Socio, Economic, and Cultural Causes of Infant Mortality The Effect of Racial Residential Segregation on Black Infant Mortality

Background This article states that the economical differences as well as proximal risk factors do not clearly explain the existing high infant mortality rate of the black (African Americans). The African American infant mortality rates are two to three times more than non Hispanic whites. Hypothesis The hypothesis states that the racial residential segregations play an autonomous role in the high rate of infant mortality in blacks; their post-neonatal mortality rate differences; and contribution in this disparity of the post-neonatal mortality rates by cause. Segregations restrict the economic and social advantages as well as it imposes negative environmental exposures which black infants and women experiences. Studys Methodology This advanced study of the current research was carried out through exploring the causal effects of the segregation using the exchangeable populations. For the purpose, 677,777 samples of black infants were collected within the cities having 250,000 or more residents during 2000-2002 (as per US Lined Birth Death records). The results were rates of post-neonatal mortality; all-causes of the infants mortality; and the external causes for infants death. The segregation was measured with the help of isolation index from 2000 US Census Housing Pattern (dichotomized at 0.60) and propensity score matching method was used.

Socio, Economic, and Cultural Causes of Infant Mortality Studys Findings In this study, it was found that the crude black infant mortality rate is two to three times more than white infant mortality rate. As per matching the propensity score, no independent effect of the segregation on the black infant mortality rate for overall, post-

neonatal, and neonatal mortality was seen, regardless of their economic status of the place. Moreover, it was found that the blacks who resided within hyper-segregated place having low tax capacity accounted 63.43 more deaths per 100,000 live births due to SIDS and 13.14 more death per 100,000 live births due to the assault. There was no statistical significance of the independent effects of segregation on blacks or white post-neonatal infants mortality or the cause specific post-neonatal deaths. Conclusion It was found that there is small statistical evidence about the fact that segregations play an independent role in case of blacks infant mortality rates as well as infant mortality disparity. At the same time it is difficult to separate the contextual effects from characteristics of the individuals. This study presents a significant theoretical and methodological advance.

Socio, Economic, and Cultural Causes of Infant Mortality

Association of Childhood Social-economic Position with Cause-specific Mortality in a Prospective Record Linkage Study of 1,839,384 Individuals Hypothesis or Objective The lack of earlier studies in assessing associations between the early life socioeconomic position as well as adult cause specific mortality has motivated the authors to carry out this research. This is very large size and record linkage study that is aim to establish association of the early life socio-economic population with wide range of the cause specific mortality outcome. The outcome variables consists of all cause and cause specific deaths that are defined as underlying cause of the deaths recorded on the death certificates. Studys Methodology In this cohort study, associations of the parental social class at the age of 0-16 years with the mortality among 1,824,064 Swedes was examined, who were born in 1944-1960 and are still alive as well as are living in Sweden in 1970. The various attributes like date of birth, sex, and unique identity numbers were retrieved from Swedish Multi-Generation Register. Afterwards, linkage was made between these records, index participants death (extracted from Swedish Cause of Death Register for the deaths till December 31, 2001) records, and to that of socio-economic population data from Swedish Population and Housing Census databases for 1960, 1970, 1980, and 1990. Here, the follow-up period was split into 10 year intervals and it was adjusted for the time updates later life socio-economic populations assessed within the 10 years of the death. Studys Findings This huge cohort study found that males and females from the manual compared with the non-manual social class background in the early life are having more chance to die from

Socio, Economic, and Cultural Causes of Infant Mortality range of the disease outcomes, like smoking related cancers, cardiovascular disease,

respiratory diseases, diabetes are associated with the behavioral risk factor. Further male form the manual as compared with non-manual backgrounds, are having more probability to die from homicide, unintentional injury, as well as alcoholic cirrhosis. Moreover, educational attainment resulted in the marked attenuation of the associations, with life social classes having less marked attenuation impacts. Conclusion This study concluded that the much of the early life socio economic position and the adult diseases can be mediated through behavioral risk factors which can be modified through improved education. Thus, for reducing socio-economic inequalities in the health can be gained through inputs in the early life through improvement in the educational achievement of the individuals who belongs from lowest socio-economic groups.

Socio, Economic, and Cultural Causes of Infant Mortality Racial Disparity in Pregnancy-related Mortality Associates with Livebirth: Can Established Risk Factors Explain It? Hypothesis or Objective

This study was nested case control study which was carried out in order to determine whether the four-fold increased risk of the pregnancy related mortality for the US Black women as compared to the White women can be explained through the racial differences in the reproductive and socio-demographic factors. In addition to this, the study also aims to determine whether racial disparity differs between the selected subgroups of the women. Studys Methodology For the above stated objectives, cases was derived from the national surveillance database of the pregnancy related deaths and was restricted to the sample of 840 White women and 448 sample of Black Women whose pregnancy resulted in livebirth as well as who died out of pregnancy related cause during 1979 to 1986. Moreover, controls were derived from the national fatality data as well as were randomly selected White and Black woman who had delivered live infant as well as did not die out of pregnancy related cause. At the same time, logistic regression was used for simultaneous risk adjustment for the risk factors but it did not explain the racial gap within the pregnancy related mortality. Studys Findings This study found that the largest racial disparity was seen among the women who were having lowest risk of the pregnancy relater death to those with low to moderate parity who have delivered normal birth weight babies. On the other hand, no racial disparity was seen among the women having highest risk of the pregnancy related deaths to those with high parity women who delivered low birth weight babies. The study also indicates that the

Socio, Economic, and Cultural Causes of Infant Mortality increased risk of the pregnancy related deaths associated with the livebirth fro the Black women cannot be presented or explained through the socio-demographic as well as reproductive variables that are available from the birth certificate data. Conclusion

It was found that the given same opportunity for prenatal health care services, Black women use less extensively than the White women. As a result, Black women suffers from more complex and advanced diseases with getting later as well as lower quality prenatal care. The above findings point out that the reproductive health-care professionals are required to develop strategies in order to reduce pregnancy related deaths among high as well as low risk black women. The strategies need to be developed in order to make reproductive health care service more readily available to the Black and minority women. In addition to this, the public health programs as well as social policies needs to complement the medical practice and also to consider the social and psychological stress that the Black woman usually goes through.

Socio, Economic, and Cultural Causes of Infant Mortality

How Does Socioeconomic Development Affect Risk of Mortality? An Age-PeriodCohort Analysis From a Recently Transitioned Population in China Hypothesis or Objective Chinese population was faced with two macro environmental changes during 20th century i.e. the transition from the essentially pre-industrial living condition to rapidly developing economy because of mass migration during 1940s and emergence of the infant as well as childhood adiposity epidemic during 1960s. This study aims to describe the effect of these two changes on the mortality. Studys Methodology For the above objective, age as well as sex specific data on the midyear populations and the known deaths (from 1976 2005) was collected from Hong Kong government Census and Statistics Department. Further, sex-specific Poisson regression model was used in order to estimate the effects of calendar period, age, and birth cohort on Hong Kong adult mortality during 1976 and 2005. All cause and cause specific mortality were considered, including ischemic heart disease, lung cancer, respiratory disease and others. Here, it was difficult to estimate age period and cohort model simultaneously as these three are linearly dependent. So, additional arbitrary reference constraint was used for period effect 17-20. Studys Findings The study found decline in other CVD diseases, respiratory diseases, and other medical cause for both sexes. Economic development, improved nutritions, medical care and living conditions help in decreasing the mortality rates. With the change in the macroenvironmental factors, there was increase rate in the cancer mortality for the women and

Socio, Economic, and Cultural Causes of Infant Mortality particularly Ischemic Heart Disease (IHD) mortality in the men. On the other hand, the emerging epidemic had long term effect on both sex equally. Conclusion The study concluded that the macro environmental changes due to economic transition have increased the mortality from IHD for the men born to a new developed

environment as well as cancer for women. The childhood adiposity seems to be associated with relative increase in CVD mortality for both the genders. The detrimental effects of the CVD morbidity occur in the younger individual and relatively quickly.

Socio, Economic, and Cultural Causes of Infant Mortality Personality, Socioeconomic Status, and All-Cause Mortality in the United States Hypothesis or Objective The authors of this study tried to assess the extent of which socioeconomic status

(SES) as well as the personality factors (extraversion, neuroticism, agreeableness, openness to experience, and conscientiousness) or the independent risk for the all-cause mortality for more than 10 year with follow-up in Midlife Development in United States cohort between 1995 and 2004. Studys Methodology This study selected non-institutionalized, English speaking adults who are between 25 and 74 years by use of random digit dialing in the year 1995. N this figure, 70 percent was completed through phone interview and out of this, 87% of these were returned through mail survey. Multivariate logit model and ordinal logit models were used for estimating association between SES and the quintiles of big five factors. Further, sensitivity analysis was used for estimating the change in SES for all the 32 combinations of the adjustment for big 5 factors of personality. Studys Findings Modest associations are observed between the SES and big 5 factors of the personality. Further, adjusting each of these variables will reveal that the personality accounts for around 20 percent in mortality and SES expressed 8% of the personality risk. Some of the SES as well as personality risk was explained with the health behaviors but some residual risks are still unexplained. Thus, findings of the study, also suggested that the both individual disposition and socio-structural inequalities hold publics health implications.. Demographic adjusted odd ratio for the 75th as compared to 25th percentile of neuroticism was 1.38 and

Socio, Economic, and Cultural Causes of Infant Mortality

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0.63 for conscientiousness; the latter one was evaluated at higher level for agreeableness. It is also found that the ameliorating SES-health disparity can be benefited from risk clustering of the social disadvantage as well as dispositional factors. Conclusion It was concluded that the SES, interface of the personality, and all cause mortality within United States is best defined by some degrees of correlated risk. It was found that the personality accounted for nearly 20 percent of risk that are associated with the lower SES, across both men and women.

Socio, Economic, and Cultural Causes of Infant Mortality Recommendations

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On analyzing the above five articles related to socio, economic, and cultural causes of infant mortality; it can be said that there are various causes for infant mortality. The several causes of infant mortality are ranked below as per their importance: I. II. III. IV. V. Racial disparity in pregnancy-related mortality those are associated with live birth. Association of childhood social-economic position with cause-specific mortality. Racial residential segregations that has impact on the high infant mortality rate. Impact of socioeconomic development on the risk of mortality. Personality, socioeconomic status, and all-cause mortality.

On analyzing the causes of infant mortality, the following recommendations are made in order to reduce the increasing infants mortality rate: first and foremost step in reducing infants mortality lies in the hands of mother. As racial disparity affects the infant mortality, specifically in case of minority women, the health care professional should implement strategies to make reproductive health care service more readily available to the Black and minority women. In addition to this, the public health programs as well as social policies needs to complement the medical practice and also to consider the social and psychological stress that the Black woman usually goes through. Next, as segregation restricts the economic and social advantage, so it must be eliminated. Further, the other recommendation is to eliminate the impact of early socio economic position and the adult disease through improved education, specifically to the lowest class.

Socio, Economic, and Cultural Causes of Infant Mortality References

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Chung, Y. Roger, Schooling, C. Mary, Cowling, J. Benjamin, and Leung, M. Gabriel. (2010). How Does Socioeconomic Development Affect Risk of Mortality? An Age-PeriodCohort Analysis From a Recently Transitioned Population in China. Am. J. Epidemiol 171 (3): 345-356. Retrieved from http://aje.oxfordjournals.org/content/171/3/345.full?sid=c67b0045-0d4b-4fce-87e342cd0721a927 Hearst, O. Mary, Oakes, J. Michael, and Jonson Jo Pamela. (2008). The Effect of Racial Residential Segregation on Black Infant Mortality. Am. J. Epidemiol 168 (11): 12471254. Retrieved from http://aje.oxfordjournals.org/content/168/11/1247.full?sid=427e9e001db8-40a3-9f40-525d4f114b02 Lawlor, A. Debbie, Sterne, A. C. Jonathan, Tynelius Per, Smith Davey George, and Rasmussen Finn. (2006). Association of childhood socioeconomic position with causespecific mortality in a prospective record linkage study of 1,839,384 individuals. Am J Epidemol 164:907-15. Retrieved from http://aje.oxfordjournals.org/content/164/9/907.full?sid=427e9e00-1db8-40a3-9f40525d4f114b02 Saftlas, F. Audrey, Koonin, M. Lisa, and Atrash, K. Hani. (2000). Racial disparity in pregnancy-related mortality associated with livebirth: can established risk factors explain it? Am J Epidemiol 152: 413-19. Retrieved from http://aje.oxfordjournals.org/content/152/5/413.full?sid=74a6bf8a-786f-4dcc-943132ad4bb012a1

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Chapman, P. Benjamin, Fiscella Kevin, Kawachi Ichiro, Duberstein, R. Paul. (2010) Personality, socioeconomic status, and all-cause mortality in the United States. Am J Epidemiol 171: 8392. Retrieved from http://aje.oxfordjournals.org/content/171/1/83.full?sid=c67b0045-0d4b-4fce-87e342cd0721a927