhat reduced for Swedes, Israeli Jews and non-Jews, and US whites, and it was markedly reduced for US blacks. Relative risk figures for both Israeli groups and both US groups (especially US blacks) declined after adjusting for maternal age, parity, and multiple gestation. These findings confirm the existence of marked differences in registering infants near borderline viability as well as differences in classifying fetal versus infant deaths. Information updating these figures, now more than a decade old, is needed. In addition, more in-depth studies are required to ascertain the reasons for these differences, whether cultural, religious, or economic.

Variations in care for cottontop tamarin, Saguinus oedipus, infants as a function of parental experience and group size

We examined the effects of parental experience and group size on infant care and development. Ten cottontop tamarin families were followed across three consecutive births of offspring to examine differences in survival, quality of care, developmental maturation and physical development for infants in two experimental conditions: (1) in large groups with previous parenting experience and (2) in small groups with little or no parenting experience. Although we found no differences in infant mortality, parents treated infants differently between conditions. However, when we examined the cumulative care provided by parents and sibling helpers together across experimental conditions, there were no differences in the rates of retrieval or rejection of infants. Overall levels of infant transport and food transfers were similar between conditions, with fathers and sibling helpers contributing the bulk of care. Fathers in small groups carried infants and transferred food with infants much more than helpers but, as group size increased, helpers augmented this role. Infant development varied with the experience of the family both between conditions and within a family. The results indicate that infants receive similar levels of care regardless of group size and parenting experience, although the individual contributions of family members change with both factors. Parental experience with previous infants had effects on early infant development, but only for the first sets of infants. Copyright 2002 The Association for the Study of Animal Behaviour. Published by Elsevier Science Ltd. All rights reserved.

Religious differentials in infant and child mortality in Holland, 1855–1912

At least three kinds of hypothesis may be invoked to interpret religious differentials in mortality. They are (i) hypotheses that refer to characteristics, (ii) those that refer to lifestyle, and (iii) those that refer to the social isolation of minorities. This paper tests all three kinds of hypothesis using data on urban child mortality from The Hague just before and during the demographic transition. A hazard analysis suggests that economic and demographic characteristics do not account for much of the variation by religion. An analysis of seasonal mortality suggests that some of the variation may be explained by differences in lifestyle. The third kind of hypothesis is presented here for the first time. We suggest that the social isolation of small religious groups lowered their exposure to certain kinds of infectious disease. We use a simulation study to show that this hypothesis could account for part of the variation.

Annual summary of vital statistics: 2000.

The birth rate in 2000 (preliminary data) was 14.8 births per 1000 population, an increase of 2% from 1999 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 3% to 67.6 in 2000, compared with 65.9 in 1999. The 2000 increases in births and the fertility rate were the third consecutive yearly increases, the largest in many years, halting the steady decline in the number of births and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, black, and Native American women each increased about 2% in 2000. The fertility rate for black women, which declined 19% from 1990 to 1996, has changed little since 1996. The rate for Hispanic women rose 4% in 2000 to reach the highest level since 1993. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third, but the number of births rose 3%. The birth rate for teen mothers declined again for the ninth consecutive year. The use of timely prenatal care (83.2%) remained unchanged in 2000, and was essentially unchanged for non-Hispanic white (88.5%), black (74.2%), and Hispanic (74.4%) mothers. The number and rate of multiple births continued their dramatic rise, but all of the increase was confined to twins; for the first time in more than a decade, the number of triplet and higher-order multiple births declined (4%) between 1998 and 1999 (multiple birth information is not available in preliminary 2000 data). The overall increases in multiple births account, in part, for the lack of improvement in the percentage of low birth weight (LBW) births. LBW remained at 7.6% in 2000. The infant mortality rate (IMR) dropped to 6.9 per 1000 live births (preliminary data) in 2000 (the rate was 7.1 in 1999). The ratio of the IMR among black infants to that for white infants was 2.5 in 2000, the same as in 1999. Racial differences in infant mortality remain a major public health concern. The role of low birth weight in infant mortality remains a major issue. Among all of the states, Utah and Maine had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rates for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 76.9 years for all gender and race groups combined. Death rates in the United States continue to decline. The age-adjusted death rate for suicide declined 4% between 1999 and 2000; homicide declined 7%. Death rates for children 19 years of age or less declined for 3 of the 5 leading causes in 2000; cancer and suicide levels did not change for children as a group. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention—measles vaccination—on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children—from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity.

Diferenciales de mortalidad infantil por malformaciones congénitas con datos pareados: Chile (1993-1995)

The analysis of infant mortality from congenital malformations, which at present is the main group of causes of this mortality in Chile, suggests that it could be decreased with a good knowledge of its conditioning factors. To study infant mortality differentials from congenital malformations with linked records, in the 1993 to 1995 Chilean birth cohorts. Analysis of mortality differentials in 1993, 1994 and 1995 birth cohorts. Multivariate logistic regression of mortality from congenital diseases. Univariate analysis showed that mortality is highest in the Southern regions of the country (VII to XII) and in rural areas. It is also higher in children from older and from very young mothers, it increases along with the birth order of the child and decreases with increasing educational level of the mother. Multiple logistic regression analysis, confirmed the higher mortality in the Southern regions, aged mothers, high birth order of the child and low educational level of the mother. However no significant influence of rurality nor greater mortality in children of very young mothers was found. These results can be attributed to the fact that this type of analysis permits the control with other variables. Although the mortality data showed interesting relationships with the independent variables, a registry of all live births and stillbirths with congenital anomalies, that would provide greater numbers and data on non fatal anomalies, would be desirable to better study their causal factors.

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

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. 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. 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. 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.

Quantifying and explaining changes in geographical inequality of infant mortality in England and Wales since the 1890s

AbstractThis paper considers the changing spatial pattern of infant mortality in England and Wales over the last century for a constant area definition. The analysis proceeds at the level of registration districts as defined in the 1890s, generated using the British Isles Historical Geographical Information System. Infant mortality at this spatial definition is followed over four points in time, the most recent being the early 1990s. Using a variety of inequality measures, the analysis demonstrates a decline in relative small‐area differentials in the chances of infant deaths up to 1958, but some resurgence since then. Regression methods are then used to evaluate the effect of available social variables, such as population density and housing conditions. The analysis incorporates adjustments for the sampling variability in what are often small counts of infant deaths by adopting ‘pooling strength’ techniques. Urban–rural differentiation has followed the same evolution: it was most marked in the 1890s and reappears by the 1990s, after being reduced somewhat in the earliest years of the UK National Health Service. Differentials in infant mortality according to the housing quality and economic status of different registration districts also gain in importance in the twentieth century compared with the 1890s. Copyright © 2001 John Wiley &amp; Sons, Ltd.

Racial/ethnic disparities in infant mortality: the role of behavioral factors.

Using the National Maternal and Infant Health Survey 1988 (NMIHS), a nationally representative sample of mothers, we investigate the role of behavioral factors in explaining racial/ethnic disparities in infant mortality. In particular, we focus on the following variables: weight gain during pregnancy, prenatal care utilization, exercise, vitamin use, and substance use during pregnancy. These analyses are conducted by modeling both time of death (neonatal vs. postneonatal) and cause of death (infections, perinatal complications, delivery complications, congenital malformations, SIDS, other causes) outcomes. Our results suggest that behavioral factors are partially responsible for observed race/ethnic differentials in infant mortality, but are not as important as sociostructural determinants such as SES.