Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, D.C, USA.
Independent Consultant, Tarragona, Spain.
Int J Equity Health. 2024 May 27;23(1):109. doi: 10.1186/s12939-024-02157-9.
The work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas.
Yearly data from 35 countries in the Americas during 2000-2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques.
A positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country's Gini index during 2000-2019 is associated with a 0.27 (95% CI [- 0.04, 0.57], P =.09) increase in the neonatal mortality rate.
The analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000-2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance.
世界卫生组织社会决定因素健康委员会的工作对于提供健康社会决定因素的概念框架至关重要。基于这一框架，本研究评估了收入不平等作为影响美洲新生儿死亡率的决定因素的关系，并将其与实现可持续发展目标 3.2 目标（将新生儿死亡率降低到每千例活产至少 12 例死亡）联系起来。其基本原理是评估收入不平等是否可以被视为影响美洲新生儿死亡率的社会因素。
收集了 2000-2019 年期间美洲 35 个国家的年度数据。数据来源包括联合国儿童死亡率估计机构间小组的新生儿死亡率（以每千例活产死亡人数衡量）和联合国大学世界发展经济学研究所的基尼指数（以 0 到 100 的规模衡量）。这是一项生态研究，采用线性回归模型将新生儿死亡率（因变量）与基尼指数（自变量）联系起来，同时控制影响新生儿死亡率的其他因素。使用面板数据技术获得系数估计值及其稳健标准误差。
在研究期间，发现美洲国家的收入不平等与新生儿死亡率之间存在正相关关系。具体而言，分析表明，一个国家在 2000-2019 年期间基尼指数增加一个单位，与新生儿死亡率增加 0.27（95%置信区间[-0.04，0.57]，P=0.09）相关。
分析表明，收入不平等可能与美洲的新生儿死亡率呈正相关。尽管如此，考虑到估计值和基尼指数的适度幅度以及 2000-2019 年的趋势，研究结果表明，在该地区实施再分配政策以支持降低新生儿死亡率的潜力有限。因此，解决国家卫生系统提供的服务覆盖范围和质量更高以及减少健康方面的社会经济不平等问题的政策和干预措施至关重要。
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