Socioeconomic Determinants of White and Black Males’ Life Expectancy Differentials, 1980

Epidemiological transition theory suggests that two population existing under disparate socioeconomic conditions would have different life expectancies as the result of cause-of-death differences. The effect of racial socioeconomic differentials on the total racial life expectancy differential are examined as they act through specific cause-of-death differentials. Results suggest that residential isolation of blacks has a strong effect on the total life expectancy differential as it acts through the racial homicide differential. The racial unemployment difference also has a strong effect on the total differential as it acts through the racial heart disease differential. Implications of the findings for reducing life expectancy differentials are discussed.     

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.     

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.     

United Nations/World Health Organization Meeting on Socio-Economic Determinants and Consequences of Mortality,Mexico City, 19-25 June 1979

The objectives of the United Nations/World Health Organization (WHO) Meeting on Socioeconomic Determinants and Consequences of Mortality, held in Mexico City in June 1979, were the following: to review the knowledge of differential mortality and to identify gaps in the understanding of its socioeconomic determinants and consequences; to discuss the methodological and technical problems associated with data collection and analysis; to consider the policy implications of the findings presented and to promote studies on the implications of socioeconomic differentials in mortality on social policy and international development strategies; to formulate recommendations and guidelines for the utilization of the 1980 round of population censuses for in-depth studies of mortality differentials; and to stimulate national and international research on differential mortality. Participants discussed the state of knowledge of socioeconomic differentials and determinants of mortality and described the socioeconomic measures available, the methods of data collection and analysis used, and the findings themselves. A number of characteristics had been employed in the study of differential mortality, and these could be grouped under the following headings: occupation; education; housing; income, wealth; family size; and place of residence. The techniques or methods used to analyze mortality were direct and indirect methods, and these are examined. Inequalities in mortality were found to be closely associated with inequalities in social and economic conditions. Any effort to reduce or remove those inequalities would have to be based on a clear understanding of their causes and interrelationships in order to succeed. Participants indicated a desire to see a resurgence of mortality research, and some research suggestions are outlined.     

The Persistence of Racial Disadvantage: The Socioeconomic Attainments of Single-Race and Multi-Race Native Americans

Using data from the 2000 U.S. Census, we investigate the schooling and earnings of single-race and multi-race Native Americans. Our analysis distinguishes between Single-Race Native Americans, biracial White Native Americans, biracial Hispanic-White Native Americans, and biracial Black Native Americans. Further differentiating by gender, the results indicate significant variation in socioeconomic attainments across these different Native American groups although almost all of them are in some way disadvantaged relative to non-Hispanic, non-Native American whites. The most disadvantaged group tends to be Single-Race Native Americans who have the lowest levels of schooling as well as lower earnings relative to non-Hispanic, non-Native American whites who are comparable in terms of schooling, age, and other basic demographic characteristics. The results demonstrate notable differentials by the racial/ethnic type of Native American group as well as by gender. In the case of men, all of the Native American groups have clear socioeconomic disadvantages. One contrast is that migration slightly increases the earnings of men but it slightly decreases the earnings of women. We interpret these findings as underscoring how measured socioeconomic differentials between demographic groups are significantly affected by the categorization of race/ethnicity in surveys and by how persons choose to be enumerated in terms of those categories.     

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention—measles vaccination—on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children—from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity.     

Socio-economic determinants of mortality in Latin America

The characteristics and sources of socioeconomic differentials of mortality in Latin America, in so far as they are currently known, are examined in an attempt to clarify the present situation and its perspectives. Mortality in a population is a function of the frequency of illness (incidence) and the probability of dying of the sick individual (lethality). Information on the socioeconomic differentials of mortality in Latin America is systematically reviewed with attention directed to the following: differentials among Latin American countries, regional differences within countries, urban-rural contrasts in mortality, mortality and income level and level of education, and mortality and ethnic groups. Latin America shows considerable heterogeneity with respect to the risk of dying, which varies from 202/1000 births in Bolivia to 38/1000 in Uruguay. It is estimated that more than 1/2 of the children born in Latin America are exposed to a mortality rate of over 120/1000. A study of the urban and rural populations of 12 Latin American countries revealed that the risk for rural populations exceeds that for urban populations by 30-60%. There is extensive evidence showing that mortality is higher in the working class and is associated with lower levels of education and income. Mortality was also higher in certain indigenous groups. Socioeconomic differentials of mortality are more marked in Latin America than in the developed nations. The mother's level of educational attainment is the variable most significantly associated with infant and child mortality. The prospect of reducing the current mortality levels is dependent primarily upon the implementation of policies aimed at a more egalitarian distribution of the benefits of socioeconomic development among the population.     

Racial differences in occupational status and income in South Africa, 1880 and 1881

Using data on employed men from the 1980 and 1991 South African Censuses, we analyze the determinants of occupational status and income. Whites are found to have much higher occupational status, and especially income, than members of other racial groups. Most of the racial differentials in occupational status can be explained by racial differences in the personal assets that determine occupational attainment (especially education), but only a much smaller fraction of the White/non-White income differential can be so explained. Despite a modest reduction between 1980 and 1991 in the role of race in socioeconomic attainment, the overall picture shows more stability than change.     

The ecology of race and socioeconomic distress: infant and working-age mortality in Chicago

We examine the effects of education, unemployment, and racial segregation on age-, sex-, and race-specific mortality rates in racially defined Chicago community areas from 1989 to 1991. Community socioeconomic factors account for large observed areal variations in infant and working-age mortality, but especially working-age mortality for the black population. For black men, the mortality consequences of living in economically distressed communities are quite severe. Segregation effects on mortality are more modest and largely operate through neighborhood socioeconomic conditions, although some direct effects of segregation on mortality for blacks are apparent.     

Infant Mortality Rate as a Measure of a Country’s Health: A Robust Method to Improve Reliability and Comparability

Researchers and policymakers often rely on the infant mortality rate as an indicator of a country’s health. Despite arguments about its relevance, uniform measurement of infant mortality is necessary to guarantee its use as a valid measure of population health. Using important socioeconomic indicators, we develop a novel method to adjust country-specific reported infant mortality figures. We conclude that an augmented measure of mortality that includes both infant and late fetal deaths should be considered when assessing levels of social welfare in a country. In addition, mortality statistics that exhibit a substantially high ratio of late fetal to early neonatal deaths should be more closely scrutinized.     

Birth Outcome Measures and Infant Mortality

Recent studies have proposed alternative birth outcome measures as means of assessing infant mortality risk; nevertheless, there hasn’t yet been an integrated analysis of these approaches. We review 14 strategies, including various combinations of birth weight, gestational age, fetal growth rate, and Apgar scores—as predictors of early neonatal, late neonatal, and postneonatal mortality, and infant mortality. Using the NCHS linked birth/infant death file for 2001, we construct multivariate logit models and assess the associations between each of the 14 key birth outcome measures and four mortality outcomes. We find that all evaluated birth outcome measures are strong predictors, but Apgar scores are the strongest among all models for all outcomes, independent of birth weight and gestational age. Apgar scores’ predictive power is stronger for Mexican-, white-, and female-infants than for black- and male-infants. Second, all birth outcome measures remain significantly associated with mortality, but their predictive power reduces drastically over time. These findings suggest a rule of thumb for predicting infant mortality odds: when available, Apgar scores should always be included along with birth weight (or LBW status) and gestational age. Additionally, these findings argue for the continued study of low birthweight, gestational age, and Apgar scores as independently salient health outcomes.     

Occupational careers and mortality of elderly men

This article presents findings from an analysis of occupational differentials in mortality among a cohort of males aged 55 years and older in the United States for the period 1966-1983. Using the National Longitudinal Survey of Mature Men, we construct event histories for 3,080 respondents who reach the exact age of 55. The dynamics that characterize socioeconomic differentials in mortality are analyzed by evaluating the differential effects of occupation over the career cycle. Maximum likelihood estimates of hazard-model parameters show that the mortality of current or last occupation differs substantially from that of longest occupation, controlling for education, income, health status, and other sociodemographic factors. In particular, the rate of mortality is reduced by the substantive complexity of the longest occupation while social skills and physical and environmental demands of the latest occupation lower mortality.     

Trends,Age Patterns and Differentials in Childhood Mortality in Haiti (1960–1987)

This paper examines the trends, patterns and differentials in childhood mortality in Haiti between 1960 and 1987 with data from three surveys and one census. Data comparability is maximized by a series of adjustments, and both direct and indirect techniques are applied. The results indicate that a slow decline in childhood mortality has occurred since 1960 for the country as a whole. Neonatal survival has shown impressive gains, especially in rural Haiti. Post-neonatal mortality has not, however, declined at the same rate. Mortality between the ages of one and five years has declined at about the same pace as infant mortality, maintaining consistency with model patterns of mortality change. The overall national decline in child mortality appears to have consisted of two phases. The first occurred in rural Haiti during the late 1960s and early 1970s and was due largely to a fall in neonatal mortality. The second phase of the decline was concentrated in Port-au-Prince, and seems to have affected all ages of childhood.     

Measuring socioeconomic mortality differentials over time

Using 1973 Current Population Survey data matched to 1973-1978 Social Security mortality records, this study measures the relationship between the income and education of men and their subsequent mortality. The estimated relationships are compared with socioeconomic mortality differentials found by Kitagawa and Hauser in their study of 1960 census-death certificate matched data. The comparison suggests that there has been no improvement in the relative mortality experience of low socioeconomic status men. More generally, the article discusses how Social Security data could be used to monitor, on a continual basis, our progress toward eradicating significant mortality differentials in the United States.     

Household income and child survival in Egypt

This article uses household-level economic and fertility survey data to examine the relationship between household income and child survival in Egypt. Income has little effect on infant mortality but is inversely related to mortality in early childhood. The relationship persists with other associated socioeconomic variables controlled. The mechanisms underlying the income effects are not evident from this analysis: income differentials in sources of household drinking water, type of toilet facilities, and maternal demographic characteristics do not explain the net impact of income on child mortality. The absence of effects on child survival of the size of the place of residence and the relatively weak effects of maternal schooling are also notable.     

Some factors associated with Urban-Rural fertility differentials in Mexico

Abstract Warren C. Robinson and others have presented strong evidence that a substantial portion of the variation in urban-rural fertility differentials is attributable to variations in infant and child mortality when the child-woman ratio is the index of fertility. This paper focuses on the contributions of several additional factors in accounting for variations in urban-rural fertility differentials. 1960 census data for 23 urban and rural areas in Mexico are investigated by means of correlation analysis. City growth and literacy differentials are found to be significantly related to the size of the urban-rural fertility (child-woman ratio) differential, but their effect appears to be indirect, and brought about by their association with urban-rural differentials in the sex ratio at the reproductive ages, age at marriage, and the percentage married. The latter three factors are positively related to the size of the urban-rural fertility differential. City growth is inversely related to the magnitude of the fertility differential. This analysis suggests that changes in (urban) population composition may favour higher as well as lower urban fertility and thus affect the size of the urban-rural fertility differential. If this is true, it would appear that urbanization does not necessarily lead to lower total fertility (at least in its early stages), but may lead to the modification of certain demographic characteristics which formerly favoured lower urban fertility. The long-run effects of urbanization are more difficult to assess, but it is suggested that migrants to urban areas may require several generations to manifest lower fertility. This would constitute an additional factor favouring higher urban fertility. The possible contribution of changing mortality conditions is also considered.     

Infant mortality and socioeconomic development: Evidence from Malaysian household data

Household data from Malaysia are used to assess the roles of a number of mortality correlates in explaining the inverse relationship between the infant mortality rate (IMR) and socioeconomic development. Increases in mothers' education and improvements in water and sanitation are the most important household-level changes that accompany regional and temporal development and contribute to the inverse relationship between the IMR and development. One concomitant of development--reduced reduced breastfeeding--has kept the relationship from being even stronger. Continued prevalence of extended breastfeeding in the poorer states of Peninsular Malaysia and a narrowing of educational and sanitation differentials helped close the IMR gap between the richer and the poorer states.     

Polygyny as social and biological differentiation among Toposa agro-pastoralists of Southern Sudan

A demographic survey of eight Toposa villages in Southern Sudan was undertaken to delineate patterns of infant and childhood mortality. Among these predominantly egalitarian agro-pastoralists few standard socio-economic variables useful in the detection of demographic differentials were found. Instead, polygyny was used as a measure of social differentiation, hypothesizing that social differentiation induces demographic differences between polygynous and monogamous marriages. Analysis indicated social differentiation through gerontocracy, while significant differences in mortality and fertility levels were found berween monogamous and polygynous marriages, with the latter featuring higher fertility and mortality levels. Underlying rationale for these differences were sought through consideration of social and biological factors.     

Neighborhood Concentrated Disadvantage and Adult Mortality: Insights for Racial and Ethnic Differences

While racial and ethnic differences in mortality are pervasive and well documented, less is known about how mortality risk varies by neighborhood socioeconomic status across racial and ethnic identity. We conducted a prospective analysis on a sample of adults living at or below 300% poverty with 8 years of the National Health Interview Survey (N = 159,400) linked to 11,600 deaths to examine the association between neighborhood disadvantage and mortality for non-Hispanic whites, non-Hispanic blacks, and U.S.- and foreign-born Hispanics. Using multilevel logistic regression, we find that the probability of death from any cause for lower-income adults is higher in more-disadvantaged neighborhoods, compared to less-disadvantaged neighborhoods, but only for whites. The adjusted likelihood of death for blacks and foreign-born Hispanics is not associated with neighborhood disadvantage, and the likelihood of death for U.S.-born Hispanics is lower in more-disadvantaged neighborhoods. While future research and policy should focus on improving health-promoting resources in all communities, care should be given to better understanding why race/ethnic groups have differential mortality returns with respect to area-specific socioeconomic conditions.