Blakely Tony, Atkinson June, Kiro Cindy, Blaiklock Alison, D'Souza Amanda
Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand.
Int J Epidemiol. 2003 Jun;32(3):410-8. doi: 10.1093/ije/dyg154.
Although the association between child mortality and socioeconomic status is well established, it is unclear whether child mortality differences by socioeconomic position are present at all ages. The association of one-parent families with mortality, and whether any such association is due to associated low socioeconomic position, is also not clear.
In all, 480 of 693 (69%) 0-14 year old deaths during 1991-1994 were linked to 1991 census records. Analyses were weighted to adjust for potential linkage bias.
There was approximately twofold higher mortality among the lowest compared with the highest socioeconomic categories of education, income, car access, and neighbourhood deprivation. Occupational class differences were weaker. These socioeconomic differences in mortality were strongest among infants (particularly sudden infant death syndrome [SIDS] mortality), but similar across other age groups (1-4, 5-9, and 10-14 years). The socioeconomic differences were of a similar magnitude for unintentional injury, cancer, congenital, and other deaths. Multivariable analyses demonstrated persistent independent associations of education, income, car access, and neighbourhood deprivation with mortality. Rate ratios (adjusted for age and ethnicity) for one-parent families compared with two-parent or other families were 1.2 (95% CI: 1.0, 1.5) and 1.8 (95% CI: 1.2, 2.5) for all-cause and unintentional injury mortality, respectively. Further adjustment for socioeconomic factors reduced these associations to 0.8 (95% CI: 0.6, 1.2) and 1.2 (95% CI: 0.7, 2.2), respectively.
There does not appear to be notable variation in relative risk terms of socioeconomic differences in child mortality by age or cause of death. Any association of one-parent families with child mortality is due to associated low socioeconomic position.
尽管儿童死亡率与社会经济地位之间的关联已得到充分证实，但尚不清楚社会经济地位导致的儿童死亡率差异是否在所有年龄段都存在。单亲家庭与死亡率之间的关联，以及这种关联是否归因于相关的低社会经济地位，也尚不明确。
1991年至1994年间，693例0至14岁儿童死亡病例中的480例（69%）与1991年人口普查记录相关联。分析采用加权法以调整潜在的关联偏倚。
在教育程度、收入、汽车拥有情况和邻里贫困程度等社会经济类别中，最低类别与最高类别相比，死亡率大约高出两倍。职业阶层差异则较弱。这些社会经济因素导致的死亡率差异在婴儿中最为显著（尤其是婴儿猝死综合征[SIDS]死亡率），但在其他年龄组（1至4岁、5至9岁和10至14岁）中类似。非故意伤害、癌症、先天性疾病和其他死因导致的社会经济差异幅度相似。多变量分析表明，教育程度、收入、汽车拥有情况和邻里贫困程度与死亡率之间存在持续的独立关联。单亲家庭与双亲家庭或其他家庭相比，全因死亡率和非故意伤害死亡率的率比（经年龄和种族调整）分别为1.2（95%置信区间：1.0, 1.5）和1.8（95%置信区间：1.2, 2.5）。进一步对社会经济因素进行调整后，这些关联分别降至0.8（95%置信区间：0.6, 1.2）和1.2（95%置信区间：0.7, 2.2）。
儿童死亡率的社会经济差异在相对风险方面，似乎不存在按年龄或死因划分的显著差异。单亲家庭与儿童死亡率之间的任何关联都归因于相关的低社会经济地位。
