title: Levels of Urbanization and Parental Education in Relation to the Mortality Risk of Young Children.
abstract: BACKGROUND
  The establishment of the National Health Insurance program in Taiwan in 1995 effectively removed the financial barrier to access health care services of Taiwanese people. This population-based cohort study aimed to determine the independent and joint effects of parental education and area urbanization on the mortality risk among children under the universal health insurance coverage in Taiwan since 1995.
  
  
  METHODS
  We linked 1,501,620 births from 1996 to 2000 to the Taiwan Death Registry to estimate the neonatal, infant, and under-five mortality rates, according to the levels of parental education and urbanization of residential areas. We used a logistic regression model that considers data clustering to estimate the independent and joint effects.
  
  
  RESULTS
  Lower levels of parental education and area urbanization exerted an independent effect of mortality on young children, with a stronger magnitude noted for areas with lower levels of urbanization. Children whose parents had lower levels of education and who were born in areas with lower levels of urbanization experienced the highest risk for neonatal (odds ratio (OR) = 1.60, 95% CI = 1.46-1.76), infant (OR = 1.58, 95% CI = 1.48-1.70), and under-five (OR = 1.71, 95% CI = 1.61-1.82) mortality.
  
  
  CONCLUSIONS
  Even with universal health insurance coverage, lower levels of area urbanization and parental education still exerted independent and joint effects on mortality in young children. This finding implies the inadequate accessibility to health care resources for children from socially disadvantaged families and less urbanized areas.
authors.affiliation: School of Preclinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China. oneal0831@yahoo.com.tw.|The Sun Vitality Clinic, Taichung 43748, Taiwan. oneal0831@yahoo.com.tw.
authors.forename: Hsin-Sheng
authors.initials: HS
authors.lastname: Fang
authors.affiliation: Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 10845, Taiwan. ivy2657356@hotmail.com.
authors.forename: Wei-Ling
authors.initials: WL
authors.lastname: Chen
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung 40454, Taiwan. chence@mail.cmu.edu.tw.
authors.forename: Chiu-Ying
authors.initials: CY
authors.lastname: Chen
authors.affiliation: School of Preclinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China. jiachunhua125@163.com.
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Jia
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung 40454, Taiwan. chence@mail.cmu.edu.tw.|Department and Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan. chence@mail.cmu.edu.tw.
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.affiliation: Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan. houwh@tmu.edu.tw.|School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan. houwh@tmu.edu.tw.|Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 11031, Taiwan. houwh@tmu.edu.tw.|Center for Evidence-Based Medicine, Taipei Medical University, Taipei 11031, Taiwan. houwh@tmu.edu.tw.
authors.forename: Wen-Hsuan
authors.initials: WH
authors.lastname: Hou
mesh_terms: D044466:Asian People; D002648:Child; D046688:Child Mortality; D015331:Cohort Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D016015:Logistic Models; D008297:Male; D009313:National Health Programs; D016017:Odds Ratio; D010290:Parents / Q000193:education*; D012042:Registries; D013624:Taiwan / Q000453:epidemiology; D014507:Urbanization
keywords: cohort studies; infant mortality; neonatal mortality; socioeconomic status; under-five mortality