Abstract
Design: Infant mortality rates (IMRs) were computed and their trends assessed by ordinary least squares. Overall trends in IMR inequalities among countries were analysed by comparing 10 year period IMRs, Gini coefficients, and Lorenz curves. Income related trends in IMR inequalities were assessed using 10 year period IMR ratios between the highest and the lowest quintiles of the per capita gross national product (GNP) distributions (adjusted for purchasing power).
Setting: Aggregated country data were used for all countries with over 200 thousand inhabitants (33 geopolitical units). The 10 year period midpoint IMR estimates used for the 1955–1995 time series were those published by the United Nations in 1997.
Main results: IMRs decreased from 90.34 to 31.31 per 1000 live births between 1955 and 1995 at an average of 15.3 every 10 years. In contrast, Lorenz curves and Gini coefficients were similar for the five 10 year periods. After grouping by adjusted GNP distribution, a similar decreasing trend of IMR was observed in all groups. The rate ratio between the group at the lowest quintile and that at the highest quintile ranged from 4 to 5. The analysis of variance for repeated observations showed that there is a significant reduction in the IMR (F=130.18; p<0.01), that trends did not differ significantly among groups (F=1.16; p=0.32), and that they were approximately linear (F=155.83; p<0.01).
Conclusions: Despite a sizable reduction in the infant mortality, whether or not income related, levels of IMR inequality among countries have remained almost constant between 1955 and 1995 in the Region of the Americas. Further analysis and focused interventions are needed to tackle the challenges of reducing these persistent mortality inequalities.
Full Text
The Full Text of this article is available as a PDF (84.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aguila A., Muñoz H. Tendencia de la natalidad, mortalidad general, infantil y neonatal en Chile desde el año 1850 a la fecha. Rev Med Chil. 1997 Oct;125(10):1236–1245. [PubMed] [Google Scholar]
- Brown M. C. Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Soc Sci Med. 1994 May;38(9):1243–1256. doi: 10.1016/0277-9536(94)90189-9. [DOI] [PubMed] [Google Scholar]
- Hollstein R. D., Vega J., Carvajal Y. Desigualdades sociales y salud. Nivel socioeconómico y mortalidad infantil en Chile, 1985-1995. Rev Med Chil. 1998 Mar;126(3):333–340. [PubMed] [Google Scholar]
- Mackenbach J. P., Kunst A. E. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997 Mar;44(6):757–771. doi: 10.1016/s0277-9536(96)00073-1. [DOI] [PubMed] [Google Scholar]
- Rasheed P. Perception of diarrhoeal diseases among mothers and mothers-to-be: implications for health education in Saudi Arabia. Soc Sci Med. 1993 Feb;36(3):373–377. doi: 10.1016/0277-9536(93)90022-v. [DOI] [PubMed] [Google Scholar]
- Singh G. K., Yu S. M. Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010. Am J Public Health. 1995 Jul;85(7):957–964. doi: 10.2105/ajph.85.7.957. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Taucher E., Jofré I. Mortalidad infantil en Chile: el gran descenso. Rev Med Chil. 1997 Oct;125(10):1225–1235. [PubMed] [Google Scholar]
- Wagstaff A., Paci P., van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–557. doi: 10.1016/0277-9536(91)90212-u. [DOI] [PubMed] [Google Scholar]