TABLE 3.
Univariate and Multivariate Associations of Mortality Ratio Changes
| Mortality Ratio Decline, Univariate Associations (P Value)a | Mortality Ratio Decline, Multivariate Associations (P Value)b | Mean (95% CI) Among Surveys With Lower Ratio (64 Surveys)c | Mean (95% CI) Among Surveys With Higher Ratio (21 Surveys)c | |
|---|---|---|---|---|
| Factor | ||||
| GDPpc, constant 2005 USDd | 0.05 (.26) | NA | 1283 (931 to 1635) | 838 (543 to 1132) |
| TFR | −0.05 (.18) | NA | 4.07 (3.71 to 4.42) | 4.55 (3.76 to 5.34) |
| Urbanization, % | 0.12 (.54) | NA | 40.8 (36.2 to 45.4) | 35.6 (27.7 to 43.5) |
| HIV prevalence, % of adult population | 0.02 (.11) | NA | 3.96 (2.47 to 5.46) | 3.45 (0.88 to 6.01) |
| Public health spending, % of GDP | −0.02 (.57) | NA | 2.66 (2.31 to 3.02) | 2.96 (2.14 to 3.78) |
| Worldwide Governance Indicatorse | ||||
| Government Effectiveness | 0.35 (.006)* | 0.43 (.01)* | −0.56 (−0.66 to –0.45) | −0.80 (−1.01 to –0.60) |
| Rule of Law | 0.27 (.02)* | 0.38 (.01)* | −0.62 (−0.74 to –0.50) | −0.88 (−1.11 to –0.65) |
| Control of Corruption | 0.31 (.02)* | 0.46 (.007)* | −0.63 (−0.74 to –0.52) | −0.81 (−0.99 to –0.62) |
| Regulatory Quality | 0.25 (.03)* | 0.38 (.03)* | −0.49 (−0.61 to –0.36) | −0.71 (−0.90 to –0.51) |
| Voice and Accountability | 0.12 (.27) | 0.17 (.17) | −0.47 (−0.60 to –0.35) | −0.62 (−0.86 to –0.37) |
| Political Stability and Absence of Violence | 0.03 (.67) | 0.01 (.98) | −0.70 (−0.88 to –0.51) | −0.84 (−1.23 to –0.45) |
These estimates provide the univariate association from separate linear regression models where the dependent variable is the difference between the first and last years of measurement within each survey and the correlates are in the first column. A positive association indicates that higher levels of the correlate were associated with greater convergence of the mortality ratio. The year of each correlate is the year of the survey, although the findings were similar when using the average value over the period of measurement or the first year of measurement for each survey.
In multivariate analysis, the dependent variable remained the difference between the first and last years of measurement within each survey; the independent variables included the governance indicators and 5 covariates shown at the top of the table (GDP per capita, total fertility rate, urbanization, HIV prevalence, and public health spending as a percentage of GDP). Each governance indicator was analyzed separately. The effect size and significance of the governance indicators is generally similar, or slightly larger, than in the univariate associations, suggesting a stable relationship between governance quality and convergence of mortality across wealth gradients.
These columns indicate the mean of the correlates in 2 groups of surveys: those surveys in which the mortality ratio declined (64 surveys), and those in which it climbed (divergence of mortality, observed in 21 surveys).
GDPpc measurements in 1000s of constant 2005 USD were used for the univariate association.
The Worldwide Governance Indicators summarize surveys, private sector, and public sector data into a score on 6 dimensions of governance. Complete descriptions of each indicator are available through the Worldwide Governance Indicators portal.34 The composite scores for each indicator are normalized and range from approximately –2.5 to 2.5, with higher values corresponding to better governance. The mean score for all indicators is <0 for the study countries, although the scores were consistently higher in those surveys in which convergence was observed compared with surveys with diverging under-5 mortality.
* P < .05.