Differences In Infant Mortality Research Articles

The role of political and welfare state characteristics in infant mortality: a comparative study in wealthy countries since the late 19th century

A close examination of the literature suggests that the consistent relation between political and welfare state characteristics and infant mortality in the second half of the 20th century in wealthy countries may not be causal. The evolution of infant mortality since the late 19th century was studied in 17 wealthy countries classified according to political traditions, family policy model and period of infant mortality transition. The relation of public health expenditure and income inequality to infant mortality from 1980 to 2005 was also evaluated. The Social Democratic and Scandinavian countries, and those with the earliest transition in infant mortality, had the lowest infant mortality rates until the early 21st century, whereas the late democracies, the Southern European countries, and those in which the transition in infant mortality took place later, had the highest rates until the late 20th century. By the early 21st century, the differences in infant mortality were negligible. Three of the four Scandinavian countries were the first to achieve infant mortality transition, whereas the Southern European countries were the last. The relation between public health expenditure and infant mortality varied depending on the time period in which the analysis was made, and increased income inequality was associated with higher infant mortality. The relation between political and welfare state characteristics and infant mortality in previous studies probably reflects the historical moment in which the transition in infant mortality took place in each country. Methodological limitations do not allow inference of causality in the associations found between welfare state characteristics and infant mortality.

Recent Trends and Differentials of Infant Mortality in Kuwait

The present study utilizes nationwide health statistical data to examine the levels, trends, and differentials in infant mortality in Kuwait during the pre-invasion (1985-89) and postliberation (1992-96) periods. The analysis reveals a considerable and statistically significant decline in infant mortality during both spans; that drop is far more substantial in the pre-invasion than in the postliberation period. On average, the rates of infant mortality are higher among non-Kuwaitis than among Kuwaitis. There was a significant rise in premature births (birth weight less than 2.5 kg) in the postliberation period for both Kuwaitis and non-Kuwaitis. More than 80 percent of all infant deaths occur in government hospitals. No evidence of any seasonal variation in infant mortality is indicated. In both nationality groups, there is higher mortality among males. The maximum level of mortality is found in the perinatal stage. Thus, it is recommended that greater attention be given to perinatal care and genetic coun...

The link between infant mortality and child nutrition in India: is there any evidence of a gender bias?

In this paper, using the 1998–1999 National Family Health Survey data-set from India, we study whether there are gender differentials in infant mortality and child nutrition. Our analysis finds no evidence of gender differentials in survival probability. However, conditional upon surviving the first year, girls are found to have poorer height-for-age outcomes. There are also significant regional differences in both survival probabilities and nutritional outcomes. We show that the height-for-age z-score is significantly lower for higher birth-order children (later-born children), and the effect is monotonically increasing. Finally, parental education and household wealth have statistically significant effects on both survival outcomes and child nutrition.

The differential association between education and infant mortality by nativity status of Chinese American mothers: a life-course perspective.

Integrating evidence from demography and epidemiology, we investigated whether the association between maternal achieved status (education) and infant mortality differed by maternal place of origin (nativity) over the life course of Chinese Americans. We conducted a population-based cohort study of singleton live births to US-resident Chinese American mothers using National Center for Health Statistics 1995 to 2000 linked live birth and infant death cohort files. We categorized mothers by nativity (US born [n = 15 040] or foreign born [n = 150 620]) and education (≥ 16 years, 13-15 years, or ≤ 12 years), forming 6 life-course trajectories. We performed Cox proportional hazards regressions of infant mortality. We found significant nativity-by-education interaction via stratified analyses and testing interaction terms (P < .03) and substantial differentials in infant mortality across divergent maternal life-course trajectories. Low education was more detrimental for the US born, with the highest risk among US-born mothers with 12 years or less of education (adjusted hazard ratio = 2.39; 95% confidence interval = 1.33, 4.27). Maternal nativity and education synergistically affect infant mortality among Chinese Americans, suggesting the importance of searching for potential mechanisms over the maternal life course and targeting identified high-risk groups and potential downward mobility.

Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia.

ObjectiveExploring the associations of regional differences in infant mortality with selected socioeconomic indicators and ethnicity could offer important clues for designing public health policy measures.MethodsData included perinatal and infant mortality in the 79 districts of the Slovak population in 2004. Linear regression was used to analyse the contribution of education, unemployment, income and proportion of Roma population on regional differences in perinatal and infant mortality rates.ResultsAll the explored socioeconomic indicators and ethnicity individually contributed significantly to both perinatal and infant mortality, with the exception of income. In the model exploring the influence of all these variables together on perinatal and infant mortality, only the effect of the proportion of Roma population remained significant. This model explained 34.9% of the variance for perinatal and 36.4% of the variance for infant mortality.ConclusionsLiving in Roma settlements indicates an accumulation of socioeconomic disadvantage. Health literacy, health-related behaviour and many other factors might contribute to the explanation of the differences in infant mortality, and a better understanding of these processes might help us to design tailored interventions.

Urban Living is Not Associated with Better Birth and Infant Outcomes among Inuit and First Nations in Quebec~!2009-11-30~!2010-04-12~!2010-07-06~!

OBJECTIVE: There is limited and inconsistent evidence concerning rural versus urban differences in birth and infant outcomes for Indigenous peoples. We assessed birth and infant outcomes among Inuit, First Nations and French mother tongue groups by rural versus urban residence in Quebec, Canada. STUDY DEIGN: A retrospective birth cohort study of 5,184 First Nations, 2,527 Inuit and 652,940 French mother tongue (the majority reference) births in Quebec, 1991-2000. RESULTS: In general, rural living was associated with slightly less favorable birth outcomes for French mother tongue women, but somewhat better outcomes for Indigenous women. For both Inuit and First Nations, rural births were half as likely to be small-for-gestational-age compared to urban births. Among First Nations, the difference in infant mortality rates comparing urban to rural areas was not statistically significant. Compared to infants of French mother tongue women, Inuit and First Nations infants were much less likely to be small-for-gestational-age in rural areas, while such an "advantage" diminished for First Nations and reversed for Inuit in urban areas. The disparities in infant mortality among First Nations versus French mother tongue births were greater in urban than in rural areas. These patterns of results remained after adjusting for maternal characteristics. CONCLUSION: Living in urban areas was not associated with better birth and infant outcomes for Inuit and First Nations in Quebec despite universal health insurance coverage, strongly indicating a need for improved socioeconomic conditions, perinatal and infant care for Indigenous people living in urban areas.

Comparisons of infant mortality in the Austrian Empire Länder using the Tafeln (1851-54)

In this paper we measure differences in infant mortality among the central European populations of the Austrian Empire during the mid-19th century using data published in the Tafeln zur Statistik der Österreichischen Monarchie (Statistical Tables of th

Stochastic variation in sex ratios in infant mortality rates due to small samples in provisioned Japanese macaque (Macaca fuscata) populations

Sex differences in infant mortality in provisioned Japanese macaque populations were examined using 10 data sets from five populations. The results indicate that there was no available data set in which a sex difference in infant mortality was statistically significant. To examine whether the observed sex ratios in infant mortality rates could be the product of stochastic variation in small samples, a correlation between sample size and the magnitude of sex ratios in infant mortality rates was also examined. Notably, the magnitude of sex ratios in infant mortality rates declined significantly as sample sizes increased. These results suggest that previously reported marked sex ratios in infant mortality could be the product of stochastic variation in small samples.

Mortality patterns in geographical areas with a high vs. low Sami population density in Arctic Norway

The aim of this study was to study mortality patterns in the population in different geographical locations in northern Norway on the basis of Sami population density. Mortality statistics by sex and age from 1991 to 2006 were obtained from Statistics Norway. Mortality rates, including infant mortality rates, were compared across geographical locations. The data material was divided into within and outside the the geographical areas of the Sami Development Fund (SUF) and into coastal and inland residence. Differences in mortality rates were tested by chi-quadrate tests. Overall, no pronounced difference in mortality rate was found in the population between geographical areas. For men, mortality rates differed only between geographical residence in the time intervals 1991-95 and 1996-2000 for the age groups 45-59 years and 60-74 years, respectively, with outside SUF area, inland having the lowest rate. For women, there were no differences between geographical areas except for the age group 60-74 years in the time period 1991-95, where SUF coast had the highest mortality rate. For the SUF area, men had the lowest probabilities for surviving the age of 74 years and women had among the highest. No geographical difference was found in infant mortality. During the time period 1991-2006, the outside SUF area, inland had an average infant mortality rate of 1.8/1000 per year, and for SUF coast it was 6.2/1000 per year. This difference was, however, not significant (p = 0.08). Overall, mortality rates were similar across geographical areas with low and with high Sami population density. However, indications of geographical differences in infant mortality should be investigated further.

Infant Mortality in Rural Bangladesh: State Dependence vs. Unobserved Heterogeneity

Using longitudinal data of the Health and Demographic Surveillance System (HDSS) in Matlab, Bangladesh, covering the time period 1982–2005, and exploiting dynamic panel data models, we analyze siblings’ death at infancy, controlling for unobserved heterogeneity and a causal effect of death of one child on survival chances of the next child. Matlab is a rural area split into two: a “treatment” area where along with standard government services extensive maternal and child health interventions are available, and a “comparison” area where only the standard government services are available. The observed infant mortality rates are 50 per 1,000 live births in the treatment area and 67.4/1,000 in the comparison area. We use separate models for the two areas and analyze the differences in infant mortality between the two areas using several decompositions. Our model predicts that in the comparison area, the likelihood of infant death is about 30% larger if the previous sibling died at infancy than if it did not, and the estimates suggest that, in the absence of this “scarring” effect, the infant mortality rate among the second and higher order births would fall by 6.2%. There is no evidence of such a scarring effect in the treatment area, perhaps because learning effects play a larger role with the available extensive health interventions. We find that distance to the nearest health clinic can explain a substantial part of the gap in infant mortality between the two areas.

Ethnic differences in infant mortality by cause of death

The purpose of this study was to examine ethnic differences among non-Hispanic black and white births in the distribution of maternal risk factors of infant mortality across specific causes of death. The data were obtained from the North Carolina linked birth/infant death files (1989 to 1997). Logistic regression models were built to assess the risk distribution of demographic, behavioral and health related variables in relation to causes of infant death, which included congenital anomalies, short gestation/low birth weight (LBW), sudden infant death syndrome, infections and obstetric conditions. Infants born to black women had the highest rates for all causes of mortality compared to those born to white women. Having at least one prior live birth now dead was associated with congenital anomalies, obstetric conditions and short gestation/LBW related deaths in both ethnic groups. Deaths caused by infections were more likely to occur among white young (<20) women. White women enrolled in Medicaid had an increased risk of infant deaths due to short gestation/LBW when compared to those with no Medicaid, while young black mothers (<20 years old) were less likely to experience an infant death due to short gestation/LBW and obstetric conditions. This study provides evidence that maternal sociodemographic risk factors somewhat vary by infant cause of death and ethnicity. This suggests that race-specific approaches may be necessary to reduce infant mortality rates. The differences, however, in the risk distribution of factors across the two ethnic groups were limited indicating that the heterogeneity in the mortality rates may be due to unmeasured factors.

Modeling the pediatric paradox: Birth weight by gestational age

The “pediatric paradox” of African versus European American infant mortality is often observed with respect to birth weight, but rarely to gestational age, even though the two measures are biologically related. This paper models the pediatric paradox by birth weight and gestational age simultaneously, using Covariate Density Defined mixture of logistic regressions (CDDmlr) fitted to 1985–1988 New York State births. The model controls for unobserved heterogeneity and isolates the pediatric paradox in the “compromised” subpopulation. The paradox is not limited to low birth weights and/or short gestational ages, but surrounds the normal birth range. Nevertheless, the pediatric paradox is only observed in the marginal distribution of birth weight and not the marginal distribution of gestational age. These results are consistent with the hypothesis that higher fetal losses in the “compromised” subpopulation may be responsible for the pediatric paradox and that African versus European American infant mortality differentials are underestimated.

Temporal changes in the spatial pattern of disease rates incorporating known risk factors

Examining the geographical pattern of temporal changes in infant mortality rates illustrates the methodological problems of documenting and understanding temporal changes in any spatial pattern of disease. Early research on geographical differences in infant mortality rates showed strong ecological correlations with socio-economic factors such as poverty rates. More recent research established relationships between individual-level socio-economic values and probabilities of death. With geographic information available at the level of individuals, it is possible to estimate the probabilities of death on a person-by-person basis from knowledge of the relationships between individual factors and socio-economic measures. These estimated probabilities provide an expected geographic pattern of deaths. The difference between the observed spatial pattern and the expected pattern is the remaining spatial variation adjusted for this knowledge. For the study area, individual factors and some socio-economic measures were available for each year of the study period. Using data from the Iowa Birth Defects Registry and the Iowa Department of Public Health (USA), I tested the stability and continuity of these cross-sectional relationships and investigated whether any temporal lags in these variables relate to the unexplained spatial variations in infant mortality rates that remain. I accounted for the ‘Change of Support Problem’ [Gotway C. A. & Young L. J. (2002). Combining incompatible spatial data. Journal of the American Statistical Association, 97458, 632–648] inherent in frame-based geographical analysis. The analysis involved a generalized linear model (GLM) to estimate individual risks and a Monte Carlo simulation model to generate the non-linear probability density functions for disease rates whose densities are theoretically intractable. Results show the temporal changes in the observed spatial pattern and the expected spatial pattern differ by geographic location. In conclusion such differences are the result of a combination of unexplained place-based risk and unmeasured individual risks.

Infant Mortality in Lesotho: Parental Education and Demographic Factors

This study is an examination of effects of parental education and demographic factors on infant mortality in Lesotho, based on the 1977 Lesotho Fertility Survey. The study showed that infant mortality, despite an erratic trend, fell over time. Although the female population of Lesotho was better educated than the male population, paternal education appeared to be more important in infant survival than maternal education. Children born to mothers aged less than 20 and between 30-34 appeared to have lower chances of survival than children born to mothers of other ages. Fourth or higher birth orders faced a higher risk of mortality than the lower birth orders. However, high death rates were not caused by birth order per se, but because mothers gave birth at early ages whereas others started child bearing at relatively older ages. The study also showed that children born less than 24 months after their preceding siblings faced higher risk of mortality than those born after a 24 month interval. Differences in infant mortality by sex were not statistically significant.

Annual Summary of Vital Statistics: 2005

The general fertility rate in 2005 was 66.7 births per 1000 women aged 15 to 44 years, the highest level since 1993. The birth rate for teen mothers (aged 15 to 19 years) declined by 2% between 2004 and 2005, falling to 40.4 births per 1000 women, the lowest ever recorded in the 65 years for which there are consistent data. The birth rates for women > or = 30 years of age rose in 2005 to levels not seen in almost 40 years. Childbearing by unmarried women also increased to historic record levels for the United States in 2005. The cesarean-delivery rate rose by 4% in 2005 to 30.2% of all births, another record high. The preterm birth rate continued to rise (to 12.7% in 2005), as did the rate for low birth weight births (8.2%). The infant mortality rate was 6.79 infant deaths per 1000 live births in 2004, not statistically different from the rate in 2003. Pronounced differences in infant mortality rates by race and Hispanic origin continue, with non-Hispanic black newborns more than twice as likely as non-Hispanic white and Hispanic infants to die within 1 year of birth. The expectation of life at birth reached a record high in 2004 of 77.8 years for all gender and race groups combined. Death rates in the United States continued to decline, with death rates decreasing for 9 of the 15 leading causes. The crude death rate for children aged 1 to 19 years did not decrease significantly between 2003 and 2004. Of the 10 leading causes of death for 2004 in this age group, only the rates for influenza and pneumonia showed a significant decrease. The death rates increased for intentional self-harm (suicide), whereas rates for other causes did not change significantly for children. A large proportion of childhood deaths continue to occur as a result of preventable injuries.

Cultural Background and Infant Survival in Ghana

This study is premised on the hypothesis that ethnic specific socio-cultural practices such as dietary taboos and food avoidances on mothers and infants, as well as perceptions of disease aetiology and treatment patterns may be salient to understanding infant mortality differentials in Ghana. To inform policy, the paper explores if there are significant ethnic differences in infant survival, and whether such differences reflect socio-economic disparities or intrinsic factors. Using data from the 1998 Ghana Demographic and Health Survey, there was evidence of significant ethnic differences in infant survival at the bivariate level. Using Asante mothers as reference, the risk of death was significantly higher among children whose mothers were Mole-Dagbani, Grussi, Gruma, Dagarti, Fanti and Other Akan. In the multivariate models, however, the higher mortality risks associated with these children significantly attenuated after controlling for the socio-economic and bio-demographic factors except for the Fanti. The findings are discussed with reference to the characteristics and cultural theoretical paradigms.

Ethnic differences in total and cause‐specific infant mortality in the Netherlands

We examined ethnic differences in infant mortality and the contribution of several explanatory variables. Data of Statistics Netherlands from 1995 to 2000 were studied (1,178,949 live borns). Proportional hazard analysis was used to show ethnic differences in total and cause-specific infant mortality. Obstetric, demographic and -geographical variables, and socio-economic status were considered as possible determinants. The four major ethnic minority groups showed an elevated risk of infant mortality, ranging from 1.28 in Turkish infants to 1.50 in Antillean/Aruban infants. In the early neonatal period, risks were elevated for Surinamese (hazard ratio [HR] 1.48, 95% confidence intervals [CI] 1.23, 1.78) and Antilleans/Arubans (HR 1.43, 95% CI 1.06, 1.92). In the post-neonatal period, risks were only elevated for Turkish (HR 2.20, 95% CI 1.80, 2.69) and Moroccan infants (HR 2.06, 95% CI 1.67, 2.55). Surinamese and Antillean/Aruban infants had an elevated risk of dying from perinatal causes (HR 1.62, 95% CI 1.33, 1.98 and 1.69, 95% CI 1.24, 2.29 respectively), Turkish and Moroccan infants had an elevated risk of dying from congenital anomalies (HR 1.42, 95% CI 1.16, 1.73 and 1.46, 95% CI 1.20, 1.79 respectively). Inequalities as a result of socio-economic position and demographic factors, such as marital status and maternal age, partially explain the ethnic differences in infant mortality. We conclude that ethnic minority groups in The Netherlands have a higher infant mortality than the native population, which in part seems preventable by reducing inequalities in socio-economic status. Marital status and age of the mother are important other risk factors of infant mortality.

An Epidemiology of Neighborhood Poverty: Causal Factors of Infant Mortality Among Blacks and Whites in the Metropolitan United States*

Despite overall declines in infant mortality over the past few decades, racial disparities between blacks and whites have persisted in the United States. This article considers the argument that racial differences in infant mortality are partially the result of the disproportionate concentration of blacks within extremely poor neighborhoods relative to whites. Using race-specific measures of neighborhood-level poverty, combined with metropolitan-wide measures of infant mortality, it was determined that trends in infant mortality for both blacks and whites reflect the impact of an intergenerational effect associated with prolonged exposure to extremely poor neighborhoods. Racial disparities in infant mortality in the early 1980s can be accounted for by black – white differences in neighborhood poverty exposure. Results suggest, however, that black infant mortality during the early 1990s was much more strongly influenced by high-risk natality behaviors among black women than by economic status or neighborhood influences.

Trends and racial differences in infant mortality in South Africa

Racial differences in infant mortality in South Africa are studied using household-level data from 1987 to 1989 and 1998. Logistic regression models are estimated to explore the determinants of the overall trend in infant mortality and racial disparities in infants’ survival chances. We do not find evidence for reduced overall risk of infant death among births that occurred from 1993 to 1998 when compared to those that occurred from 1982 to 1989, despite policy and action directed toward this goal by the new government that was elected in early 1994. We also find that persistent inequalities in the personal and household resources of South Africa's four main racial groups substantially account for racial differences in infant survival rates in both periods. These findings are discussed in light of contemporary social and health issues in South Africa.

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.