Socioeconomic status and infant mortality among Hispanics in a southwestern city

Abstract

From data on census tract groupings from Corpus Christi, Texas, for 1979–83, this study shows that, unlike the inverse infant‐mortality‐socioeconomic‐status association observed for Anglos, no such association exists for the Spanish surname population. This finding is discussed in terms of recent research suggesting that the Spanish surname population of the Southwest has lower infant death rates than expected from its generally lower socioeconomic status.     

A methodological note on the relationship between infant mortality and socioeconomic status with evidence from San Antonio, Texas.

A number of previous studies have concluded from social area analyses of medium-size cities that there is no longer a significant correlation between socioeconomic status (SES) and infant mortality in the U.S. To determine if these findings were an artifact of too small samples, the total, neonatal, and postneonatal infant mortality rates were analyzed for 115 census tracts of San Antonio, Texas. The SES of each tract was measured by a score reflecting equally the variables of income, education, and occupation, and allowed assignment of the tracts to 1 of 4 socioeconomic rankings. All 3 infant mortality rates rose as SES decreased, with the most marked relationship being between SES and postneonatal rates. It was also found that of the 3 variables used to measure SES, income bore the strongest relationship to infant mortality. In general it should be noted that social area analysis of infant mortality is limited by the extreme reductions of sample size when additional variables are induced.     

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 fall and rise of US inequities in premature mortality: 1960-2002

Background

Debates exist as to whether, as overall population health improves, the absolute and relative magnitude of income- and race/ethnicity-related health disparities necessarily increase—or derease. We accordingly decided to test the hypothesis that health inequities widen—or shrink—in a context of declining mortality rates, by examining annual US mortality data over a 42 year period.

Methods and Findings

Using US county mortality data from 1960–2002 and county median family income data from the 1960–2000 decennial censuses, we analyzed the rates of premature mortality (deaths among persons under age 65) and infant death (deaths among persons under age 1) by quintiles of county median family income weighted by county population size. Between 1960 and 2002, as US premature mortality and infant death rates declined in all county income quintiles, socioeconomic and racial/ethnic inequities in premature mortality and infant death (both relative and absolute) shrank between 1966 and 1980, especially for US populations of color; thereafter, the relative health inequities widened and the absolute differences barely changed in magnitude. Had all persons experienced the same yearly age-specific premature mortality rates as the white population living in the highest income quintile, between 1960 and 2002, 14% of the white premature deaths and 30% of the premature deaths among populations of color would not have occurred.

Conclusions

The observed trends refute arguments that health inequities inevitably widen—or shrink—as population health improves. Instead, the magnitude of health inequalities can fall or rise; it is our job to understand why.     

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.     

Racial differences in the relationship between infant mortality and socioeconomic status

This study presents an ecological analysis of the relationship between infant mortality and economic status by race in metropolitan Ohio, using census data on mother's residence and economic status determined by the percentage of low-income families living in each area. The analysis updates previous studies as white-non-white comparisons for total infant mortality are examined for the US censuses of 1960, 1970, 1980, 1990 and 2000; and more detailed period- and broad cause-specific rates are presented for 2000. A pronounced inverse association is consistently found between income status and infant mortality for whites, while for non-whites this pattern first emerges in 1979-81, disappears during the 1980s and then returns more strongly during the 1990s. Similarly, the 2000 data reveal a consistent inverse pattern between income status and infant mortality for white and non-white neonatal and postneonatal death rates, as well as exogenous cause-specific death rates. It is concluded that low-income whites and non-whites have infant mortality rates substantially higher than the overall rate for the population. Policy implications are discussed.     

Teenage fertility, socioeconomic status and infant mortality

This paper examines the relationship between infant mortality and a complex measure of socioeconomic status for evidence of diminution. In data on counties in the US with a minimum of 20 infant deaths over the 5-year period 1971-75, no evidence of a declining relationship between socioeconomic status and infant mortality was found. Both level of community affluence and racial composition of the population exerted direct effects on levels of infant deaths. In addition, both socioeconomic status and racial composition exhibited indirect effects which operated through teenage childbearing. When total infant mortality was subdivided, teenage fertility serves as a mediating variable in the link between socioeconomic status and neonatal mortality, but not for the postneonatal components. Given the nearly equivalent total effect of socioeconomic status on infant mortality, it is concluded that the classic division into neonatal (supposedly a function of biological and genetic agents) and postneonatal (traditionally attributed to social and environmental agents), may be too crude to allow the contemporary effects of the socioenvironmental milieu to be evaluated effectively.     

Urban Neighborhoods and Depressive Symptoms in Late Middle Age

This study examines associations between multiple urban neighborhood characteristics (socioeconomic disadvantage, affluence, and racial/ethnic composition) and depressive symptoms among late middle aged persons and compares findings to those previously obtained for persons age 70 years and older. Survey data are from the Health and Retirement Study (HRS), a U.S. national probability sample of noninstitutionalized persons aged 51 to 61 years in 1992. Neighborhoods are 1990 U.S. census tracts. Hierarchical linear regression is used to estimate multilevel models. Depressive symptoms vary significantly across urban neighborhoods among late middle age persons. Neighborhood socioeconomic disadvantage is significantly associated with depressive symptoms, net of both individual-level sociodemographic and health variables. However, this association is contingent upon individual-level wealth in that persons with low wealth in the most disadvantaged neighborhoods report the most depressive symptoms. Unlike findings for older adults for whom neighborhood effects appear to be entirely compositional in nature, neighborhood context matters to subgroups of late middle age adults.     

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.     

Deformed nasal septa and relaxed selection

Abstract

Demographic studies undertaken in several Andean countries have found that women residing at high altitudes have significantly fewer live births than do their low altitude counterparts. This reduction has been explained as being due to various factors: the debilitating effects of hypoxia upon the reproductive system; the effects of sociocultural factors which vary with altitude and which affect reproductive behavior; and errors in data collection. In order to examine the validity of some of these hypotheses, the fertility of a group of 906 Bolivian women residing at low, medium, and high altitudes was examined. The women were selected from the lower socioeconomic strata and reported never having used any method of contraception. A detailed analysis of the fertility of these women showed no significant altitude‐related differences in the number of live births. However, as a result of significantly higher childhood mortality rates at altitude, there was a significant reduction in numbers of living children. The results of this study suggest that the collection and analysis of census data that ignores socioeconomic differences within a population or differences among census units in neonatal or early childhood mortality may bias or complicate the study of the impact of altitude on human fertility. Although the present research does not prove that hypoxic stress does not affect the reproductive system, the results suggest that if altitude does reduce fecundity, the reduction is not great and is likely to be shown only through studies of reproductive physiology.     

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.     

Cancer incidence in the Zuni Indians of New Mexico

The total age-adjusted incidence of cancer in the Zuni Indians of New Mexico was significantly lower than that of the New Mexico Anglo population during the period 1969-1982. Specific sites at which the Zunis had a significantly lower number of cases than expected, based on the rates for Anglos, are: colon, rectum and anus, lung, breast, endometrium, melanoma of the skin, pancreas, and the leukemias. Sites at which the Zunis had a higher number of cases than expected are stomach and gallbladder. The Zunis have a pattern of occurrence of cancer that is similar to other American Indians of New Mexico (Navajo, Apache, and Pueblo); however, rates of lung, colonic, and pancreatic cancer among the Zunis are significantly lower. The occurrence and anatomic distribution of cancer among the Zunis may be the result of cultural and environmental conditions or genetic influences. Further studies may clarify the risk factors which contribute to this pattern of disease.     

Relationships between pregnancy spacing,sex of infants,maternal age,and birth order,and neonatal and post‐neonatal mortality in Bangladesh

Abstract

The relationships between length of the interpregnancy interval, outcome of the pregnancy preceding the interval, sex of the infants, pregnancy order, maternal age, and maternal history of previous child deaths and neonatal and postneonatal mortality were explored in a rural Bangladeshi population using a multiple regression analysis. Specific interactions between the interpregnancy interval, outcome of the pregnancy preceding the interval, sex of the infants, and history of previous child deaths were examined. An inverse relationship was observed between postneonatal mortality and the length of the interpregnancy interval when the pregnancy preceding the interval was a surviving infant. No such trend was observed for neonatal mortality. Post‐neonatal mortality rates among children whose mothers had experienced two or more previous child deaths were essentially the same as that for infants whose mothers had experienced 0–1 child deaths when the interpregnancy intervals were more than 24 months. Although female infants have a lower neonatal mortality than male infants, the neonatal mortality rate for female infants conceived less than twelve months following a male infant birth was higher than for a male infant conceived less than twelve months following another male infant birth. Post‐neonatal mortality is consistently higher for female compared to male infants in all interval categories.     

Birth-weight-specific infant and neonatal mortality: effects of heterogeneity in the birth cohort

Birth-weight-specific infant mortality is examined using a novel statistical procedure, parametric mixtures of logistic regressions. The results indicate that birth cohorts are composed of two or more subpopulations that are heterogeneous with respect to infant mortality. One subpopulation appears to account for the "normal" process of fetal development, while the other, which accounts for the majority of births at both low and high birth weights, may represent fetuses that were "disturbed" during development. Surprisingly, estimates of neonatal and infant mortality indicate that the "disturbed" subpopulation has lower birth-weight-specific mortality, although overall crude mortality rates are higher for this subpopulation. It is hypothesized that this is due to high rates of fetal loss among the "disturbed" subpopulation, resulting in a highly selected group at birth. The heterogeneity identified in the birth cohort could be responsible for recent decelerations in the decline in infant mortality, and might be the cause of unexplained ethnic differences in birth-weight-specific infant mortality. The novel statistical methodology developed here has broad application within human biology. In particular, it could be used in any context where parametric mixture modeling is applied, such as complex segregation analysis.     

Self-destructive behaviour in the Hungarian population

In Hungary today the mortality rate of middle aged (55-64 years old) men is higher than it was in the 1930s. Within these statistics there are considerable socioeconomic differences, the mortality rate of lower secondary or lower educated middle aged men is 1.45 times higher than among those with higher education. About 40% of these socioeconomic mortality differences can be explained by higher prevalence of risk behaviour in lower socioeconomic groups. According to the results of our national representative survey conducted in the Hungarian population with 12640 persons in 1995, the prevalence of smoking was 45.5% among men and 26.6% among women. In the populaton younger than 45 years old the prevalence of smoking among men was 47.9%, among women 31.9%. Among men there is a clear socioeconomic gradient in smoking, in the number of daily cigarettes, the quantity of spirit consumption in one occasion, among women this socioeconomic gradient is not so obvious. The effectiveness of health promotion programmes depends on effective management of the motivational, psychological determinants of risk behaviour.     

Socioeconomic status and its relation with breast cancer recurrence and survival in young women in the Netherlands

BackgroundAssociations between socioeconomic status (SES) and breast cancer survival are most pronounced in young patients. We further investigated the relation between SES, subsequent recurrent events and mortality in breast cancer patients < 40 years. Using detailed data on all recurrences that occur between date of diagnosis of the primary tumor and last observation, we provide a unique insight in the prognosis of young breast cancer patients according to SES.MethodsAll women < 40 years diagnosed with primary operated stage I-III breast cancer in 2005 were selected from the nationwide population-based Netherlands Cancer Registry. Data on all recurrences within 10 years from primary tumor diagnosis were collected directly from patient files. Recurrence patterns and absolute risks of recurrence, contralateral breast cancer (CBC) and mortality – accounting for competing risks – were analysed according to SES. Relationships between SES, recurrence patterns and excess mortality were estimated using a multivariable joint model, wherein the association between recurrent events and excess mortality (expected mortality derived from the general population) was included.ResultsWe included 525 patients. The 10-year recurrence risk was lowest in high SES (18.1%), highest in low SES (29.8%). Death and CBC as first events were rare. In high, medium and low SES 13.2%, 15.3% and 19.1% died following a recurrence. Low SES patients had shorter median time intervals between diagnosis, first recurrence and 10-year mortality (2.6 and 2.7 years, respectively) compared to high SES (3.5 and 3.3 years, respectively). In multivariable joint modeling, high SES was significantly related to lower recurrence rates over 10-year follow-up, compared to low SES. A strong association between the recurrent event process and excess mortality was found.ConclusionsHigh SES is associated with lower recurrence risks, less subsequent events and better prognosis after recurrence over 10 years than low SES. Breast cancer risk factors, adjuvant treatment adherence and treatment of recurrence may possibly play a role in this association.     

The demographic and socioeconomic factors predictive for populations at high-risk for La Crosse virus infection in West Virginia

Although a large body of literature exists for the environmental risk factors for La Crosse virus (LACV) transmission, the demographic and socioeconomic risk factors for developing LACV infection have not been investigated. Therefore, this study investigated the demographic and socioeconomic risk factors for LACV infection in West Virginia from 2003 to 2007, using two forward stepwise discriminant analyses. The discriminant analyses were used to evaluate a number of demographic and socioeconomic factors for their ability to predict: 1) those census tracts with at least one reported case of LACV infection versus those census tracts with no reported cases of LACV infection and 2) to evaluate significantly high-risk clusters for LACV infection versus significantly low-risk clusters for LACV infection. In the first model, a high school education diploma or a general education diploma or less and a lower housing densitywere found to be predictive of those census tracts with at least one case of LACV infection. A high school or a general education diploma or less, lower housing density, and housing built in 1969 and earlier were all found to be predictive of those census tracts displaying high-risk clusters versus census tracts displaying low-risk clusters in the second model. The cluster discriminant analysis was found to be more predictive than the census tract discriminant analysis as indicated by the Eigenvalues, canonical correlation, and grouping accuracy. The results of this study indicate that socioeconomically disadvantaged populations are at the highest risk for LACV infection and should be a focus of LACV infection prevention efforts.     

Object Representations in Dreams of Chicanos and Anglos

The relationship between the cultures to which persons belong and their internalized object representations as revealed by manifest dream content was investigated. It was hypothesized that because Chicanos are from a more nurturing culture than Anglos, they would represent persons in their dreams as more differentiated, articulated, and integrated, with more benevolent interactions. 50 Chicano and 50 Anglo university students (25 of each gender in each culture) reported a total of 555 dreams that were scored according to the Concept of the Object Scale (Blatt, Brenneis, Schimek & Glick, 1976). The Scale applies developmental principles concerning the three dimensions of differentiation, articulation, and integration to the study of human responses given to the Rorschach. This research applied the Scale to the manifest content of the subjects' reported dreams. The cross-cultural hypothesis was disconfirmed; however, there were strong findings concerning gender. Gender differences across culture were statistically significant in each developmental dimension, ranging from females representing more humans, who are better articulated and more benevolently interactive (p < .01) to females reporting more intentional, congruent actions and more interactions (p < .05). The only cross-cultural finding was that Anglos represent more action in their dreams than Chicanos (p < .05). Within the sample of acculturated Chicano subjects, genders were polarized to a much greater extent than in the Anglo sample. Implications of the findings for theoretical understanding of gender and cultural differences in object representations are discussed.     

Colloquium on the role and behavior of sex chromosomes in mammalian development and reproduction: Basel,May 6–8, 1965

Abstract

There are significant mortality disparities across racial and socioeconomic (SES) groups. Although the mechanisms behind these disparities remain vague, there is a clear connection between the mortality disparities across racial and SES groups. It is less clear, though, if the relationship between SES and racial mortality disparities varies across the life course. Prior research indicates that both racial and SES mortality disparities decline over the life course. These results suggest that if we standardize mortality rates for age‐variation in the SES‐mortality relationship, then the age‐pattern of racial mortality disparities will be attenuated. Using data from the National Longitudinal Mortality Study, I analyze the relationship between SES and racial disparities in age‐specific mortality among adults aged 25 and over. The results suggest that racial differences in SES are most important early in the adult life, and are minimally related to the convergence in racial mortality disparities at the oldest ages.     

Seasonality of birth: two findings from the decennial census

The enigmatic seasonality of births in the US has been analyzed extensively, but gaps in the knowledge of this phenomenon exist along dimensions not accessed by the national vital registration system. Live births in the US have for some time followed a pattern of spring trough and summer peak--at least since the initiation of the national birth registration system in 1933. The pattern is known to be more pronounced for the South than for other regions and for blacks than for whites. In this study it has been shown that this pattern existed as far back as the 1890's, and currently is more pronounced for lower than for higher socioeconomic groups. These findings come from an analysis of census population data, rather than vital registration data. In this way census data have been used in an innovative way to address 2 aspects of the phenomenon which had heretofore not been adequately treated.