Socio-economic factors in Infant and child mortality: A cross-national comparison

This paper analyzes the connection between life expectancy according to sex and numerous factors on which its level depends on. Statistical analysis understood application of correlation and regression analysis for determining the connection strength of life expectancy and researched factors separately and then all factors together, as well as separately groups of health-medical and socio-economic factors. The analysis was carried out for a group of developed countries, medium developed, mixed group and Yugoslavia (now SCG) on available data for the second half of the 20th century. Analysis results for Yugoslavia showed that the greatest influence on life expectancy of all factors together were setting aside funds for social security (p<0.05). If only health-medical factors are observed, then child mortality up to 5 years and tumor mortality are in question. With women, the greatest influence is with child mortality up to five years old among all factors (<p0.05), or only among health-medical, but in that case it is far less than with men. In developed countries, the strongest connection with life expectancy were the number of sick-beds with men (p<0.05), and with women the parameter of potentially lost years due to tumor (p<0.01). In medium developed countries the most influence on women's life expectancy was maternal mortality (p=0.014), and with men no researched factor was statistically significant. In the mixed sample, the strongest connection with men was with gross national income per capita (p<0.01), and with women with child mortality up to five years old (p=0.017). Therefore on the basis of the determined statistical importance of certain factors analysis showed that the influence of socio-economic factors on life expectancy was very strong in present conditions of mortality, not only in positive, but in negative direction as well, and that their influence in that second half of the 20th century was greater than the influence of health-medical factors. Also, it seems that the males are more sensitive to these factors than women.

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A comparison of child mortality from potentially preventable causes in England and Sweden using birth cohorts from linked administrative datasets

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.919 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Ania Zylbersztejn ◽

Ruth Gilbert ◽

Anders Hjern ◽

Pia Hardelid

Keyword(s):

Child Mortality ◽

Congenital Anomalies ◽

Low Birthweight ◽

Hospital Admissions ◽

Cox Proportional Hazards ◽

Economic Factors ◽

Birth Cohorts ◽

Birth Characteristics ◽

Related Mortality ◽

Socio Economic Factors

IntroductionChild mortality is nearly twice as high in England as in Sweden. A comparison of mortality from potentially preventable causes could inform health system responses. This study focused on respiratory tract infection (RTI)-related deaths, amenable to healthcare interventions, and sudden unexpected deaths in infancy (SUDI), amenable to public health interventions. Objectives and ApproachWe developed nationally-representative birth cohorts of singleton live births in 2003-2012 using a hospital admissions database in England and the Medical Birth Register in Sweden. Children were followed-up from 31st day of life until their fifth birthday via linkage to hospital admission and mortality records. We compared child mortality using Cox proportional hazards models to estimate hazard ratios (HR) for England versus Sweden for RTI-related mortality at 31-364 days and 1-4 years, and for SUDI mortality at 31-364 days. Models were adjusted for birth characteristics (gestational age, birthweight, sex, congenital anomalies), and socio-economic factors (maternal age and socio-economic status). ResultsOf 3,928,483 children in England, there were 807 RTI-related deaths at 31-364 days (17% of all deaths in the age range), 691 deaths at 1-4 years (31%), and 1,166 SUDIs (24%) in England. Corresponding figures for 1,012,682 children in Sweden were 136 (18%), 118 (25%) and 189 (24%). Unadjusted HRs for RTI-related deaths in England versus Sweden were 1.50 (95% confidence interval: 1.25-1.80) at 31-364 days. Adjustment for birth characteristics reduced the HR to 1.16 (0.97-1.39), and for socio-economic factors to 1.11 (0.92-1.33). Corresponding figures for RTI-related mortality at 1-4 years were 1.58 (1.30-1.92), 1.32 (1.09-1.61) and 1.30 (1.07-1.59), respectively. Unadjusted HRs for SUDIs reduced from 1.59 (1.36-1.85) to 1.40 (1.20-1.63) after adjusting for birth characteristics, and to 1.19 (1.02-1.39) after adjusting for socio-economic factors. Conclusion/ImplicationsHigher prevalence of adverse birth characteristics (such as prematurity, low birthweight, congenital anomalies) contributed to increased risks of RTI-related and SUDI mortality in England relative to Sweden. Therefore, preventive strategies should focus on maternal health and socio-economic circumstances before and during pregnancy to reduce RTI-related and SUDI mortality in England.

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