Socioeconomic status and infant mortality among Hispanics in a southwestern city

Recent investigations of infant mortality in the Southwest part of the US have shown that Spanish surname infant death rates are lower than might be expected from the relatively low socioeconomic standing of the Spanish surname population, a phenomenon that appears to be confined to the neonatal componont of the infant mortality rate. The relationship between socioeconomic status (ses) and infant mortality is examined overall and separately within the Anglo and Spanish surname populations of Corpus Christ, Texas. The investigation utilizes data from the 36 Nueces County census tracts. Most recent data on infant, neonatal, and postneonatal mortality was provided by the local health department. Subjects were limited to Anglos and those whites with at least 1 Spanish surname parent. The 1979-1983 cohort is analyzed. Information from the 1980 US census was utilized to divide the 36 census tracts into 3 SES groups: high, medium and low. The most immediately striking aspect of the findings is the significant inverse gradient in Anglos between SES and both the total infant mortality rate (IMR) and the neonatal mortality (NMR), a gradient which is nonexistent in the Spanish surname population as well as overall. In addition, Anglos and Spanish persons differ significantly with respect to all IMRs and NMRs. In the high and medium SES groups and overall, all Anglo rates are lower, while in the low SES group, Spanish surname rates are lower. These findings suggest that, among Anglos, SES is a crucial factor in infant deaths, whereas, among the Spanish surname population, having a medium or high SES does not offer any additional protection against mortality. Alternatively, lower SES does not translate into significantly lower infant mortality among Spanish persons. These findings provide support for the study's hypotheses that the SES-infant mortality association is weaker among Spanish persons than among Anglos. The analysis also shows the importance of analyzing the SES-infant mortality association separately by ethnicity. Studies in larger cities and also studies utilizing matched birth and death records are needed to further elaborate these findings.     

Heredity counseling

Abstract

An ecological analysis of infant mortality rates is conducted using data on Texas counties for the years 1968–72. It is found that when counties along the Texas‐Mexico border (which have unreasonably low infant death rates and which are economically less advantaged than the remainder of the counties) are excluded from the analysis, the associations between socioeconomic status variables and infant mortality rates improve considerably. A significant negative correlation between neonatal mortality and per cent Spanish surname is retained and does not disappear when the effects of other relevant variables (per cent Negro, per cent urban, and per cent below poverty) are controlled using partial correlation and regression analysis. Possible explanations for this unexpected finding are suggested, and implications for further research are discussed.     

The relationship between socioeconomic status and infant mortality in metropolitan Ohio, 1999–2001

Abstract

Empirical evidence has consistently documented the direct relationship between infant mortality and socioeconomic inequality in the United States and numerous other countries. While the majority of these studies reveal an inverse relationship between socioeconomic level and infant mortality, not even this finding is free from disagreement. Furthermore, the specific nature and magnitude of this relationship has varied over time.

This study will examine the relationship between socioeconomic status and infant mortality in metropolitan Ohio by using birth and infant death data centered on the 2000 Census. The analyses presented herein will describe and analyze the relationship between infant mortality and socioeconomic status in metropolitan Ohio in the year 2000. The key finding is that in spite of remarkable declines in infant mortality during the past several decades, most notably in neonatal mortality, there continues to be a pronounced inverse association between the infant death rate and the economic status of a population.     

Sudden infant death syndrome and the age‐cause proxy relationship in infancy

Abstract

Evidence from a longitudinal study of the relationship between socioeconomic status and infant mortality in metropolitan Ohio is presented in an effort to throw additional light on the continuing debate over the validity of the age‐cause proxy relationship in infancy. The results indicate that while there is a fairly strong and consistent association between neonatal mortality and endogenous causes of death that is little affected by the classification of Sudden Infant Death Syndrome, the nature of the association between postneonatal mortality and exogenous causes of death varies from weak to moderate depending upon where this cause is included. Additional evidence pertaining to the role of SIDS in contributing to the long‐standing inverse association between infant mortality and socioeconomic status is presented, thus further emphasizing the need for continued research to clarify the etiologic mechanisms of this poorly understood condition.     

Heredity of joint diseases

Abstract

This research examines the infant mortality/socioeconomic status relationship in Toledo, Ohio, for the years centering around 19S0, 1960, and 1970 in order to depict variables that contributed most to infant mortality for each time period. Zero‐order correlation coefficients demonstrated that the relationship has widened mainly as a result of an increasing inverse neonatal/socioeconomic pattern which was due in part to a “cause‐period cross‐over effect” (exogenous causes of death were contributing to deaths in the neonatal period in 1970). Further examination suggested that the status variables through which the differentials were operating have shifted from one time period to another. In 1950, crowded housing conditions and unemployment were primarily responsible; in 1960, it was housing and income; and in 1970, marital instability and income predominated. This paper suggests that as new social phenomena emerge they quickly affect sensitive indicators of well‐being such as the infant mortality rate.     

Patterns and variations in the relationship between infant mortality and socioeconomic status

Abstract

This study utilizes an ecological approach based on census tracts of residence to examine the relationship between infant mortality and socioeconomic status in metropolitan Ohio at two points in time (1959–61 and 1969–71). The data presented clearly indicate that the infant mortality rate continues to exhibit a pronounced inverse association with a wide variety of socio‐economic variables. Although there were some notable exceptions and/or variations from the general patterns, a basic inverse relationship was generally found to be characteristic of both neonatal and postnatal components of infant mortality, for both males and females, and for both major exogenous and endogenous causes of death. Of all the variables examined, the one factor that emerged as the strongest and most consistent determinant of census tract variations in infant mortality was the proportion of low income families. Thus, the overriding conclusion suggested by this study is that in spite of such things as continued advances in medicine and public health, the expansion of a variety of social programs during the 1960's, and the recent resumption of a downward trend in the overall infant mortality rate, there has been little if any progress in achieving more equitable life chances for the economically deprived segments of our population.     

Occupational Status,Cortisol Secretory Pattern,and Visceral Obesity in Middle‐aged Men

Objective: Despite several studies indicating that social gradients are predictive of cardiovascular mortality, the pathogenetic mechanisms remain incompletely understood. Research Methods and Procedures: A population sample of 51‐year‐old men (N = 284) was divided into a socioeconomic gradient with manual laborers, civil servants, and university graduates. Anthropometric measurements were registered. Cortisol concentrations were measured in saliva, collected repeatedly during an ordinary working day, and a low‐dose dexamethasone suppression test was performed. Results: Lower socioeconomic status was associated with visceral obesity and higher cortisol values in relation to perceived stress. However, total cortisol secretion over the day of study was not elevated. The regulation of cortisol secretion showed less plasticity and dexamethasone inhibition was less efficient in the men in the lower socioeconomic status group than in those with a higher socioeconomic status. These are known consequences of long term stress. Longer duration in low socioeconomic conditions seemed to worsen these phenomena. Discussion: It was concluded that a low socioeconomic status is associated with perturbed cortisol secretion, which is elevated in relation to perceived stress. When the hypothalamic‐pituitary‐adrenal axis is subjected to prolonged increases in cortisol elicited by chronic stress, the regulation of cortisol secretion is affected, indicating neuroendocrine dysregulations. These observations may provide a means for understanding the association of socioeconomic impairments with visceral obesity and the social inequality in risk for prevalent and serious diseases.     

Reproductive and socioeconomic determinants of child survival: Confounded,interactive, and age‐dependent effects

Abstract

Studies of infant and child mortality have evolved to distinguish between two sets of explanatory variables—factors related to reproductive or maternal characteristics and socioeconomic factors, generally described as characteristics of the family or household. Almost all multivariate analyses include variables from each of these two sets, but there has been little consideration of the relationship between them. We examine how these two sets of variables jointly affect mortality. We test first for confounded effects by examining socioeconomic effects while excluding and then including reproductive variables in nested multivariate models. Next, we look for age‐dependent effects among the explanatory variables and find that reproductive and socioeconomic factors affect mortality at differing ages of children. Finally, we examine interactive effects of the two sets of variables. We conclude that the higher mortality observed among the low status groups is not a result of greater concentration of poor reproductive patterns in those groups. Instead, higher status groups probably have more resources available for combating the negative effects of the same high‐risk reproductive patterns.     

Socioeconomic development,medical care,and nutrition as determinants of infant mortality in less‐developed countries

Abstract

Using data for sixty less‐developed countries, we constructed a causal model in which medical care, nutrition, status of women, and socioeconomic development are examined as determinants of infant mortality. Social and economic development are treated as exogenous variables; medical care, nutrition, and status of women are viewed as variables endogenous to the model. The model is tested by maximum likelihood methods. Results indicate that good nutrition and the presence of informally trained health care personnel, i.e., midwives, are more significantly related to low rates of infant mortality than are the employment status of women and the presence of formally trained health care personnel such as physicians and nurses. The general level of social and economic development conditions these relationships.     

Determinants of infant and early childhood mortality in Cameroon: The role of socioeconomic factors,housing characteristics,and immunization status

Abstract

This study examines factors impinging on the survival of children in Cameroon using longitudinal data collected by the United Nations Demographic Training and Research Institute of Yaounde, Cameroon. It deals especially with the role of socioeconomic factors (mother's education, employment, marital status, ethnicity, and household income), housing characteristics (construction materials, power source, source of water supply, extent of crowding), and immunization status on infant and child mortality. Two‐state parametric and nonparametric hazards models for the risk of death at any time within the course of the study are used, with and without accounting for unmeasured heterogeneity. Overall, overcrowding has robust deleterious effects on infant and child survival. As regards the effects of socioeconomic variables, the robustness of the effects of household income and ethnic differentials are unchanged, even after controlling for unmeasured heterogeneity; the deleterious effects of marital status are also apparent, but these effects are largely explained by unmeasured covariates. The data also suggest that the protective effects of full immunization status are robust and not contaminated by confounding factors, at least in the first 16 months of life. These findings provide solid ground to support immunization programs and efforts as a means to reduce significantly infant and child mortality.     

The relationship between socioeconomic status and infant mortality in metropolitan Ohio, 1999-2001

Empirical evidence has consistently documented the direct relationship between infant mortality and socioeconomic inequality in the United States and numerous other countries. While the majority of these studies reveal an inverse relationship between socioeconomic level and infant mortality, not even this finding is free from disagreement. Furthermore, the specific nature and magnitude of this relationship has varied over time. This study will examine the relationship between socioeconomic status and infant mortality in metropolitan Ohio by using birth and infant death data centered on the 2000 Census. The analyses presented herein will describe and analyze the relationship between infant mortality and socioeconomic status in metropolitan Ohio in the year 2000. The key finding is that in spite of remarkable declines in infant mortality during the past several decades, most notably in neonatal mortality, there continues to be a pronounced inverse association between the infant death rate and the economic status of a population.     

Socioeconomic status and cancer survival in Brazil: Analysis of population data from the municipalities of Aracaju and Curitiba, 1996–2012

IntroductionThe association between socioeconomic status and cancer prognosis has been demonstrated in several countries. Despite the existence of indirect evidence of this phenomenon in Brazil, few studies in this regard are available.ObjectivesThe objective of the present study is to analyse socioeconomic related survival gaps for patients diagnosed with breast, cervical, lung, prostate, and colorectal cancer in the cities of Aracaju (SE) and Curitiba (PR).MethodsUsing population-based data, we estimated net survival by tumour site, year of diagnosis, socioeconomic status and local of residence. Net survival estimation was done with multilevel parametric model allowing flexible spline functions do estimate excess mortality hazards.Results28,005 cases were included in survival analysis. Five-year net survival showed positive association with SES. Intermunicipal survival gaps favouring Aracaju where prominent for breast (reaching 16,1% in 5 years)ObjectivesStudy the impact of socioeconomic factors on cancer survival in two Brazilian capitals. Methods: Survival analysis using population-based cancer data including patients diagnosed with breast, lung, prostate, cervical and colorectal cancer between 1996 and 2012 in Aracaju and Curitiba. Outcomes were excessive mortality hazard (EMH) and 5- and 8-years net survival (NS). The association of race/skin color and socioeconomic level (SES) with EMH and net survival were analyzed using a multilevel regression model with flexible splines.Results28,005 cases were included, 6636 from Aracaju and 21,369 from Curitiba. NS for all diseases studied increased more prominently for Curitiba population. We observed NS gap between the populations of Aracaju and Curitiba that increased or remained stable during the study period, with emphasis on the growth of the difference in NS of lung and colon cancer (among men). Only for cervical cancer and prostate cancer there was a reduction in the intermunicipal gaps. 5-year NS for breast cancer in Aracaju ranged from 55.2% to 73.4% according to SES. In Curitiba this variation was from 66.5% to 83.8%.ConclusionThe results of the present study suggests widening of socioeconomic and regional inequalities in the survival of patients with colorectal, breast, cervical, lung and prostate cancers in Brazil during the 1990 s and 2000 s     

Socioeconomic status and incidence of pediatric leukemia in Canada: 1992–2010

BackgroundLeukemia is the most common cancer among Canadian children, representing about a third of pediatric cancers in Canada and is responsible for about one-third of pediatric cancer deaths. Understanding the effect of socioeconomic status (SES) on pediatric leukemia incidence provides valuable information for cancer control and interventions in Canada.MethodsUsing a linked data from the Canadian Cancer Registry (CCR), Canadian Census of Population (CCP) and National Household Survey (NHS) we aimed to quantify socioeconomic inequalities in the incidence of pediatric leukemia from 1992 to 2010. We used the concentration index (C) approach to quantify income- and education-related inequalities in the incidence of pediatric leukemia over time.ResultsThough there were fluctuations in incidence over the study period, our results showed that the total incidence of pediatric leukemia in Canada was generally consistent from 1992 to 2010. Incidence rate of 47 per 1,000,000 as at 1992 rose to 57 per 1,000,000 in 2010. The estimated values of the C over the study period failed to show any significant association between pediatric leukemia incidence and household income or education status.ConclusionsAlthough pediatric leukemia incidence is not rising significantly, it is not reducing significantly either. The incidence of pediatric leukemia showed no significant association with socioeconomic status. Future cancer control interventions should focus more on mitigating risk factors that are independent of socioeconomic status.     

Socioeconomic and ethnic group differences in self reported health status and use of health services by children and young people in England: cross sectional study

ObjectivesTo examine whether self reported health status and use of health services varies in children of different social class and ethnic group.DesignCross sectional study from the 1999 health survey for England.Subjects6648 children and young adults aged 2-20 years.SettingPrivate households in England.ResultsLarge socioeconomic differences were observed between ethnic subgroups; a higher proportion of Afro-Caribbean, Indian, Pakistani, and Bangladeshi children belonged to lower social classes than the general population. The proportion of children and young adults reporting acute illnesses in the preceding two weeks was lower in Bangladeshi and Chinese subgroups (odds ratio 0.41, 95% confidence interval 0.27 to 0.61 and 0.46, 0.28 to 0.77, respectively) than in the general population. Longstanding illnesses was less common in Bangladeshi and Pakistani children (0.52, 0.40 to 0.67 and 0.57, 0.46 to 0.70) than in the general population. Irish and Afro-Caribbean children reported the highest prevalence of asthma (19.5% and 17.7%) and Bangladeshi children the lowest (8.2%). A higher proportion of Afro-Caribbean children reported major injuiries than the general population (11.0% v 10.0%), and children from all Asian subgroups reported fewer major and minor injuries than the general population. Indian and Pakistani children were more likely to have consulted their general practitioner in the preceding fortnight than the general population (1.86, 1.35 to 2.57 and 1.51, 1.13 to 2.01, respectively). Indian, Pakistani, Bangladeshi, and Chinese children were less likely to have attended outpatient departments in the preceding three months. No significant differences were found between ethnic groups in the admission of inpatients to hospitals. Acute and chronic illness were the best predictors of children''s use of health services. Social classes did not differ in self reported prevalence of treated infections, major injuries, or minor injuries, and no socioeconomic differences were seen in the use of primary and secondary healthcare services.ConclusionsChildren''s use of health services reflected health status rather than ethnic group or socioeconomic status, implying that equity of access has been partly achieved, although reasons why children from ethnic minority groups are able to access primary care but receive less secondary care need to be investigated.

What is already known on this topic

Children from lower socioeconomic classes and from Indian ethnic subgroups may make more use of general practitioners'' services than other childrenAfro-Caribbean, Indian, Pakistani, and Bangladeshi children are less likely to be referred to outpatient and inpatient services at hospitals than white children

What this study adds

Indian, Pakistani, and Bangladeshi children reported less acute and chronic illness, asthma, and injuries than the general population, whereas Afro-Caribbean children reported moreChildren''s self reported health status and use of health services did not vary by social classIndian and Pakistani children make more use of general practitioners'' services, but Indian, Pakistani, Bangladeshi, and Chinese children are less likely to be referred to outpatient clinicsSelf reported health status rather than socioeconomic status or ethnicity is the best predictor of use of primary and secondary services     

Endpiece: Genius (1815)

ObjectiveTo examine the proposition that a used infant mattress is associated with an increased risk of sudden infant death syndrome.DesignCase-control study.SettingScotland (population 5.1 million, with about 53 000 births a year).Participants131 infants who died of sudden infant death syndrome between 1 January 1996 and 31 May 2000 and 278 age, season, and obstetric unit matched control infants.ResultsRoutine use of an infant mattress previously used by another child was significantly associated with an increased risk of sudden infant death syndrome (multivariate odds ratio 3.07, 95% confidence interval 1.51 to 6.22). Use of a used infant mattress for last sleep was also associated with increased risk (6.10, 2.31 to 16.12). The association was significantly stronger if the mattress was from another home (4.78, 2.08 to 11.0) than if it was from the same home (1.64, 0.64 to 4.2).ConclusionA valid significant association exists between use of a used infant mattress and an increased risk of sudden infant death syndrome, particularly if the mattress is from another home. Insufficient evidence is available to judge whether this relation is cause and effect.

What is already known about this topic

The major risk factors for sudden infant death syndrome are sleeping prone and parental smokingOne study has suggested that the syndrome is associated with sleeping on an infant mattress previously used by another child

What this study adds

New case-control data show that the association between a previously used infant mattress and sudden infant death syndrome is validWhen source of used mattress is categorised, the association is significant only if the mattress is from another homeInsufficient evidence is available to judge whether this is a cause and effect relation     

Birth spacing and infant mortality: evidence for eighteenth and nineteenth century German villages

Data from an historical population in which fertility control was minimal and modern health services were mostly unavailable are used to show that there appears to have been a strong association between previous birth interval length and infant mortality, especially when the previous child survived. Although only imperfect proxies for breast-feeding practices and other potentially confounding factors are available for this population, the results suggest that the association between previous interval length and infant mortality in this population is not solely, or primarily, a function of differences in breast-feeding behaviour or socioeconomic status. Other factors, e.g. maternal depletion or sibling competition, are more likely to explain the observed association.     

The influence of early conditions on health status among elderly Puerto Ricans

Abstract

The demographic origins of aging in Puerto Rican and other Latin American and Caribbean (LAC) countries may have important implications for the profile of health status and mortality of elderly people. For this article we tested a general conjecture about the relation between early childhood conditions and adult health status among Puerto Rican elderly using a rich data set recently collected through an island‐wide survey (N=4,293). We examined the association between markers of early nutritional status, self‐reports of health and on socioeconomic conditions during early childhood, and the prevalence of 3 conditions during adult ages: obesity, diabetes, and cardiovascular diseases. Although we found that obesity and diabetes are associated with markers of early malnutrition, that heart disease is associated with early deprivations and selected early childhood conditions, the evidence we were able to tease out from the data provides only fragile support for the conjecture.     

BMI,Waist Circumference,and Mortality According to Health Status in the Older Adult Population of Spain

Among the explanations proposed for the weak and inconsistent association between BMI and mortality in the elderly are the lack of adjustment for waist circumference (WC) and that the association varies with health status. This work examines the independent association of BMI and WC with mortality in older adults, and the influence of health status on this association. A cohort of 3,536 persons representative of the Spanish population aged ≥60 years was selected in 2000 and 2001, and followed prospectively until 2007. The analyses were performed with Cox models and adjusted for the main confounders. During follow‐up, 659 persons died (18.6% of the cohort). Before adjusting for WC, mortality in the upper quartile of BMI was 15% lower than in the lower quartile (hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.66–1.08; P for linear trend = 0.076). After adjusting for WC, the association was even stronger, so that mortality in the upper quartile of BMI was 37% lower than in the lower quartile (HR: 0.63; 95% CI: 0.45–0.88; P for linear trend < 0.003). Before adjusting for BMI, no association was observed between WC and mortality. After adjusting for BMI, WC was positively associated with mortality (HR for upper vs. lower quartile of WC: 1.48; 95% CI: 1.07–2.05; P for linear trend = 0.008). These associations were mainly observed in those with limitations in mobility and agility. BMI has an inverse, and WC has a direct, independent association with mortality in older adults, particularly in those with worse health status.     

Childhood Overweight and Academic Performance: National Study of Kindergartners and First‐Graders

Objective: To examine the association between children's overweight status in kindergarten and their academic achievement in kindergarten and first grade. Research Methods and Procedures: The data analyzed consisted of 11, 192 first time kindergartners from the Early Childhood Longitudinal Study, a nationally representative sample of kindergartners in the U.S. in 1998. Multivariate regression techniques were used to estimate the independent association of overweight status with children's math and reading standardized test scores in kindergarten and grade 1. We controlled for socioeconomic status, parent‐child interaction, birth weight, physical activity, and television watching. Results: Overweight children had significantly lower math and reading test scores compared with nonoverweight children in kindergarten. Both groups were gaining similarly on math and reading test scores, resulting in significantly lower test scores among overweight children at the end of grade 1. However, these differences, except for boys’ math scores at baseline (difference = 1.22 points, p = 0.001), became insignificant after including socioeconomic and behavioral variables, indicating that overweight is a marker but not a causal factor. Race/ethnicity and mother's education were stronger predictors of test score gains or levels than overweight status. Discussion: Significant differences in test scores by overweight status at the beginning of kindergarten and the end of grade 1 can be explained by other individual characteristics, including parental education and the home environment. However, overweight is more easily observable by other students compared with socioeconomic characteristics, and its significant (unadjusted) association with worse academic performance can contribute to the stigma of overweight as early as the first years of elementary school.     

Socioeconomic development and mortality levels in less developed countries

Abstract

Some demographers have argued that post‐World War II mortality declines in the less‐developed countries (LDC's) are not associated with economic and social development because of the diffusion of health and medical techniques from the developed to the underdeveloped countries. This paper examines the current relationship between socioeconomic development and mortality levels in 124 countries, 94 of which are LDC's. The argument is tested with a path model consisting of five multidimensional and three unidimensional indicators. Results indicate that for the LDC's, there is a very strong set of direct and indirect relationships between indicators of socioeconomic development and mortality. Between 62 and 80 per cent of the variances in the crude death rate, infant mortality, and life expectancy are explained in the LDC model. The empirical test of the model demonstrates that lower mortality levels in the LDC's are dependent on socioeconomic factors and health services; continued improvement of socioeconomic levels in the LDC's will result in further mortality declines. For comparative purposes, the same model also is tested for more developed countries. Results for the model with more developed countries (MDC's) show that entirely different measures are necessary for MDC mortality models; the concept of “mortality” for LDC's and MDC's is orthogonal and requires different empirical indicators.