Trends in Mortality in Puerto Rico Between 1979 and 2018: An Analysis of the Puerto Rico Healthcare Reform

Abstract Between 1993 and 2000, the Government of Puerto Rico decided to transform the role of the government from a provider of healthcare to an insurer. Despite claims about the success of the reform, no study has assessed whether it improved the health of the population or reduced mortality. The aim of this study is to assess whether the implementation of the Puerto Rico Healthcare Reform of 1993 reduced mortality and infant mortality in Puerto Rico in a significant way. I calculated crude death rates (CDR), age-standardized death rates, infant mortality rates, total deaths and life expectancy between 1980 and 2018. I used a quasi-experimental design to study the effect of the implementation of the Puerto Rico Healthcare Reform on these indicators. The primary objective was to estimate changes in trends after 2000. The Age-Specific Mortality Rates have reduced since 1980. The least pronounced change for 2018, in comparison to 1980, was for young adults (20-24 years, 25-29 years, and 30-34 years). The CDR was affected based on the implementation of the reform, but the Infant Mortality Rates was not. The Standardized Death Rate and deaths indicate that there was a small reduction in these indicators. I also found that the gains in life expectancy were concentrated in older adults (aged 65 and older). Analysis of all-cause mortality indicators allows for the evaluation of this healthcare reform. The reduction in mortality in the post-2000 period was not entirely due to the trend that existed before the healthcare reform was implemented.

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Impacts of the Regional Greenhouse Gas Initiative (RGGI) on infant mortality: a quasi-experimental study in the USA, 2003–2014

BMJ Open ◽

10.1136/bmjopen-2018-024735 ◽

2019 ◽

Vol 9 (4) ◽

pp. e024735 ◽

Cited By ~ 16

Author(s):

Jaeseok Lee ◽

Taehwan Park

Keyword(s):

Infant Mortality ◽

Greenhouse Gas ◽

Ambient Air ◽

Mortality Rates ◽

Death Rates ◽

Live Births ◽

Increased Risk ◽

Quasi Experimental ◽

The Usa ◽

The Impact

ObjectivesThe Regional Greenhouse Gas Initiative (RGGI) is the first mandatory market-based regulatory programme to limit regional carbon dioxide (CO2) emissions in the USA. Empirical evidence has shown that high concentrations of ambient air pollutants such as CO2 have been positively associated with an increased risk of morbidity (eg, respiratory conditions including asthma and lung cancer) and premature mortality. The purpose of this study was to examine the impacts of RGGI on death rates in infancy.DesignA quasi-experimental difference-in-differences design.Setting and participantsWe estimated the impacts of RGGI on infant mortality from 2003 through 2014 in the USA (6 years before and after RGGI implementation). Our analytic models included state- and year-fixed effects in addition to a number of covariates.Outcome measuresDeath rates in infancy: neonatal mortality rates (NMRs), deaths under 28 days as well as infant mortality rates (IMRs), deaths under 1 year.ResultsImplementation of RGGI was associated with significant decreases in overall NMRs (a reduction of 0.41/1000 live births) and male NMRs (a reduction of 0.43/1000 live births). However, RGGI did not have a significant effect on female NMRs. Similarly, overall IMRs and male IMRs decreased significantly by 0.37/1000 live births and 0.61/1000 live births, respectively, after implementation of RGGI while female IMRs were not significantly affected by RGGI.ConclusionsRGGI was associated with decreases in overall infant mortality and boy mortality through reducing air pollutant concentrations. Of note, the impact of this environmental policy on infant girls was much smaller.

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Stillbirth, newborn and infant mortality: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

International Journal of Epidemiology ◽

10.1093/ije/dyy129 ◽

2019 ◽

Vol 48 (Supplement_1) ◽

pp. i54-i62 ◽

Cited By ~ 6

Author(s):

Ana M B Menezes ◽

Fernando C Barros ◽

Bernardo L Horta ◽

Alicia Matijasevich ◽

Andréa Dâmaso Bertoldi ◽

...

Keyword(s):

Black Women ◽

Infant Mortality ◽

Low Income ◽

Causes Of Death ◽

Mortality Rates ◽

Population Based ◽

Birth Cohorts ◽

Mortality Trends ◽

Death Rates ◽

Economic Inequalities

Abstract Background Infant-mortality rates have been declining in many low- and middle-income countries, including Brazil. Information on causes of death and on socio-economic inequalities is scarce. Methods Four birth cohorts were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. Surveillance in hospitals and vital registries, accompanied by interviews with doctors and families, detected fetal and infant deaths and ascertained their causes. Late-fetal (stillbirth)-, neonatal- and post-neonatal-death rates were calculated. Results All-cause and cause-specific death rates were reduced. During the study period, stillbirths fell by 47.8% (from 16.1 to 8.4 per 1000), neonatal mortality by 57.0% (from 20.1 to 8.7) and infant mortality by 62.0% (from 36.4 to 13.8). Perinatal causes were the leading causes of death in the four cohorts; deaths due to infectious diseases showed the largest reductions, with diarrhoea causing 25 deaths in 1982 and none in 2015. Late-fetal-, neonatal- and infant-mortality rates were higher for children born to Brown or Black women and to low-income women. Absolute socio-economic inequalities based on income—expressed in deaths per 1000 births—were reduced over time but relative inequalities—expressed as ratios of mortality rates—tended to remain stable. Conclusion The observed improvements are likely due to progress in social determinants of health and expansion of health care. In spite of progress, current levels remain substantially greater than those observed in high-income countries, and social and ethnic inequalities persist.

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Changes in life expectancy due to avoidable and non-avoidable deaths in Argentina, Chile, Colombia and Mexico, 2000-2011

Cadernos de Saúde Pública ◽

10.1590/0102-311x00093417 ◽

2018 ◽

Vol 34 (6) ◽

Cited By ~ 4

Author(s):

Claudio Dávila-Cervantes ◽

Marcela Agudelo-Botero

Keyword(s):

Latin America ◽

Life Expectancy ◽

Information Source ◽

Age Groups ◽

Population Data ◽

Mortality Rates ◽

Vital Statistics ◽

Death Rates ◽

Avoidable Deaths ◽

Avoidable Death

Abstract: The objective of this study was to analyze the level and trend of avoidable deaths and non-avoidable deaths and their contribution to the change in life expectancy in Latin America by studying the situations in Argentina, Chile, Colombia and Mexico between the years 2000 and 2011, stratified by sex and 5-year age groups. The information source used in this study was the mortality vital statistics, and the population data were obtained from censuses or estimates. The proposal by Nolte & McKee (2012) was used to calculate the standardized mortality rates and the influence from avoidable and non-avoidable causes in the change in life expectancy between 0 and 74 years. In Argentina, Chile and Colombia, all the rates declined between the years 2000 and 2011, whereas in Mexico, the avoidable deaths and non-avoidable deaths rates increased slightly for men and decreased for women. In all the countries, the non-avoidable death rates were higher than the avoidable death rates, and the rates were higher for men. The largest contributions to changes in life expectancy were explained by the non-avoidable deaths for men in all countries and for women in Argentina; in contrast, in Chile, Colombia and Mexico, the gains in years of life expectancy for women were mainly a result of avoidable causes. The results suggest there have been reductions in mortality from these causes that have resulted in gains in years of life expectancy in the region. Despite these achievements, differences between countries, sex and age groups are still present, without any noticeable progress in the reduction of these inequalities until now.

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Letter To The Editor

PEDIATRICS ◽

10.1542/peds.45.6.1044 ◽

1970 ◽

Vol 45 (6) ◽

pp. 1044-1044

Author(s):

Alfred Yankauer

Keyword(s):

United States ◽

Infant Mortality ◽

Infant Death ◽

The United States ◽

Mortality Rates ◽

European Countries ◽

Death Rates ◽

Letter To The Editor

Second, Dr. Yankauer: "Disgraceful and totally unacceptable" are inflammatory adjectives. They stir up uncomfortable feelings of personal guilt and blame. It would be reassuring if the differences between infant mortality rates in the United States and those of several small European countries with relatively homogenous populations and stable traditions could be explained away as statistical artefacts. Unfortunately the differences cannot be explained away. Clear evidence for their substance is the fact that infant death rates after the first month of life are three times as high in the United States as in Sweden.

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On African Responsibility for Economic Problems

Issue A Journal of Opinion ◽

10.1017/s0047160700502546 ◽

1997 ◽

Vol 25 (1) ◽

pp. 50-53

Author(s):

Richard E. Mshomba

Keyword(s):

Developing Countries ◽

Infant Mortality ◽

Life Expectancy ◽

Mortality Rates ◽

Sub Saharan Africa ◽

African Countries ◽

Economic Problems ◽

High Infant Mortality ◽

Sub Saharan ◽

Poor Infrastructure

African countries, like many other developing countries, suffer the problems associated with poverty—malnutrition, poor health services, high infant mortality rates, low life expectancy, high illiteracy rates, poor infrastructure, and inadequate technology. These problems are especially severe in Sub-Saharan Africa.

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The Great Equalizer: Health Care Access and Infant Mortality in Thailand

American Economic Journal Applied Economics ◽

10.1257/app.6.1.91 ◽

2014 ◽

Vol 6 (1) ◽

pp. 91-107 ◽

Cited By ~ 37

Author(s):

Jonathan Gruber ◽

Nathaniel Hendren ◽

Robert M. Townsend

Keyword(s):

Health Care ◽

Infant Mortality ◽

Healthcare Utilization ◽

Health Care Access ◽

Healthcare Reform ◽

Mortality Rates ◽

Access To Healthcare ◽

Supply Side ◽

Care Access ◽

The Poor

This paper analyzes Thailand’s 2001 healthcare reform, “30 Baht.” The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially among the poor. Moreover, we find significant impacts on infant mortality. Prior to 30 Baht, poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht, this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates. (JEL H51, I12, I13, I14, I18, J13, O15)

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Analisis Angka Harapan Hidup di Jawa Timur Tahun 2015

Jurnal Biometrika dan Kependudukan ◽

10.20473/jbk.v6i1.2017.17-25 ◽

2018 ◽

Vol 6 (1) ◽

pp. 17

Author(s):

Lina Septi Danasari ◽

Arief Wibowo

Keyword(s):

Public Health ◽

Mortality Rate ◽

Infant Mortality ◽

Life Expectancy ◽

Secondary Data ◽

Infant Mortality Rate ◽

North Coast ◽

Health Improvement ◽

Central Java ◽

The Government

Life expectancy is one of the indicators to calculate the Human Development Index (HDI) which determined by infants’ health, toddlers’ health, frequency of liveborn children and death rate in the community. East Java Province has four dominant cultural areas such as Mataraman including the western part of the border of Central Java to Kediri, Madura including Bangkalan to Pamekasan, Arek including north coast of Surabaya to Malang and Tapal Kuda including Pasuruan, Probolinggo, Situbondo, Bondowoso, Lumajang and Jember. Those four cultural areas have different characteristic that can affect public health status especially life expectancy in East Java Province. The analysis aimed to know the correlation between infant mortality rate and life expectancy and to know the differences of life expectancy among four cultural areas in East Java year 2015. This analysis used secondary data obtained from Central Bureau of Statistic of East Java on May, 2017. The data were life expectancy as dependent variable, infant mortality rate as independent variable and cultural areas in East Java as grouping variables. The result showed that there was correlation between infant mortality rate with life expectancy (p=0.000) and there was different in life expectancy among four cultural areas in East Java year 2015 (p=0.000) such as cultural areas Mataraman-Madura, Mataraman-Tapal Kuda and Arek-Tapal Kuda. It suggested the government to continue improving the socio-economic welfare of the community and public health improvement in the Tapal Kuda area which had high infant mortality rate and low life expectancy.

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Health Status, Government Health Expenditure and Economic Growth Nexus in India: A Toda–Yamamoto Causality Approach

Arthaniti-Journal of Economic Theory and Practice ◽

10.1177/0976747920963401 ◽

2020 ◽

pp. 097674792096340

Author(s):

Avinash Kaur

Keyword(s):

Economic Growth ◽

Health Status ◽

Mortality Rate ◽

Infant Mortality ◽

Life Expectancy ◽

Health Expenditure ◽

Infant Mortality Rate ◽

Government Health ◽

The Government ◽

Government Health Expenditure

This article attempts to examine the causal linkage among government health expenditure, health status and economic growth in India for the period from 1981–1982 to 2015–2016. The results of Johansen co-integration test indicate that government health expenditure, health status and economic growth have long-run relationship in India. The results of Toda–Yamamoto causality test showed that there existed unidirectional causal relationship running from government health expenditure to gross domestic product—GDP (economic growth); GDP (economic growth) to life expectancy; government health expenditure to infant mortality rate and infant mortality rate to life expectancy. On the other hand, there is no evidence showing causality in any direction between infant mortality rate to GDP (economic growth) and government health expenditure to life expectancy. The study strongly confirmed that the government health expenditure has an effect on GDP (economic growth) and infant mortality rate (which depicts health status) in India. The health outcomes, namely life expectancy and infant mortality rare, reveal unidirectional causality between them. Therefore, the study concludes that policymakers and the government should pay proper attention to the health sector in order to ultimately achieve economic growth in the country.

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The Implementation of Early Initiation of Breastfeeding and The Sucking Reflex in Newborns

Journal of Maternity Care and Reproductive Health ◽

10.36780/jmcrh.v1i1.16 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Ermiati E ◽

Restuning Widiasih ◽

Anita Setyawati

Keyword(s):

Infant Mortality ◽

Sampling Technique ◽

Mortality Rates ◽

Early Initiation ◽

Breastfeeding Initiation ◽

Early Initiation Of Breastfeeding ◽

Descriptive Approach ◽

The Government ◽

Quantitative Descriptive ◽

Initiation Of Breastfeeding

Early initiation of breastfeeding (IMD) is a program recommended by the government in increasing the breastfeeding success, achieving exclusive breastfeeding and reducing the infant mortality rates. The IMD is a process of mothers initiates breastfeeding within one hour after delivery of their baby. During an hour, the baby looks for his mother's nipples without help. This would be useful to increase the ability of the baby's sucking reflex. The IMD is implemented in the delivery room as part of the APN procedure, however limited study in Indonesia assessed the IMD procedure. This study is aimed to assess the implementation of IMD and the sucking reflect of newborns in a hospital in Bandung city. This design of the study was the quantitative descriptive approach. The samples were 30 newborns. The samples were chosen using the accidental sampling technique. There were two types of instruments which are an observation sheet to check the procedure of IMD, and an instrument to assess babies’ sucking reflex including rooting, sucking, and swallowing reflexes. The study findings described in a frequency distribution. This study found that 100% of deliveries were carried out IMD inappropriately, and 86.7% of babies' sucking reflects were not achieved. The study concluded that the implementation of IMD was not maximal, and would be affected babies had not succeeded in breastfeeding. It is expected that the hospital would implement IMD as the standard of maternity services.Keywords: Early Breastfeeding Initiation, Reflect

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