IJE Advance Access originally published online on September 13, 2005
International Journal of Epidemiology 2005 34(6):1257-1265; doi:10.1093/ije/dyi190
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Special Theme: Health and Economic Change |
Determinants of under-5 mortality among the poor and the rich: a cross-national analysis of 43 developing countries
Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
* Corresponding author. Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: a.houweling{at}erasmusmc.nl
Background Under-5 mortality is unacceptably high in many countries, the burden of which is mainly borne by the poor. Whereas country characteristics are known to influence under-5 mortality, it is unknown whether these have a different impact on the poor and the rich. We aimed to describe how the association between under-5 mortality and socioeconomic, political, and health care factors varies in strength between richer and poorer children.
Methods Cross-national analysis of 43 developing countries using wealth-group specific under-5 mortality rates as outcome. Relative effects were estimated using OLS regression; differences in associations between wealth groups were tested.
Results Higher national incomes were associated with lower under-5 mortality rates. This association was significantly weaker for the poor compared with the rich (P = 0.014). Ethnic fragmentation was significantly more strongly associated with higher under-5 mortality among the poor compared with the rich (P = 0.027). The association between public spending on health and under-5 mortality was stronger for the poor (P = 0.0001). Skilled delivery attendance and immunization coverage among the poor were significantly more strongly related to public spending on health than such health care use among the rich (P = 0.0001 and P = 0.045, respectively). No differentials in the relative effect of female literacy, democracy, and state strength were observed.
Conclusion Our results suggest that economic growth is associated with widening poor–rich disparities in under-5 mortality. Increased public spending on health might partly remedy this effect.
Keywords Child mortality, socioeconomic factors, developing countries, income, health expenditures, health services utilization, political factors, ethnic groups, comparative study
Accepted 15 August 2005
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