Environmental and socio-economic determinants of infant mortality in Poland: an ecological study

Climate vulnerability and child health outcomes in developing countries: Do women's political empowerment and female education make the difference?

Health as a common good is of paramount importance for the world, especially in developing countries. This paper contributes to the literature by analysing the effect of climate vulnerability on child health outcomes in a sample of 107 developing countries over the period 2000-2020. We also analyse the mediating role of women's political empowerment and women's education in the relationship between climate vulnerability and child health outcomes. Using the method of generalised moments in a two-stage system and linear regression absorbing several levels of fixed effects, we found robust evidence that climate vulnerability worsens child health outcomes. We also found that women's political empowerment (WPE) and women's education mitigate the negative effect of climate vulnerability on child health outcomes. These results remain robust against several alternative tests and therefore highlight the need to better examine how the health consequences of climate vulnerability are structured by gender in developing countries. Given the importance of women as agents of change, it would be more beneficial for policymakers to include them in the decision-making process.

Emission of Industrial Air Pollution and Mortality Due to Respiratory Diseases: A Birth Cohort Study in Poland

BACKGROUND

Air pollution is a major risk factor for public health worldwide, but evidence linking this environmental problem with the mortality of children in Central Europe is limited.

OBJECTIVE

To investigate the relationship between air pollution due to the emission of industry-related particulate matter and mortality due to respiratory diseases under one year of age.

METHODS

A retrospective birth cohort analysis of the dataset including 2,277,585 children from all Polish counties was conducted, and the dataset was matched with 248 deaths from respiratory diseases under one year of age. Time to death during the first 365 days of life was used as a dependent variable. Harmful emission was described as total particle pollution (TPP) from industries. The survival analysis was performed using the Cox proportional hazards model for the emission of TPP at the place of residence of the mother and child, adjusted individual characteristics, demographic factors, and socioeconomic status related to the contextual level.

RESULTS

Infants born in areas with extremely high emission of TPP had a significantly higher risk of mortality due to respiratory diseases: hazard ratio (HR) = 1.781 [95% confidence interval (CI): 1.175, 2.697], p = 0.006, compared with those born in areas with the lowest emission levels. This effect was persistent when significant factors were adjusted at individual and contextual levels (HR = 1.959 [95% CI: 1.058, 3.628], p = 0.032). The increased risk of mortality was marked between the 50th and 150th days of life, coinciding with the highest exposure to TPP.

CONCLUSIONS

The emission of TPP from industries is associated with mortality due to respiratory diseases under one year of age. A considerable proportion of children's deaths could be prevented in Poland, especially in urban areas, if air pollution due to the emission of particle pollution is reduced.

Russian subject-level index of multidimensional deprivation and its association with all-cause and infant mortality

Background

Social and environmental inequalities in public health are recognized as global problems of our time. From the point of view of the theory of deprivation, social and environmental determinants identified as deprivation indicators, which help to detect health inequality. Indices are one of the most practical and powerful tools for measuring the level of deprivation.

Objectives

The aims of our study are (1) to develop a Russian derivation index to measure the levels of deprivation and (2) to analyze its associations with total and infant mortality.

Material and methods

Deprivation indicators were obtained from the Federal State Statistics Service of Russia. All mortality data were taken from the official website of the Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation from 2009 to 2012. Principal components analysis with varimax rotation was used to (1) select suitable deprivation indicators and (2) create the index. A Spearman's correlation was run to determine the relationship of deprivation with all-cause and infant mortality. Ordinary least squares (OLS) regression was used to assess the relationship between deprivation and infant mortality. Development of the index and statistical analysis were carried out using R and SPSS software.

Results

There is not a statistically significant correlation between deprivation and all-cause mortality. OLS regression showed a significant relationship between deprivation and infant mortality (p = 0.02). For every one-unit increase in the index score, infant mortality rate increases by about 20%.

The Labin Region, an ecologically vulnerable geographical area in Croatia: Mortality characteristics in an area polluted by industrial over a 40-year period

The history of the Labin region in Croatia includes intensive industrial development with repercussions of pollution on environment and health. Assuming that prolonged exposure to polluted environments causes qualitative changes in mortality, the aim was to analyse the mortality characteristics of the population of the Labin Region for the 1968-2008 period based on data from the Croatian Bureau of Statistics. Public health and social opportunities in this geographical area carry a long-term burden of exposure to an industrial polluted environment with outcomes expressed by mortality or/and morbidity in the population. This study includes data on 11,903 deaths, most of which due to diseases of the circulatory, respiratory and digestive systems as well as neoplasms. In the third and fourth decade of the study period, a group of neoplasms showed significant increases, while the increase in respiratory diseases were more gradual. The female population died mostly from diseases of the circulatory and endocrine system as well as neoplasms, while the male population mainly died from diseases of the digestive system and external causes. This research provides guidelines that could create better public health, raising the quality of life and contribute to a future environmental protection in local communities by targeted policies.

Cherish your children: socio-economic and demographic characteristics associated with child mortality

BACKGROUND

The United Nations Interagency Group for Child Mortality Estimation (UNIGME) indicates that child mortality is the death rate of children between age zero to five. The importance of this area of research is high where worldwide a number of studies have been led on infant and child mortality, despite limited research discoveries with regards to Sri Lanka. The aim of this study is to investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.

METHODS

Using the context of Sri Lanka as a case study, this study carried out based on data gathered from the micro level national survey. Using the logit regression model through the step-wise technique, the study investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.

RESULTS

According to the generated results, place of residence province-wise, household head's education level and source of drinking water have negative effect (lower risk) on child mortality in Sri Lanka. Exceptionally, the Western province has the highest negative effect on child mortality which demonstrates it as the least harmful region in Sri Lanka in child endurance. Household heads who owns private entities and Sri Lankan Moors has a positive effect on child mortality as well.

CONCLUSION

This study is helpful to address the population health of local arena and results can be supportive to the government and policymakers to gain an overview of physical health status of the country and able to uplift their policies based on the new findings.

The Nexus between Sustainable Economic Development and Government Health Expenditure in Asian Countries Based on Ecological Footprint Consumption

Health has vital importance in maintaining economic development since it is essential for, and a result of, economic development. This indicates that health makes a large contribution in achieving sustainable development and health outcomes. The significance of health is shown in the millennium development goals (MDGs) and in the sustainable development goals (SDGs), where four of the seventeen objectives focus on improving health outcomes (UN, 2021). As compared to other countries, some Asian countries are still worse off regarding health outcomes and are facing challenges in achieving positive outcomes for such goals. This study mainly focuses on identifying the link between public health expenditures and health outcomes in nine Asian economies from 2000 to 2018. The study implements fixed effects panel data estimations by using the Hausman specification test to identify the fixed effects model as the suitable estimator for the study. The empirical results from the fixed effects technique show that immunization, GDP per capita, trade openness, and utilization of basic water service facilities improve under-five and infant mortality in Asian economies. However, ecological footprint increases under-five and infant deaths by damaging the environment.

Disparities in infant mortality by payment source for delivery in the United States

In this study, we hypothesized that infant mortality varies among health insurance status. Furthermore, we examined whether there are racial and ethnic disparities in the association between infant death and payment source for delivery. Our study used US national linked birth and infant death data for 2013 and 2017 collected by the National Center for Health Statistics and included 3,311,504 and 3,218,168 live births for each year. The principal source of payment for delivery was classified into three groups: Medicaid, private insurance, and self-payment. The outcome measures were infant mortality, neonatal mortality, and postneonatal mortality. Subgroup analysis for race and ethnicity was also performed. Overall infant mortality was lower in mothers who paid with private insurance than in those who paid with Medicaid insurance (RR = 0.87, 95% CI 0.84-0.90 in 2013; RR = 0.91, 95% CI 0.87-0.94 in 2017), but it was higher in self-paid women than in Medicaid-insured women at delivery (RR = 1.25, 95% CI 1.17-1.33 in 2013; RR = 1.16, 95% CI 1.08-1.24 in 2017). Non-Hispanic black (RR = 1.67, 95% CI 1.47-1.90 in 2013; RR = 1.16, 95% CI 1.00-1.35 in 2017) and Hispanic (RR = 1.30, 95% CI 1.17-1.44 in 2013; RR = 1.22, 95% CI 1.09-1.36 in 2017) mothers with self-payment had a higher risk for infant mortality than those with Medicaid at delivery. Newborns whose mothers have no health insurance would be more vulnerable to infant mortality than Medicaid beneficiaries, and non-white ethnic groups with self-payment would have an elevated risk of infant mortality among other racial and ethnic groups.

Mortalidad infantil y desigualdades sociales en Argentina, 1980-2017

Objetivo.

Estimar la tendencia de la mortalidad infantil, de la desigualdad entre jurisdicciones y de la desigualdad asociada a las condiciones sociales en Argentina entre 1980 y 2017.

Métodos.

Estudio ecológico y de serie temporal de la mortalidad infantil y de su desigualdad. Se obtuvieron los datos oficiales de mortalidad infantil, de nacimientos y de necesidades básicas insatisfechas; se calculó la tasa de mortalidad infantil, el índice de Gini y el índice de concentración. También se analizó la tendencia con un modelo de regresión lineal y se calculó el coeficiente de regresión y su significación estadística.

Resultados.

La mortalidad infantil se redujo 71,2% (de 32,41 a 9,34 por 1 000 nacidos vivos). La desigualdad por jurisdicción también se redujo y el índice de Gini pasó de 0,163 a 0,09. La desigualdad asociada a las condiciones sociales también mostró una reducción, y el índice de concentración disminuyó de -0,153 a -0,079. Si bien la mortalidad infantil se redujo en todo el período, este descenso no siempre se acompañó de una reducción del índice de Gini y del índice de concentración.

Conclusiones.

La tendencia de la tasa de mortalidad infantil fue al descenso mientras que la desigualdad en su distribución por jurisdicción y la desigualdad asociada a las condiciones sociales no siempre acompañaron esa reducción.

Spatiotemporal association of low birth weight with Cs-137 deposition at the prefecture level in Japan after the Fukushima nuclear power plant accidents: an analytical-ecologic epidemiological study

BACKGROUND

Perinatal mortality increased in contaminated prefectures after the Fukushima Daichi Nuclear Power Plant (FDNPP) accidents in Japan in 2011. Elevated counts of surgeries for cryptorchidism and congenital heart malformations were observed throughout Japan from 2012 onward. The thyroid cancer detection rate (2011 to 2016) was associated with the dose-rate at the municipality level in the Fukushima prefecture. Since the birth weight is a simple and objective indicator for gestational development and pregnancy outcome, the question arises whether the annual birth weight distribution was distorted in a dose-rate-dependent manner across Japan after Fukushima.

METHODS

The Japanese Ministry of Health, Labour, and Welfare provides prefecture-specific annual counts for 26.158 million live births from 1995 to 2018, of which 2.366 million births (9.04%) with weights < 2500 g. Prefecture-specific spatiotemporal trends of the low birth weight proportions were analyzed. Logistic regression allowing for level-shifts from 2012 onward was employed to test whether those level-shifts were proportional to the prefecture-specific dose-rates derived from Cs-137 deposition in the 47 Japanese prefectures.

RESULTS

The overall trend of the low birth weight prevalence (LBWp) in Japan discloses a jump in 2012 with a jump odds ratio (OR) 1.020, 95%-confidence interval (1.003,1.037), p-value 0.0246. A logistic regression of LBWp on the additional dose-rate after the FDNPP accidents adjusted for prefecture-specific spatiotemporal base-line trends yields an OR per μSv/h of 1.098 (1.058, 1.139), p-value < 0.0001. Further adjusting the logistic regression for the annual population size and physician density of the prefectures, as well as for the counts of the dead, the missing, and the evacuees due to earthquake and tsunami (as surrogate measures for medical infrastructure and stress) yields an OR per μSv/h of 1.109 (1.032, 1.191), p-value 0.0046.

CONCLUSIONS

This study shows increased low birth weight prevalence related to the Cs-137 deposition and the corresponding additional dose-rate in Japan from 2012 onward. Previous evidence suggesting compromised gestational development and pregnancy outcome under elevated environmental ionizing radiation exposure is corroborated.

Environmental Justice in Industrially Contaminated Sites. A Review of Scientific Evidence in the WHO European Region

In the WHO European Region the topic of contaminated sites is considered a priority among environment and health themes. Communities living in or close to contaminated sites tend to be characterized by a high prevalence of ethnic minorities and by an unfavorable socioeconomic status so rising issues of environmental justice. A structured review was undertaken to describe the contents of original scientific studies analyzing distributive and procedural justice in industrially contaminated sites carried out in the WHO European Region in the period 2010⁻2017. A systematic search of the literature was performed. In total, 14 articles were identified. Wherever assessments on environmental inequalities were carried out, an overburden of socioeconomic deprivation or vulnerability, with very few exemptions, was observed. The combined effects of environmental and socioeconomic pressures on health were rarely addressed. Results show that the studies on environmental and health inequalities and mechanisms of their generation in areas affected by industrially contaminated sites in the WHO European Region are in their early stages, with exemption of UK. Future efforts should be directed to improve study strategies with national and local assessments in order to provide evidence for equity-oriented interventions to reduce environmental exposure and related health risks caused by industrial contamination.

Cumulative Risk and Impact Modeling on Environmental Chemical and Social Stressors

PURPOSE OF REVIEW

The goal of this review is to identify cumulative modeling methods used to evaluate combined effects of exposures to environmental chemicals and social stressors. The specific review question is: What are the existing quantitative methods used to examine the cumulative impacts of exposures to environmental chemical and social stressors on health?

RECENT FINDINGS

There has been an increase in literature that evaluates combined effects of exposures to environmental chemicals and social stressors on health using regression models; very few studies applied other data mining and machine learning techniques to this problem. The majority of studies we identified used regression models to evaluate combined effects of multiple environmental and social stressors. With proper study design and appropriate modeling assumptions, additional data mining methods may be useful to examine combined effects of environmental and social stressors.

Adverse neonatal outcomes and house prices in London

Objective To explore whether the average price of houses per postcode sector [sector house average prices (SHAP)] is related to perinatal outcomes and whether gestational age would be lower and mortality higher in the least expensive areas compared to the most expensive. Methods All neonatal unit admissions at King's College Hospital from 1/1/2012 to 31/12/2016 were reviewed. The SHAP was retrieved from the Land Registry and the population was divided in equal quintiles with quintiles 1 and 5 representing the most and least expensive areas, respectively. Gestational age and birth weight z-score were collected. Mortality was defined as death before discharge from neonatal care. Results Three thousand three hundred and sixty infants were included and divided in quintiles consisting of 672 infants. Gestational age was lower in quintile 5 compared to all other quintiles (adjusted P<0.001). Birthweight z-score was not significantly different between the quintiles. The SHAP was lower in the infants who died before discharge (n=92) compared to the SHAP of the infants who were alive at discharge (n=3268) (P<0.001). Infants of quintile 5 had 6 times higher risk of death before discharge from neonatal care compared to infants of quintile 1. Conclusion Low SHAPs were associated with poorer perinatal outcomes suggesting SHAP could potentially be used in perinatal populations to determine socio-economic status and associated outcomes.

The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh

INTRODUCTION

Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly.

OBJECTIVES

This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions).

DESIGN

We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality.

RESULTS

The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh.

CONCLUSION

The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.