title: Social inequality in infant mortality: what explains variation across low and middle income countries?
abstract: Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household samples (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality.
authors.affiliation: Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, Quebec H3A 1A3, Canada. Electronic address: mohammad.hajizadeh@mcgill.ca.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hajizadeh
authors.affiliation: Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, Quebec H3A 1A3, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada.
authors.forename: Arijit
authors.initials: A
authors.lastname: Nandi
authors.affiliation: Fielding School of Public Health, The University of California-Los Angeles (UCLA), USA.
authors.forename: Jody
authors.initials: J
authors.lastname: Heymann
mesh_terms: D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Developing country; Infant mortality; Meta-regression analysis; Socioeconomic inequality