Inequalities in mortality of infants under one year of age according to foetal causes and maternal age in rural and urban areas in Poland, 2004-2013.
BACKGROUND
European countries are characterized by low mortality during the infancy period compared to other areas of the world. However, there are significant disparities in the state of infant health which are related to socio-economic conditions and place of residence.


OBJECTIVE
Analysis of mortality in Poland from foetal and maternal causes (length of gestation, birth weight, maternal age) in the neonatal and post-neonatal period depending on place of residence (rural and urban areas) in 2004-2013.


METHODS
Data on mortality during the neonatal and infancy period in 2004-2013 was obtained from the Central Statistical Office. Diagnosed cases of deaths in rural and urban areas were analyzed, taking into account the causes of death according to ICD-10, the duration of pregnancy in weeks, birth weight, and maternal age. Trend analysis and comparison of mortality between rural and urban areas were performed using the Poisson regression model.


RESULTS
In rural areas, neonatal and post-neonatal death rates due to congenital malformations were siginificantly higher than in urban areas. The mortality rate was also higher in rural areas in children born to women aged 20-34 years, and children born after 37 weeks gestation with low birth weight. In the cities, higher post-neonatal mortality was due to respiratory diseases, and in children born after 37 weeks gestation to mothers under the age of 20 years. A decrease in the mortality of newborns and infants was observed, but in rural areas neonatal mortality decreased significantly more slowly.


CONCLUSIONS
The results indicate the need to intensify programmes aimed at improving access to prenatal and maternity care, especially among women in rural areas.
Department of Public Health, Medical University of Bialystok, Poland.
Agnieszka
A
Genowska
Department of Public Health, Medical University of Bialystok, Poland.
Magdalena
M
Zalewska
Department of Public Health, Medical University of Bialystok, Poland.
Jacek
J
Jamiołkowski
Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland.
Urszula
U
Stepaniak
Institute of Rural Health, Lublin, Poland.
Andrzej
A
Szpak
Department of Developmental Medicine and Pediatric Nursing, Medical University of Bialystok, Poland.
Elżbieta
E
Maciorkowska
School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland.
Jarosław
J
Pinkas
D001724:Birth Weight; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D008423:Maternal Age; D011044:Poland / Q000453:epidemiology; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population