Inequalities in infant mortality in Colombia: 2000-2011
Background: The infant mortality rate (IMR), defined as the annual number of deaths of infants under the age of one year per 1,000 live births, is commonly used as an indicator of health in a population. A variety of factors are associated with the IMR, including maternal education level, quality of healthcare, access to health services, health insurance coverage, access to sanitation and clean water, public health practices, maternal health, and per capita Gross Domestic Product (GDP). Infant mortality is often broken down into subgroups (early, late and postneonatal mortality) since rates and causes of death vary within these groups. A review of the literature has revealed a scarcity of current information regarding socioeconomic factors associated with infant mortality in Colombia specifically. A better understanding of the relationship between socioeconomic factors and infant mortality rates in Colombia will help to inform policy decisions at national and departmental levels. Research Question: The goal of the current research is to describe the overall trend in infant mortality rates in Colombia between 2000 and 2011, to examine regional variation in early neonatal, late neonatal and postneonatal mortality rates in Colombia, and to examine the relationship between maternal education level, health insurance coverage, and departmental GDP on early neonatal, late neonatal and postneonatal mortality rates for the years 2000-2011. Methods: A secondary data analysis of the vital statistics database collected by the National Administrative Department of Statistics was performed for years 2000-2011. Poisson regression was utilized to model early neonatal, late neonatal, postneonatal and total infant mortality rates. Incidence-rate ratios were used to compare mortality rates between groups. Results: Early neonatal, late neonatal, postneonatal and total infant mortality rates in Colombia all decreased significantly between 2000 and 2011 (43%, 26%, 40%, and 38%, respectively). Mortality rates were highest in Caribe and Amazonía regions and lowest in the Orinoquía region. IMR was significantly higher for infants whose mothers were in the subsidized/linked healthcare scheme compared to the contributory scheme (IRR=1.57, p<0.000). IMR was significantly lower for infants whose mothers had completed some/all of a primary education, some/all of a secondary education, or more than a secondary education compared to infants whose mothers had less than a basic primary education (IRR=.47, .31, .22, respectively, p<0.000). IMR was significantly lower in medium and high GDP departments than low GDP departments in the unadjusted model (IRR=.85, .84, respectively, p<0.000), but in overall model including other SES variables, year and gender, IMR was highest in high GDP departments. Conclusion: Early neonatal, late neonatal, postneonatal, and total infant mortality rates in Colombia decreased significantly between 2000 and 2011, with early neonatal mortality exhibiting the most pronounced rate of decrease. The Amazonía and Caribe regions presented the highest rates of infant mortality across age groups. Of the socioeconomic factors examined, low maternal education level was the strongest independent risk factor for infant mortality.
Van Winkle, Lauren, "Inequalities in infant mortality in Colombia: 2000-2011" (2015). Texas Medical Center Dissertations (via ProQuest). AAI1597553.