National Institute for Occupational Health, Johannesburg, South Africa.
Glob Health Action. 2013 Jan 24;6:19278. doi: 10.3402/gha.v6i0.19278.
Disparities in health outcomes between the poor and the better off are increasingly attracting attention from researchers and policy makers. However, policies aimed at reducing inequity need to be based on evidence of their nature, magnitude, and determinants.
The study aims to investigate the relationship between household socio-economic status (SES) and under-five mortality, and to measure health inequality by comparing poorest/least poor quintile mortality rate ratio and the use of a mortality concentration index. It also aims to describe the risk factors associated with under-five mortality at Rufiji Demographic Surveillance Site (RDSS), Tanzania.
This analytical cross sectional study included 11,189 children under-five residing in 7,298 households in RDSS in 2005. Principal component analysis was used to construct household SES. Kaplan-Meier survival incidence estimates were used for mortality rates. Health inequality was measured by calculating and comparing mortality rates between the poorest and least poor wealth quintile. We also computed a mortality concentration index. Risk factors of child mortality were assessed using Poisson regression taking into account potential confounders.
Under-five mortality was 26.9 per 1,000 person-years [95% confidence interval (CI) (23.7-30.4)]. The poorest were 2.4 times more likely to die compared to the least poor. Our mortality concentration index [-0.16; 95% CI (-0.24, -0.08)] indicated considerable health inequality. Least poor households had a 52% reduced mortality risk [incidence rate ratio (IRR) = 0.48; 95% CI 0.30-0.80]. Furthermore, children with mothers who had attained secondary education had a 70% reduced risk of dying compared to mothers with no education [IRR = 0.30; 95% CI (0.22-0.88)].
Household socio-economic inequality and maternal education were associated with under-five mortality in the RDSS. Targeted interventions to address these factors may contribute towards accelerating the reduction of child mortality in rural Tanzania.
穷人和富人之间健康结果的差距越来越受到研究人员和政策制定者的关注。然而，旨在减少不平等的政策需要基于其性质、程度和决定因素的证据。
本研究旨在调查家庭社会经济地位（SES）与五岁以下儿童死亡率之间的关系，并通过比较最贫穷/最不贫穷五分位死亡率比和使用死亡率集中指数来衡量健康不平等。它还旨在描述坦桑尼亚 Rufiji 人口监测点（RDSS）与五岁以下儿童死亡相关的风险因素。
这项分析性横断面研究包括 2005 年 RDSS 中居住在 7298 户家庭的 11189 名五岁以下儿童。主成分分析用于构建家庭 SES。Kaplan-Meier 生存发生率估计用于死亡率。通过计算和比较最贫穷和最不富裕财富五分位之间的死亡率来衡量健康不平等。我们还计算了死亡率集中指数。使用泊松回归考虑潜在混杂因素评估儿童死亡的危险因素。
五岁以下儿童死亡率为每 1000 人年 26.9 人[95%置信区间（CI）（23.7-30.4）]。最贫穷的人死亡的可能性是最不贫穷的人的 2.4 倍。我们的死亡率集中指数[-0.16；95%CI（-0.24，-0.08）]表明存在相当大的健康不平等。最不贫穷的家庭死亡风险降低了 52%[发病率比（IRR）=0.48；95%CI 0.30-0.80]。此外，母亲受过中学教育的儿童死亡风险降低了 70%，而没有受过教育的母亲[IRR=0.30；95%CI（0.22-0.88）]。
RDSS 中家庭社会经济不平等和母亲教育与五岁以下儿童死亡有关。针对这些因素的有针对性的干预措施可能有助于加速坦桑尼亚农村儿童死亡率的降低。
