Social Inequality In Infant Mortality Research Articles

Social inequality in infant mortality in Angola: Evidence from a population based study.

Within country inequality in infant mortality poses a big challenge for countries moving towards the internationally agreed upon targets on child mortality by 2030. There is a lack of high-quality evidence on infant mortality measured through different dimensions of social inequality in Angola. Thus, this paper was carried out to address the knowledge gap by conducting in-depth examination of infant mortality rate (IMR) inequality among population subgroups to provide more nuanced evidence to help end IMR disparity in the country. The World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used to analyze IMR inequality. HEAT is a software application that facilitates examination of disparities in reproductive, maternal, neonatal and child health indicators using the WHO Health Equity Monitor (HEM) database. Inequality of IMR was analyzed through disaggregation by five equity stratifiers: education, wealth, gender, subnational region and residence. These were analyzed through three inequality measures: Population Attributable Risk, Ratio and Slope Index of Inequality. A 95% confidence Interval (CI) was built around point estimates to determine statistical significance. A notable disadvantage was found for children born to poor (Population Attributable Risk (PAR): -27.0; -28.4, -26.0) and uneducated (PAR: -17.0; -17.9, -16.0), women who live in rural areas (PAR: -7.3;-7.8, -6.7) and those residing in certain regions of the country (PAR: -43.0; 45.3, -4). Male infants had a higher risk of death than female infants (PAR: -6.8;-7.5, -6.2). The subnational regional variation of IMR had been the most evident when compared with the disparities in the other equity stratifers. Policymakers and planners need to address the disproportionately higher clustering of IMR among infants born to disadvantaged subpopulations through interventions that benefit such subgroups.

Infant Mortality in the United States, 1915-2017: Large Social Inequalities have Persisted for Over a Century.

Objectives:We examined trends in racial/ethnic, socioeconomic, and geographic disparities in age- and cause-specific infant mortality in the United States during 1915-2017.Methods:Log-linear regression and inequality indices were used to analyze temporal infant mortality data from the National Vital Statistics System and the National Linked Birth/Infant Death files according to maternal and infant characteristics.Results:During 1915-2017, the infant mortality rate (IMR) declined dramatically overall and for black and white infants; however, black/white disparities in mortality generally increased through 2000. Racial disparities were greater in post-neonatal mortality than neonatal mortality. Detailed racial/ethnic comparisons show an approximately five-fold difference in IMR, ranging from a low of 2.3 infant deaths per 1,000 live births for Chinese infants to a high of 8.5 for American Indian/Alaska Natives and 11.2 for black infants. Infant mortality from major causes of death showed a downward trend during the past 5 decades although there was a recent upturn in mortality from prematurity/low birthweight and unintentional injury. In 2016, black infants had 2.5-2.8 times higher risk of mortality from perinatal conditions, sudden infant death syndrome, influenza/pneumonia, and unintentional injuries, and 1.3 times higher risk of mortality from birth defects compared to white infants. Educational disparities in infant mortality widened between 1986 and 2016; mothers with less than a high school education in 2016 experienced 2.4, 1.9, and 3.7 times higher risk of infant, neonatal, and post-neonatal mortality than those with a college degree. Geographic disparities were marked and widened across regions, with states in the Southeast region having higher IMRs.Conclusions and Global Health Implications:Social inequalities in infant mortality have persisted and remained marked, with the disadvantaged ethnic and socioeconomic groups and geographic areas experiencing substantially increased risks of mortality despite the declining trend in mortality over time. Widening social inequalities in infant mortality are a major factor contributing to the worsening international standing of the United States.

Trends of Social Inequalities in the Specific Causes of Infant Mortality in a Nationwide Birth Cohort in Korea, 1995-2009.

The relationship between social disparity and specific causes of infant mortality has rarely been studied. The present study analyzed infant mortality trends according to the causes of death and the inequalities in specific causes of infant mortality between different parental social classes. We analyzed 8,209,836 births from the Statistics Korea between 1995 and 2009. The trends of disparity for cause-specific infant mortality according to parental education and employment were examined using the Cox proportional hazard model for the birth-year intervals of 1995–1999, 2000–2004, and 2005–2009. Adjusted hazard ratios were calculated after adjusting for infants' gender, parents' age, maternal obstetrical history, gestational age, and birth weight. An increasing trend in social inequalities in all-cause infant mortality according to paternal education was evident. Social inequalities in infant mortality were greater for “Not classified symptoms, signs and findings” (International Classification of Diseases 10th revision [ICD-10]: R00–R99) and “Injury, poisoning and of external causes” (S00–T98), particularly for “Ill-defined and unspecified causes” (R990) and “Sudden infant death syndrome (SIDS)” (R950); and increased overtime for “Not classified symptoms, signs and findings” (R00–R99), “Injury, poisoning and of external causes” (S00–T98) and “Conditions in perinatal period” (P00–P96), particularly for “SIDS” (R950) and “Respiratory distress syndrome of newborns (RDS)” (P220). The specific causes of infant mortality, in particular the “Not classified causes” (R00–R99 coded deaths) should be investigated more thoroughly to reduce inequality in health.

Social inequality in infant mortality: What explains variation across low and middle income countries?

Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household samples (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality.

Green space and spatial analysis of social inequalities in infant mortality in France

Background- Few studies considered environmental benefits to explain social health inequalities. Natural environments that contribute to good health might have an effect on socioeconomic health inequalities. In developed countries, the evidence that green spaces have health benefits for urban population is now strong. Recent studies suggest such positive effects on pregnancy outcomes. Aims- To investigate the relationships between green spaces and the spatial distribution of infant mortality taking into account neighborhood deprivation levels. Methods- The study took place in the Lyon metropolitan area, France (1340 155 in 2009). All infant deaths cases aged <1 yearthat occurred between 2000 and 2009 were geocoded at the census block level (n= 715). Each census block was assigned greenness and socioeconomic deprivation levels. Using a spatial–scan statistic, we examined whether there were significant clusters of high risk of infant mortality according to these neighborhood characteristics. Results- Our results highlight that infant mortality is not randomly spatially distributed, with clusters of high riskin the southwest of the Lyon metropolitan area (53 census blocks; RR:1.70; p<0.003). After adjustment on greenness levels and socioeconomic deprivation, this cluster disappears, suggesting that these factors explain in great part the spatial distribution of infant mortality. No interaction was found between the two factors. Conclusions- We propose 3 hypotheticals not exclusive pathways by which green space may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway. This work adds some evidence to the link between access to green space and pregnancy outcomes but requires further research for confirmation.

Social determinants for infant mortality in the Nordic countries, 1980 - 2001

Social equity in health is an important goal of public health policies in the Nordic countries. Infant mortality is often used as an indicator of the health of societies, and has decreased substantially in the Nordic welfare states over the past 20 years. To identify social patterns in infant mortality in this context the authors set out to review the existing epidemiological literature on associations between social indicators and infant mortality in Denmark, Finland, Norway, and Sweden during the period 1980-2000. Nordic epidemiological studies in the databases ISI Web of Science, PubMed, and OVID, published between 1980 and 2000 focusing on social indicators of infant, neonatal, and postneonatal mortality, were identified. The selected keywords on social indicators were: education, income, occupation, social factors, socioeconomic status, social position, and social class. Social inequality in infant mortality was reported from Denmark, Finland, Norway, and Sweden, and it was found that these increased during the study period. Post-neonatal mortality showed a stronger association with social indicators than neonatal mortality. Some studies showed that neonatal mortality was associated with social indicators in a non-linear fashion, with high rates of mortality in both the lowest and highest social strata. The pattern differed, however, between countries with Finland and Sweden showing consistently less social inequalities than Denmark and Norway. While the increased inequality shown in most studies was an increase in relative risk, a single study from Denmark demonstrated an absolute increase in infant mortality among children born to less educated women. Social inequalities in infant mortality are observed in all four countries, irrespective of social indicators used in the studies. It is, however, difficult to draw inferences from the comparisons between countries, since different measures of social position and different inclusion criteria are used in the studies. Nordic collaborative analyses of social gradients in infant death are needed, taking advantage of the population-covering registers in longitudinal designs, to explore the mechanisms behind the social patterns in infant mortality.

Effects of maternal education on infant mortality and stillbirths in Denmark

This study examined inequalities in infant mortality in Denmark in relation to maternal educational level, and compared the inequalities to those observed in a similar study 10 years earlier. It was a register-based study of all singleton births in Denmark 1991-92, a study population of 113,814 births. When adjusted for mother's age, parity, and smoking, the stillbirth rate was independent of mother's educational level, but a clear social gradient in infant mortality was observed. Compared with a similar study in 1982-83, infant mortality has decreased most in the highest educational group and has increased in the lowest educational group. In conclusion, social inequality in infant mortality in Denmark is pronounced and cannot be explained by differences in smoking habits. The social gap between different educational groups has widened during the last decade, but may partly be explained by the decreasing number of women in the lowest educational group.

Death in its season: class, environment and the mortality of infants in nineteenth-century Sheffield.

Until the early twentieth century urban living carried with it a cost on health. For infants these risks were heightened considerably. Overcrowding and high population densities, insufficient water supplies and inadequate systems of excrement removal, all increased the vulnerability of infants to infection within the urban environment. But these risks of death were not shared equally by the urban population. Drawing on the results of a nominative record-linkage study for Sheffield, this paper examines the geographical and social inequalities in infant mortality within the urban environment. It compares the seasonal pattern of infant deaths on a class-specific basis across a broad range of differing sanitary areas within the town. Although the summer months posed the greatest threat for all infants, these risks varied considerably according to socio-economic background and also according to the part of the town where the infant lived. And although both factors exerted an independent contribution to the pattern of infant mortality, the effects were cumulative. These results are discussed in relation to historical interpretations and also the nineteenth-century debates about the causes of infant mortality.

Social-class inequality in infant mortality in England and Wales from 1921 to 1980

This paper examines the trend in social inequality in infant mortality in England and Wales between 1921 and 1980, using both class- and occupation-specific data. It employs a summary measure of inequality that uses all of the available data and can be evaluated in terms of its sensitivity to errors using accepted diagnostic techniques. Occupations that played a significant role in determining the time trend in inequality are identified and the effect of mortality among out-of-wedlock births is examined. Implications of these findings for assessing the determinants of social inequality in infant mortality and evaluating the contribution of the National Health Service in its amelioration are discussed.