Absolute Change in Cause-Specific Infant Mortality for Blacks and Whites in the US: 1983–2002

This paper examines absolute change in infant mortality from 5 leading causes of death for whites and blacks over a 20 year period. Change in infant mortality varies by cause, race, and birth weight. Absolute decline in mortality from respiratory distress syndrome (RDS) and sudden infant death syndrome (SIDS) in the overall study population has been more rapid for black infants during the period after specific technological innovations were approved and behavioral practices were recommended for these conditions. For low birth weight infants, blacks experienced greater decline in mortality from SIDS and whites experienced greater decline in RDS mortality. Despite remarkable declines in mortality from these causes, relative racial disparities have increased over this time period. For the overall study population, blacks and whites experienced similar rates of mortality decline from congenital anomalies. Mortality decline from this cause among low birth weight infants occurred at a faster pace for whites. Mortality from causes for which no specific innovations were developed increased for blacks but remained relatively constant for whites. An analysis of absolute change complements the relative disparities approach by revealing the dynamics of change, thus providing a more complete understanding of changing racial disparities in infant mortality.     

Social Class Inequality in Mortality From 1921 to 1972 in England and Wales

In this paper the data on occupational and social class mortality published decennially for England and Wales are used to examine the trend in the size of class differentials in mortality from 1921 to 1972 for adult men, married women and infants. Using summary measures which take into account changes in the relative sizes of the social classes over time, it was found that absolute inequality in mortality increased among adult men and married women during the 1950s and 1960s and relative inequality increased for all three groups. Two widely recognized potential sources of error, changes in the occupational composition of the social classes over time, and discrepancies between the numerators and denominators of occupation-specific death rates are examined to determine their effect on the trend indicated, and the initial findings are confirmed. Finally, the possible causes and implications of rising inequality coincident with declining overall levels of mortality, relative affluence, and the uniform availability of basic medical services to all socio-economic sub-groups of the population are considered.     

Polygynous Contexts,Family Structure,and Infant Mortality in Sub-Saharan Africa

Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features and that it has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over to elevate infant mortality for all families, and (2) conditions the survival disadvantage for children living in polygynous families (i.e., compared with monogamous families). We use data from Demographic and Health Surveys to estimate multilevel hazard models that identify associations between infant mortality and region-level prevalence of polygyny for 236,336 children in 260 subnational regions across 29 sub-Saharan African countries. We find little evidence that the prevalence of polygyny influences mortality for infants in nonpolygynous households net of region-level socioeconomic factors and gender inequality. However, the prevalence of polygyny significantly amplifies the survival disadvantage for infants in polygynous families. Our findings demonstrate that considering the broader marital context reveals important insights into the relationship between family structure and child well-being.     

Race/Ethnicity/Nativity Differentials and Changes in Cause-Specific Infant Deaths in the Context of Declining Infant Mortality in the U.S.: 1989–2001

Using data from the national linked birth/infant death cohort files, we examined race/ethnicity/nativity disparities and changes in infant mortality due to the five leading causes of infant death between 1989 and 2001. Our results indicate substantial decreases in infant mortality from three causes (congenital anomalies, sudden infant death syndrome, and respiratory distress syndrome) for which specific perinatal health innovations emerged or were expanded. However, for these three causes, the relative disparities in infant mortality between infants born to U.S.-born black women as compared to infants of U.S.-born white women increased following the introduction (or expansion) of beneficial interventions. Among infants of U.S.-born Mexican American mothers, the findings differed. In the static comparisons, our results show the often-reported similarity in the risk of death of these babies compared to those born to non-Hispanic white mothers. However, when changes over time were modeled, there was an erosion of the relatively favorable survival chances of Mexican American infants. Our models show little change in the relative risk of death for infants of immigrant women. Regarding the other two causes (disorders relating to short gestation and unspecified low birth weight and maternal complications) for which no efficacious innovations occurred, either little change or actual increases in risks were observed. Future studies and health policy efforts should be geared toward further understanding and aggressively working to close infant mortality gaps, especially for infants of U.S.-born black mothers—an effort that will be facilitated by research focused on cause-specific infant mortality.     

Changes in world inequality in length of life: 1970–2000

Previous research has revealed much global convergence over the past several decades in life expectancy at birth and in infant mortality, which are closely linked. But trends in the variance of length of life, and in the variance of length of adult life in particular, are less well understood. I examine life-span inequality in a comprehensive panel of 180 countries observed in 1970 and 2000. Convergence in infant mortality has unambiguously reduced world inequality in total length of life starting from birth, but world inequality in length of adult life has remained largely unchanged. Underlying both of these observations is a growing share of total inequality attributable to between-country variation. Especially among developed countries, the absolute level of between-country inequality has risen over time. The sources of widening inequality in length of life between countries remain unclear, but signs point away from changes in income, leaving patterns of knowledge diffusion as a likely candidate.     

Paradox Revisited: A Further Investigation of Racial/Ethnic Differences in Infant Mortality by Maternal Age

I reexamine the epidemiological paradox of lower overall infant mortality rates in the Mexican-origin population relative to U.S.-born non-Hispanic whites using the 1995–2002 U.S. NCHS linked cohort birth-infant death files. A comparison of infant mortality rates among U.S.-born non-Hispanic white and Mexican-origin mothers by maternal age reveals an infant survival advantage at younger maternal ages when compared with non-Hispanic whites, which is consistent with the Hispanic infant mortality paradox. However, this is accompanied by higher infant mortality at older ages for Mexican-origin women, which is consistent with the weathering framework. These patterns vary by nativity of the mother and do not change when rates are adjusted for risk factors. The relative infant survival disadvantage among Mexican-origin infants born to older mothers may be attributed to differences in the socioeconomic attributes of U.S.-born non-Hispanic white and Mexican-origin women.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

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.     

Spanish Surname and Anglo Infant Mortality: Differentials Over a Half-Century

Using a half-century of death records from San Antonio/Bexar County, Texas, we examine the timing and cause structure of Spanish surname and Anglo infant mortality. Our findings show that despite the substantial disparities between ethnic-specific infant mortality rates in the early years of the study, there have been consistent declines in overall, neonatal, and postneonatal mortality for both groups, as well as a major convergence of mortality rates between Spanish surname and Anglo infants. Further, we demonstrate that the convergence is of relatively recent origin and is due primarily to shifts in postneonatal mortality. Finally, we examine the transition reflected in the cause structure of ethnic-specific infant mortality and show that the convergence was largely the result of reductions in deaths from exogenous causes. Implications for research into the "epidemiologic paradox" are discussed.     

Trends in the relationship between socioeconomic status and infant mortality in metropolitan Ohio, 1960–1990

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio at four points in time centering on the censuses of 1960, 1970, 1980 and 1990. The basic unit of analysis is the census tract of mother's usual residence, with economic status being determined by the percentage of low income families living in each tract. For each period, the census tracts were aggregated into broad income groups and three-year average infant mortality rates were computed for each area, by age, sex, race and exogenous-endogenous causes of death. The most important conclusion to be drawn from the data is that in spite of some very remarkable declines in infant mortality for all socioeconomic groups since 1960, there continues to be a very clear and pronounced inverse association between income status and infant mortality. Indeed, there is some evidence to suggest that it is stronger in 1990 than it was three decades earlier. The general inverse association is observed for both sexes, for whites and nonwhites, and for all major causes of death. At the same time, the data reveal notable variations in the pattern of the relationship over time, as well as several differences between whites and nonwhites in the nature and magnitude of the relationship. Some macro-economic hypotheses are offered to explain these temporal and racial differences in the pattern of the relationship between economic status and infant mortality.This article is an expanded version of a paper presented at the annual meetings of the Southern Demographic Association in New Orleans, 21–23 October 1993.     

Infant mortality decline in Malaysia, 1946–1975: The roles of changes in variables and changes in the structure of relationships

This analysis has identified several factors contributing to the dramatic decline in infant mortality since World War II in Malaysia, as well as one factor that prevented the infant mortality rate from declining even more rapidly. Our main findings are the following: On average, mothers' education more than doubled over the study period, contributing to the decline in their infants' mortality. In addition, the beneficial effect of mothers' education on infant survival appears to have become stronger over the study period. Hence, further advances in education should lead to further improvements in infants' survival prospects. Another analysis of these data (Peterson et al. 1985) found that education is somewhat more influential in affecting child mortality in low-mortality, high-income areas than in the opposite type of areas. Therefore, socioeconomic development may have complemented, instead of substituted for, the the beneficial effect of mothers' education in promoting infant and child survival in Malaysia. Improvements in water and sanitation also contributed to the infant mortality decline, especially for babies who did not breastfeed. However, unlike education, these influences have become less important over time, especially for babies who are not breastfed. Hence, further improvements in water and sanitation, a goal of Malaysia's Rural Environmental Sanitation Programme, may have smaller relative effects on infant mortality than did previous improvements. Targeting such improvements on areas where women breastfeed little or not at all, however, will increase their effectiveness in promoting infant survival. The substantial reductions in breastfeeding that have taken place since World War II have kept the infant mortality rate in Malaysia from declining as rapidly as it would have otherwise. We estimate that, in our sample, the detrimental effects on infant survival of the decline in breastfeeding have more than offset the beneficial effects of improvements in water and sanitation. Unlike some other researchers (e.g., Palloni 1981), we find that changes in fertility levels and in the timing and spacing of births have had negligible effect in explaining the decline in infant mortality within the samples we have considered. We have excluded births to older women from our analysis, however; this exclusion may have led to an understatement of the influence of changes in the age pattern of childbearing.(ABSTRACT TRUNCATED AT 400 WORDS)     

Paradox found (again): Infant mortality among the Mexican-origin population in the united states

Recent research suggests that the favorable mortality outcomes for the Mexican immigrant population in the United States may largely be attributable to selective out-migration among Mexican immigrants, resulting in artificially low recorded death rates for the Mexican-origin population. In this paper we calculate detailed age-specific infant mortality rates by maternal race/ethnicity and nativity for two important reasons: (1) it is extremely unlikely that women of Mexican origin would migrate to Mexico with newborn babies, especially if the infants were only afew hours or afew days old; and (2) more than 50% of all infant deaths in the United States occur during the first week of life, when the chances of out-migration are very small. We use concatenated data from the U.S. linked birth and infant death cohort files from 1995 to 2000, which provides us with over 20 million births and more than 150,000 infant deaths to analyze. Our results clearly show that first-hour, first-day, and first-week mortality rates among infants born in the United States to Mexican immigrant women are about 10% lower than those experienced by infants of non-Hispanic, white U.S.-born women. It is extremely unlikely that such favorable rates are artificially caused by the out-migration of Mexican-origin women and infants, as we demonstrate with a simulation exercise. Further, infants born to U.S.-born Mexican American women exhibit rates of mortality that are statistically equal to those of non-Hispanic white women during the first weeks of life and fare considerably better than infants born to non-Hispanic black women, with whom they share similar socioeconomic profiles. These patterns are all consistent with the definition of the epidemiologic paradox as originally proposed by Markides and Coreil (1986).     

Why poverty remains high: The role of income growth,economic inequality,and changes in family structure, 1949–1999

After dramatic declines in poverty from 1950 to the early 1970s in the United States, progress stalled. This article examines the association between trends in poverty and income growth, economic inequality, and changes in family structure using three measures of poverty: an absolute measure, a relative measure, and a quasi-relative one. I found that income growth explains most of the trend in absolute poverty, while inequality generally plays the most significant role in explaining trends in relative poverty. Rising inequality in the 1970s and 1980s was especially important in explaining increases in poverty among Hispanics, whereas changes in family structure played a significant role for children and African Americans through 1990. Notably, changes in family structure no longer had a significant association with trends in poverty for any group in the 1990s.     

Do fertility transitions influence infant mortality declines? Evidence from early modern Germany

The timing and sequencing of fertility transitions and early-life mortality declines in historical Western societies indicate that reductions in sibship (number of siblings) may have contributed to improvements in infant health. Surprisingly, however, this demographic relationship has received little attention in empirical research. We outline the difficulties associated with establishing the effect of sibship on infant mortality and discuss the inherent bias associated with conventional empirical approaches. We offer a solution that permits an empirical test of this relationship while accounting for reverse causality and potential omitted variable bias. Our approach is illustrated by evaluating the causal impact of family size on infant mortality using genealogical data from 13 German parishes spanning the sixteenth, seventeenth, eighteenth, and nineteenth centuries. Overall, our findings do not support the hypothesis that declining fertility led to increased infant survival probabilities in historical populations.     

Registration completeness and international comparisons of infant mortality

The physical development of the live born infant is the single most important variable governing its survival: infant mortality among those weighing 2,500 grams (5 1/2 pounds) or less at birth is 17 times the mortality among those weighing more than 2,500 grams at birth. The variation in mortality according to birth weight (or gestation) is greater than for subclasses of color, sex, maternal age, or birth order. Infant mortality in the United States is significantly higher than in a number of other countries e.g., Sweden, Netherlands, Norway. The difference is thought, by some, to be due to underregistration of low birth weight infants in other countries. In this paper, distributions of live births by birth weight for Denmark, England and Wales, New Zealand, and the United States, and infant mortality data for Denmark and the United States are examined. The data do not support a hypothesis of gross underregistration of live born infants in other countries. The results indicate that some index of physical development (birth weight, gestation, or a combination of both) should be included in any appraisal of infant mortality.     

The global and regional impact of mortality and fertility transitions, 1950-2000

During the second half of the twentieth century, world population grew at a record pace, both in absolute and relative terms, from 2.5 billion to 6 billion (or 1.75 percent annually). Demographers have long identified rapid mortality declines as the main explanation. This article finds that one-fourth of today's world population is alive because of mortality improvements since mid-century. Very rapid growth is unlikely to continue as substantial fertility declines also occurred in recent decades. This article finds that already by the year 2000, these fertility declines have almost exactly compensated for the impact of mortality declines from mid-century levels. This result may suggest homeostasis, but analyses of underlying trends contradict this impression. First, the impact of fertility declines will soon and significantly exceed that of mortality declines. Second, that mortality and fertility declines jointly affect the size of the world population by less than one percent conceals a significant impact on the population's age composition as well as on regional population sizes.     

Multidimensional Racial Inequality in the United States

This paper measures racial inequalities in the US using a multidimensional ‘wellbeing’ approach that simultaneously considers the distributions of income, health and education. The primary objective is to examine trends in US wellbeing inequality with an emphasis on changes in racial composition. Data is taken from 1990 to 2007 and we observe increases in income inequality, a decline in education inequality and unchanged health inequality over the period. Taken together, these results show a slight increase in the dispersion in multidimensional wellbeing. Stratifying by racial groups shows that this increase is due to widening intra-racial inequalities while inter-racial differences remained unchanged. The method is also used to evaluate wellbeing across groups and we estimate black wellbeing to average around 76 % of whites, while persons from other races average approximately 93 %. Some other changes in composition occur through time and the results are shown to be robust to a number of changes in parametric weightings.     

Infant Mortality and Socioeconomic Status: New Bottle,Same Old Wine

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio for the period 1960–2000. The data examined are centered on the five censuses undertaken during this 40-year period. The basic unit of analysis is the census tract of mother’s usual residence, with economic status being determined by the percentage of low income families living in each tract. For each of the five periods covered, census tracts were aggregated into broad income areas and three-year average infant mortality rates were computed for each area, by age, sex, race and exogenous-endogenous causes of death. The most important conclusion to be drawn from the data is that in spite of some very remarkable declines in infant mortality at all class levels since 1960, there continues to be a very clear and pronounced inverse association between income status and infant mortality. Indeed, the evidence indicates that the relationship has become stronger over the years. These observations are applicable for both sexes, for whites and nonwhites, for neonatal and postneonatal deaths, and for both major cause of death groups. It is concluded that while public health programs are important, any progress in narrowing this long-standing differential is unlikely unless ways can be found to enhance the economic well-being of the lower socioeconomic groups.