Levels of Urbanization and Parental Education in Relation to the Mortality Risk of Young Children
Abstract
:1. Introduction
2. Methods
2.1. Source of Data and Measures of Urbanization and Parental Education
2.2. Study Design, Measurements, and Statistical Analysis
3. Results
Variables | Study Groups | |||||||
---|---|---|---|---|---|---|---|---|
Lower Urbanization/Lower Parental Education | Lower Urbanization/Higher Parental Education | Higher Urbanization/Lower Parental Education | Higher Urbanization/Higher Parental Education | |||||
n | % | n | % | n | % | n | % | |
Gender | ||||||||
Boy | 318,052 | 52.3 | 104,564 | 52.0 | 205,590 | 52.1 | 147,442 | 52.2 |
Girl | 290,261 | 47.7 | 96,375 | 48.0 | 189,117 | 47.9 | 135,248 | 47.8 |
Type of birth | ||||||||
Singleton | 593,877 | 97.8 | 195,525 | 97.4 | 384,997 | 97.7 | 274,102 | 97.1 |
Twin | 12,440 | 2.1 | 4888 | 2.4 | 8561 | 2.2 | 7844 | 2.8 |
≥Triplets | 657 | 0.1 | 271 | 0.1 | 578 | 0.2 | 487 | 0.2 |
Birth order | ||||||||
1 | 248,534 | 40.9 | 100,774 | 50.2 | 172,196 | 43.7 | 142,623 | 50.5 |
2 | 218,292 | 35.9 | 74,673 | 37.2 | 145,710 | 36.9 | 109,162 | 38.6 |
3 | 110,415 | 18.2 | 22,477 | 11.2 | 62,399 | 15.8 | 27,594 | 9.8 |
≥4 | 30,733 | 5.1 | 2940 | 1.5 | 14,222 | 3.6 | 3239 | 1.2 |
Gestational wks | ||||||||
<32 | 8383 | 1.4 | 1973 | 1.0 | 4576 | 1.2 | 2507 | 0.9 |
32–36 | 37,752 | 6.2 | 11,427 | 5.7 | 23,622 | 6.0 | 16,618 | 5.9 |
≥37 | 562,178 | 92.4 | 187,539 | 93.3 | 366,509 | 92.9 | 263,565 | 93.2 |
x ± sd | 38.7 ± 1.8 | 38.7 ± 1.7 | 38.7 ± 1.8 | 38.7 ± 1.7 | ||||
Birth weight (g) | ||||||||
<1500 | 5918 | 1.0 | 1531 | 0.8 | 3320 | 0.8 | 2032 | 0.7 |
1500–2499 | 35,996 | 5.9 | 9833 | 4.9 | 22,088 | 5.6 | 14,017 | 5.0 |
≥2500 | 566,399 | 93.1 | 189,575 | 94.3 | 369,299 | 93.6 | 266,641 | 94.3 |
x ± sd | 3138 ± 478 | 3167 ± 456 | 3157 ± 476 | 3183 ± 463 | ||||
SGA a | ||||||||
Yes | 68,208 | 11.2 | 17,698 | 8.8 | 40,182 | 10.2 | 22,335 | 7.9 |
No | 540,105 | 88.8 | 183,241 | 91.2 | 354,525 | 89.8 | 260,355 | 92.1 |
LGA b | ||||||||
Yes | 60,095 | 9.9 | 20,750 | 10.3 | 41,203 | 10.4 | 31,506 | 11.2 |
No | 548,218 | 90.1 | 180,189 | 89.7 | 353,504 | 89.6 | 251,184 | 88.9 |
Maternal age (years) | ||||||||
<20 | 44,715 | 7.5 | 1729 | 0.9 | 18,848 | 4.8 | 1587 | 0.6 |
20–29 | 370,177 | 61.7 | 103,708 | 51.8 | 214,875 | 54.9 | 107,349 | 38.1 |
30–39 | 178,910 | 29.8 | 92,887 | 46.4 | 151,810 | 38.8 | 167,481 | 59.4 |
≥40 | 6270 | 1.0 | 2086 | 1.0 | 6118 | 1.6 | 5588 | 2.0 |
x ± sd | 26.8 ± 4.9 | 28.9 ± 4.1 | 27.9 ± 5.0 | 30.2 ± 4.1 | ||||
Paternal age (years) | ||||||||
<20 | 10,842 | 1.8 | 178 | 0.1 | 4,424 | 1.1 | 126 | 0.0 |
20–29 | 234,766 | 39.0 | 54,590 | 27.2 | 125,681 | 32.4 | 47,703 | 16.9 |
30–39 | 320,206 | 53.2 | 134,222 | 66.9 | 228,879 | 58.9 | 206,830 | 73.4 |
≥40 | 36,474 | 6.1 | 11,550 | 5.8 | 29,473 | 7.6 | 27,200 | 9.7 |
x ± sd | 30.5 ± 5.6 | 31.8 ± 4.5 | 31.4 ± 7.6 | 33.1 ± 9.7 | ||||
Total c | 608,313 | 40.9 | 200,939 | 13.5 | 394,707 | 26.6 | 282,690 | 19.0 |
Classification | No. of Deaths | (‰) | Unadjusted Estimates | Adjusted Estimates a | ||
---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | |||
<28 day mortality | ||||||
Urbanization | ||||||
Lower | 2890 | 2.88 | 1.34 | 1.26–1.42 | 1.34 | 1.26–1.42 |
Higher | 1806 | 3.73 | 1.00 | 1.00 | ||
Parental education | ||||||
Lower | 3427 | 3.42 | 1.30 | 1.22–1.39 | 1.28 | 1.19–1.37 |
Higher | 1269 | 2.62 | 1.00 | 1.00 | ||
<1 year mortality | ||||||
Urbanization | ||||||
Lower | 5241 | 5.23 | 1.36 | 1.30–1.42 | 1.32 | 1.26–1.38 |
Higher | 3227 | 6.67 | 1.00 | 1.00 | ||
Parental education | ||||||
Lower | 6295 | 6.28 | 1.40 | 1.33–1.47 | 1.28 | 1.22–1.36 |
Higher | 2173 | 4.49 | 1.00 | 1.00 | ||
<5 year mortality | ||||||
Urbanization | ||||||
Lower | 7045 | 7.02 | 1.46 | 1.41–1.52 | 1.39 | 1.34–1.45 |
Higher | 4049 | 8.37 | 1.00 | 1.00 | ||
Parental education | ||||||
Lower | 8363 | 8.34 | 1.48 | 1.42–1.55 | 1.34 | 1.28–1.40 |
Higher | 2731 | 5.65 | 1.00 | 1.00 |
Classification | No. of Deaths | (‰) | Unadjusted Estimates | Adjusted Estimates a | |||
---|---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | ||||
<28 day mortality | |||||||
Lower urbanization/lower parental education | 2289 | 3.76 | 1.60 | 1.46–1.74 | 1.60 | 1.46–1.76 | |
Lower urbanization/higher parental education | 601 | 2.99 | 1.27 | 1.13–1.41 | 1.31 | 1.17–1.46 | |
Higher urbanization/lower parental education | 1138 | 2.88 | 1.22 | 1.11–1.34 | 1.23 | 1.11–1.35 | |
Higher urbanization/higher parental education | 668 | 2.36 | 1.00 | 1.00 | |||
<1 year mortality | |||||||
Lower urbanization/lower parental education | 4221 | 6.94 | 1.71 | 1.60–1.82 | 1.58 | 1.48–1.70 | |
Lower urbanization/higher parental education | 1020 | 5.08 | 1.25 | 1.15–1.36 | 1.25 | 1.15–1.36 | |
Higher urbanization/lower parental education | 2074 | 5.25 | 1.29 | 1.20–1.39 | 1.22 | 1.13–1.31 | |
Higher urbanization/higher parental education | 1153 | 4.08 | 1.00 | 1.00 | |||
<5 year mortality | |||||||
Lower urbanization/lower parental education | 5731 | 9.42 | 1.89 | 1.78–2.00 | 1.71 | 1.61–1.82 | |
Lower urbanization/higher parental education | 1314 | 6.54 | 1.31 | 1.21–1.41 | 1.30 | 1.21–1.40 | |
Higher urbanization/lower parental education | 2632 | 6.67 | 1.33 | 1.25–1.42 | 1.24 | 1.16–1.33 | |
Higher urbanization/higher parental education | 1417 | 5.01 | 1.00 | 1.00 |
Causes | Lower Urbanization/Lower Parental Education | Lower Urbanization/Higher Parental Education | Higher Urbanization/Lower Parental Education | |||
---|---|---|---|---|---|---|
OR a | 95% CI | OR a | 95% CI | OR a | 95% CI | |
All causes | 1.71 | 1.61–1.82 | 1.30 | 1.21–1.40 | 1.24 | 1.16–1.33 |
Infectious and parasitic diseases (001–139) | 1.60 | 1.12–2.29 | 0.98 | 0.61–1.57 | 1.11 | 0.75–1.65 |
Neoplasm (140–239) | 1.47 | 1.00–2.17 | 1.65 | 1.06–2.56 | 0.90 | 0.58–1.40 |
Leukemia (204–208) | 2.06 | 1.05–4.04 | 2.78 | 1.34–5.75 | 1.25 | 0.5–2.64 |
Circulatory disease (390–459) | 1.73 | 0.62–4.87 | 1.69 | 0.51–5.57 | 1.00 | 0.31–3.21 |
Respiratory disease (460–519) | 2.97 | 1.63–5.42 | 2.18 | 1.08–4.39 | 1.56 | 0.81–3.02 |
Congenital anomalies (740–759) | 1.52 | 1.36–1.70 | 1.25 | 1.09–1.44 | 1.15 | 1.02–1.30 |
Conditions originating in the perinatal period (760–779) | 1.79 | 1.62–1.99 | 1.40 | 1.24–1.59 | 1.34 | 1.20–1.50 |
Injury and poisoning (800–999) | 2.41 | 1.99–2.91 | 1.39 | 1.09–1.76 | 1.38 | 1.12–1.69 |
4. Discussion
4.1. Major Findings
4.2. Strengths and Limitations
4.3. Interpretations and Implications
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Fang, H.-S.; Chen, W.-L.; Chen, C.-Y.; Jia, C.-H.; Li, C.-Y.; Hou, W.-H. Levels of Urbanization and Parental Education in Relation to the Mortality Risk of Young Children. Int. J. Environ. Res. Public Health 2015, 12, 7682-7696. https://doi.org/10.3390/ijerph120707682
Fang H-S, Chen W-L, Chen C-Y, Jia C-H, Li C-Y, Hou W-H. Levels of Urbanization and Parental Education in Relation to the Mortality Risk of Young Children. International Journal of Environmental Research and Public Health. 2015; 12(7):7682-7696. https://doi.org/10.3390/ijerph120707682
Chicago/Turabian StyleFang, Hsin-Sheng, Wei-Ling Chen, Chiu-Ying Chen, Chun-Hua Jia, Chung-Yi Li, and Wen-Hsuan Hou. 2015. "Levels of Urbanization and Parental Education in Relation to the Mortality Risk of Young Children" International Journal of Environmental Research and Public Health 12, no. 7: 7682-7696. https://doi.org/10.3390/ijerph120707682