Infant feeding and post-neonatal mortality in Derbyshire,England, in the early twentieth century

This paper examines influences on post-neonatal mortality in Derbyshire (England) in the early twentieth century, by applying multivariate hazard analysis to a rare individual-level data set. The data allow detailed patterns of breastfeeding and weaning to be examined. The role of feeding is given special attention as a mediator between mortality and the other environmental, social, and demographic factors considered. Twins and illegitimate children were more likely to have been hand-fed, but this could explain only a small fraction of their increased vulnerability. Artificial feeding was associated with increased risks of death from diseases was predominantly the result of the greater likelihood of congenitally weak children being hand-fed. Most of the variation in post-neonatal mortality, particularly from respiratory disease, was explained by environmental influences - population density, altitude, and the presence of mining.     

Neonatal mortality and stillbirths in early twentieth century Derbyshire,England

Neonatal mortality and stillbirths are recognised to be subject to similar influences, but survival after a successful live birth is usually considered in isolation of foetal wastage. Moreover, individual-level data on age-specific influences and causes of death in a historical context are rare. This paper uses an unusual data set to compare the influences on neonatal mortality and stillbirths in early twentieth century Derbyshire, England. Multivariate hazard and logistic analyses are performed to examine the relative roles of various social, environmental, and demographic factors. The influences on and causal structures of neonatal mortality and stillbirths emerge as broadly similar, with previous reproductive history linked to a considerable amount of variation. The clustering of endogenous deaths was much greater than the clustering of exogenous and post-neonatal deaths, probably reflecting the cause-of-death structure and the relatively healthy social and environmental position of early twentieth century Derbyshire.     

Polygyny and child survival in Nigeria: Age-dependent effects

Mortality risks under age five are estimated using data from the 1990 Nigerian Demographic and Health Survey for children in monogamous and polygynous families. Integrating existing theories on polygyny’s relationship with infant and child mortality and some demographic concepts, the study shows that polygyny has different effects on infant and child mortality at different ages. The results indicate that polygyny does not have a significant effect on neonatal mortality (age less than one month). In contrast to the results of previous research, polygyny is significantly associated with lower child mortality during the post-neonatal period (1–11 months), but not during childhood (12–59 months). The study found socio-economic factors to be important confounders of the relationship between polygyny and mortality during the neonatal and post-neonatal periods. The protective effect of polygyny during the post-neonatal period suggests the need to further investigate circumstances that may favour post-neonatal child survival in polygynous families including availability of childcare.     

Structure and change in causes of death: An international summary

Abstract Model patterns of the cause structure of mortality at different levels were established for males and females, based on data for 165 national populations. These patterns suggest that the cause of death most responsible for mortality variation is influenza/bronchitis, followed by 'other infectious and parasitic diseases', respiratory tuberculosis, and diarrhoeal disease. Together, these causes typically account for about 60 per cent of the change in level of mortality from all causes combined. Their respective contributions have not depended in an important way on the initial level of mortality. These results - especially tbe importance of the respiratory and diarrhoeal diseases - imply that past accounts may have over-emphasized the role in mortality decline of specific and well-defined infectious diseases and their corresponding methods of control. There is strong statistical support for the suggestion that most of the remainder of mortality variation should be ascribed to changes in cardio-vascular diseases, but that methods of cause-of-death assignment in high-mortality populations have often obscured the importance of these diseases. When death rates from 'other and unknown' causes are held constant, changes in cardio-vascular disease account for about one-quarter of the decline in mortality from 'all causes'.Although the causal factors are poorly established, corroborative results have been demonstrated cross-sectionally in the United States. The composition of the group of populations most deviant from the structural norms is apparently dominated by differentials in the mode of assigning deaths to cardio-vascular disease. However, when broad groups of regions or periods are distinguished, more subtle differences emerge. Controlling mortality level for all causes combined, diarrhoeal diseases are significantly higher in non-Western populations and southern/eastern Europe than in overseas Europe or northern/western Europe. These differences are probably related to standards of nutrition and personal hygiene, but may also reflect climatic factors. Much higher cardio-vascular mortality in overseas European populations than in non-Western populations at similar overall levels probably reflects variation in habits of life. Regional differences in death rates from violence, maternal mortality, respiratory tuberculosis and influenza/pneumonia/bronchitis are briefly noted and commented upon. Cause-of-death structures at a particular level of mortality display some important changes over time. Respiratory tuberculosis and 'other infectious and parasitic diseases' have tended to contribute less and less to a certain level of mortality. They have in part been 'replaced' by diarrhoeal disease, specifically in non-Western populations. These developments reflect an accelerating rate of medical and public health progress against the specific infectious diseases, and a disappointing rate of progress against diarrhoeal disease. Western and non-western populations have shared to approximately the same extent in the accelerating progress against infectious diseases, and developments during the post-war period are more appropriately viewed as an extension of prior trends rather than as radical departures therefrom. For males, cardio-vascular disease and cancer have significantly increased their contribution to a particular level of mortality, while no such tendency is apparent for females. These developments may be related to changes in personal behaviour and in environmental influences whose differential impact on the sexes has been demonstrated in epidemiological studies. Although we have avoided an explicit treatment of age by having recourse at the outset to standardization, certain of the results are apparently reflected in studies of age patterns of mortality. The joint occurrence in non-Western populations and Southern/Eastern populations of exceptionally high death rates from diarrhoeal disease may explain why the 'South' age-pattern, with it high death rates between ages one and five, is often the most accurate referent for use in Latin America and Asia. The fact that the list of populations with the least deviation cause structure is almost exclusively confined to members of the 'West' group of Coale and Demeny may account for the lack of persistent deviation in this group's age patterns. Finally, tbe increasing importance of cardio-vascular disease and neoplasms in cause-of-death structures for males but not females is probably associated with the changing age patterns of male mortality noted by Coale and Demeny.     

A survey of cause of death (1973-1979) in Bao Jing County]

Findings from 1976 and 1980 surveys conducted by the Provincial Tumor Prevention Bureau and the County Department of Health concerning causes of death in Baojing, China, from 1973 to 1979 are reported. The data show that mortality rates for women and children were relatively high. The leading cause of death was contagious disease, particularly dysentery, followed by respiratory diseases. No relationship between cause of death and ethnic origin was established.     

Religious differentials in infant and child mortality in Holland, 1855–1912

At least three kinds of hypothesis may be invoked to interpret religious differentials in mortality. They are (i) hypotheses that refer to characteristics, (ii) those that refer to lifestyle, and (iii) those that refer to the social isolation of minorities. This paper tests all three kinds of hypothesis using data on urban child mortality from The Hague just before and during the demographic transition. A hazard analysis suggests that economic and demographic characteristics do not account for much of the variation by religion. An analysis of seasonal mortality suggests that some of the variation may be explained by differences in lifestyle. The third kind of hypothesis is presented here for the first time. We suggest that the social isolation of small religious groups lowered their exposure to certain kinds of infectious disease. We use a simulation study to show that this hypothesis could account for part of the variation.     

Sustained Effects of the 1974–5 Famine on Infant and Child Mortality in a Rural Area of Bangladesh

In this paper the sustained effects of the 1974–75 famine on cohort mortality in a rural area of Bangladesh are studied. In the analysis, mortality rates for children born and conceived during the famine are compared with those from a post-famine cohort. In the famine-born cohort, mortality was higher during the first and second years of life, while in the famine-conceived cohort it was higher during the first year and lower during the second compared to the non-famine cohort. No significant differences in mortality by cohort were observed between the ages of 24 and 59 months. Using logistic regression, interactions between famine and socio-demographic characteristics were also studied. Three principal results emerged: first, a differential effect of the famine by socio-economic group was only present during the post-neonatal period for the famine-born cohort; secondly, children aged 12–23 months who were born to younger mothers were more adversely affected by the famine than those born to older mothers; and thirdly, although there was excess mortality for girls aged 24–59 months relative to boys of the same age in the non-famine and famine-conceived cohorts, there was little difference between mortality by sex for the famine-born.     

Post-neonatal mortality in Rural India: Implications of an economic model

In this paper we develop and test a theory of childhood mortality after the first month of life. Parents are assumed to have well-defined family size and sex composition objectives and to face severe budget constraints. In this set of circumstances, it is understandable that they will make allocative decisions that will affect the survival probabilities of children. These decisions and the environmental influences on mortality are the basic forces which determine whether a child will survive through the post-neonatal period. The model is tested with survey data from rural Uttar Pradesh, India. The results are consistent with the hypothetical framework discussed above. The burden of this pattern of choice is felt particularly strongly by female births.     

Continuity of women's work,breastfeeding, and fertility in Ghana in the 1980s

Much of the inconsistency that has appeared in studies of the effect of women's work on fertility in less developed countries has been attributed to the varying accessibility of employment in the modern sector. The analysis presented in this paper shows that continuity of work matters more than sector of work. It also confirms that, even in a setting of low contraceptive prevalence, increased fecundity associated with the less intense breastfeeding practices of working women do not result in shorter birth intervals. The influence of women's work on fertility control is likely to be underestimated if the effects of sporadic versus continuous work are conflated, or if fecundity differentials by work status are unmeasured.     

Relative Trends In Mortality From Related Respiratory and Airborne Infectious Diseases

Poor living conditions and inadequate diet were undoubtedly major contributors to high infectious disease death rates in Britain during the nineteenth century, but improvements were not necessarily the precondition for mortality decline. Evidence of consistent improvements is far from conclusive, while different trends for different diseases have to be explained. Scarlet fever and whooping cough death rates did not decline until the last few decades of a century in which measles mortality was continuing high Respiratory and gastro-intestinal complications are frequently involved in conditions of overcrowding and poverty. Death rates for recorded respiratory diseases themselves reveal a downturn at the end of the century, but respiratory tuberculosis mortality declined throughout and smallpox was virtually eliminated through vaccination measures. The interrelated nature and aetiology of these diseases has implications for changes in mortality, while population variables and other transmission factors including social behaviour patterns are probably crucial for an understanding of historical and contemporary trends.     

Estimating seasonality effects on child mortality in Matlab,Bangladesh

This paper estimates the net effect of seasonality on child mortality in Matlab. Results suggest that childhood mortality was well above the average monthly level in the hot, dry month of April and in November, the first harvest month of the aman crop. It was found to be remarkably low in the post harvest months of February and March. and also in August. During the hungry months of September and October, children were at a considerably increased risk of mortality. particularly from diarrheal diseases, if mothers had no schooling. but this was not the case if mothers had schooling. The protective effect of the Matlab interventions on childhood death from diarrheal diseases was also greater during the hungry months than during other months of the year.     

The contribution of medical measures to the decline of mortality from respiratory tuberculosis: An ageperiod-cohort model

The decline of mortality in the more developed nations has been related to two major influences, economic development and the introduction of medical measures. The contribution of medical measures has been a source of continuing controversy. Most previous studies employ either a birth cohort or calendar year arrangement of mortality data to address this controversy. The present study applies an age-period-cohort model to mortality from respiratory tuberculosis in England and Wales, Italy, and New Zealand in an attempt to separate economic influences from that of medical measures. The results of the analysis indicate that while the overall contribution of medical measures is small when examined by calendar year, specific birth cohorts both in Italy and in England and Wales benefited substantially from these measures. The environmental conditions in New Zealand, however, were such that the introduction of medical measures barely affected declining mortality levels from respiratory tuberculosis.     

Residential exposure to air toxics is linked to lower grade point averages among school children in El Paso,Texas, USA

Children in low-income neighborhoods tend to be disproportionately exposed to environmental toxicants. This is cause for concern because exposure to environmental toxicants negatively affects health, which can impair academic success. To date, it is unknown if associations between air toxics and academic performance found in previous school-level studies persist when studying individual children. In pairing the National Air Toxics Assessment risk estimates for respiratory and diesel particulate matter risk disaggregated by source, with individual-level data collected through a mail survey, this paper examines the effects of exposure to residential environmental toxics on academic performance for individual children for the first time and adjusts for school-level effects using generalized estimating equations. We find that higher levels of residential air toxics, especially those from non-road mobile sources, are statistically significantly associated with lower grade point averages among fourth- and fifth-grade school children in El Paso (Texas, USA).     

Ethnic and Birth Weight Differences in Cause-Specific Infant Mortality

This article examines ethnic differences in cause-specific infant mortality, using linked birth and infant death records from a cohort of New Mexican singleton infants, 1980-1983. The research, which applies log-linear analysis, focuses on the combined influences of ethnicity, birth weight, maternal age, and plurality on birth outcomes--that is, on infant survival and deaths due to perinatal, congenital, and respiratory diseases and to sudden infant death syndrome. The results confirm the pronounced impact of birth weight on infant mortality and identify similarities and differences among Anglo, Hispanic, and American Indian babies with respect to cause-specific infant mortality.     

Living and dying in the U.S.A.: Sociodemographic determinants of death among blacks and whites

This paper examines the demographic and social factors associated with differences in length of life by race. The results demonstrate that sociodemographic factors--age, sex, marital status, family size, and income--profoundly affect black and white mortality. Indeed, the racial gap in overall mortality could close completely with increased standards of living and improved lifestyles. Moreover, examining cause-specific mortality while adjusting for social factors shows that compared to whites, blacks have a lower mortality risk from respiratory diseases, accidents, and suicide; the same risk from circulatory diseases and cancer; and higher risks from infectious diseases, homicide, and diabetes. These results underscore the importance of examining social characteristics to understand more clearly the race differences in overall and cause-specific mortality.     

The effects of maternal employment on child injuries and infectious disease

This article presents estimates of effects of maternal paid work and nonmaternal child care on injuries and infectious disease for children aged 12 to 36 months. Mother-child fixed-effects estimates are obtained by using data from the NICHD Study of Early Child Care. Estimates indicate that maternal employment itself has no statistically significant adverse effects on the incidence of infectious disease and injury. However greater time spent by children in center-based care is associated with increased rates of respiratory problems for children aged 12 to 36 months and increased rates of ear infections for children aged 12 to 24 months.     

Mortality in England and Wales from 1848 to 1947

This is a survey of the changing causes of death in England and Wales during the past 100 years. Based on the published mortality statistics of the General Register Office the framework of the survey is a series of specially prepared tables of death rates by sex, age and cause of death for the periods 1848–72, 1901–10, 1921, 1931, 1939 and 1947. Adjustments were made wherever necessary to compensate for changes in medical nomenclature and in the statistical classification of disease.

After allowance has been made for the changing age structure of the population, the male death rate at all ages in 1947 was 42% of the rate in 1846–50, and the female rate 35 %. Maximum improvement was among girls aged 5–9 years, whose death rate in 1947 was 9% of the rate 100 years before.

In 1848–72 the group to which were allocated the largest proportion of the deaths at all ages were the infectious diseases with one-third of the total; and these were followed by the respiratory, nervous and digestive diseases. In 1947, on the other hand, diseases of the circulatory system came first with rather more than one-third of the total at all ages, and these were followed by cancer.

Changes in proportionate mortality rates from various causes have been examined at successive ages from infancy to old age. There was a decline in proportionate mortality from the infectious diseases other than tuberculosis, but increased mortality from tuberculosis in the younger age groups and from violence, circulatory diseases and cancer.

The trends of absolute mortality from the various causes were also studied. The reduction in total mortality was such that whereas there were half a million deaths of civilians registered in England and Wales in 1947, the total would have been over a million had the death rates of 1848–72 still prevailed.

The article concludes with a brief review of the factors responsible for the changes that have taken place.     

Recent health trends in the Native American population

This paper reviews the changes in the health status of Native Americans since the mid-1950s, how the disease pattern differs from non-Natives, and regional differences within the Native American population. Despite some limitations, data from the Indian Health Service indicate that substantial decline in the infant mortality rate and mortality from such infectious diseases as tuberculosis and gastroenteritis has occurred. With the exception of cardiovascular diseases and cancer, the risk of death from most causes are higher among Native Americans than the total US population. Geographic variation in disease rates can be demonstrated, most notable in diabetes. The unique pattern of diseases among Native Americans reflect the interaction of environmental and genetic factors. Genetic susceptibility plays a significant role in some diseases, such as diabetes, while for others, the generally lower socioeconomic status, higher prevalence of certain health risk behaviors and lower utilization of preventive services in the Native American population are important determinants.     

A macrodynamic analysis of changes in mortality indexes in the United States, 1946–75: Some preliminary results

This paper extends earlier research by Brenner and by Land and Felson on the specification and estimation of macrodynamic structural-equation models to explain changes in American mortality indexes as a function of exogenous changes in societal conditions (social, demographic, economic, and health care). After reviewing the record of annual changes in several general and cause — specific mortality indexes for the post-World War II United States, patterns of temporal covariation in the indexes are discussed and some tentative structural-equation models are described. Among other findings, these models indicate: (1) that changes in the age structure of the American population have substantial impacts on changes in mortality rates for diseases of the respiratory and circulatory systems as well as on deaths due to cirrhosis of the liver, accidents, and violence; (2) that the infective and parasitic diseases mortality rate is more closely related to per capita public health expenditures than to improvements in the general level of living in this post — war period; (3) that the business cycle, as indexed by the unemployment rate, has significant impacts on the cardiovascular, accident, and violence mortality rates; (4) that Brenner's finding of a positive association of an increase in the unemployment rate with an increase in cardiovascular diseases mortality two to three years later is partially mediated by an increase in per capita cigarette consumption during the economic recovery following a recession; (5) that an increase in the per capita level of cigarette consumption increases the respiratory systems mortality rate; (6) that both the general and the respiratory neoplasms mortality rates are more strongly affected by long-term moving averages of annual per capita levels of cigarette consumption than by single-years levels; (7) that the level of the degenerative diseases mortality rate is positively affected by an increase in per capita liquor consumption and negatively affected by an increase in health care utilization; (8) that the percentage of all vehicles traveling on highways at high speed is the exposure index most closely associated (of several that were studied) to the motor vehicle accident mortality rate; (9) that the levels of the maternal and infant mortality rates are positively related to an increase in the fertility rate (exposure) and negatively related to those advances in health care services associated with hospital births; (10) that the accuracy with which short-term changes in the crude mortality rate can be predicted from a knowledge of cause-specific mortality rates and how the latter are affected by societal conditions is effectively limited by the degree of accuracy of predictions of the respiratory diseases mortality rate because of its volatile influenza, pneumonia, and bronchitis component; and (11) that short-term changes in the life expectancy index can be somewhat more accurately predicted from such knowledge. Although most of these relationships have been noted before in mortality studies, only a small fraction have been studied in a macrodynamic structural-equation models context. These findings thus constitute a baseline of statistical evidence which can be explored in future research.     

Long-term effects of childbearing on mortality: Evidence from pre-industrial Sweden

This paper presents an analysis of the impact of childbearing history on later-life mortality for ever-married men and women using historical micro-level data of high quality for southern Sweden. The analysis uses a Cox proportional hazards model, estimating the effects on old-age mortality of number of births and timing of first and last births. By studying the effects of previous childbearing on mortality by sex and social status, we also gain important insights into the mechanisms relating childbearing to mortality in old age. The results show that number of children ever born had a statistically significant negative impact on longevity after age 50 for females but not for males. Analysis by social group shows that only landless women experienced higher mortality from having more children, which seems to indicate that the main explanations are to be found in social or economic conditions specific to females, rather than in the strictly biological or physiological effects of childbearing.