Etiological and ecological perspectives on geographical variations in infant mortality in British Columbia
Date
2017-12-01
Authors
Hu, Weimin
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Abstract
Infant mortality has been viewed widely as an important indicator of population health status. The infant mortality rate in British Columbia has fallen dramatically during the past three decades, and this province now has lowest rate in Canada. The infant mortality rate of Canada is the third lowest rate in the world, higher only than that of Japan and Sweden. Despite this general decline, however, geographical inequalities in infant mortality still exist in British Columbia at the Health Unit level. Reducing differences in health status amongst regions is a goal which has been addressed recently at the international level. “Health for All by year 2000” is a public health goal set by the World Health Organization. This dissertation seeks to investigate whether or not regional inequalities in infant mortality rates in British Columbia have fallen in the same way that the provincial mortality rate as a whole has declined. Secondly, it seeks to explore, etiologically and ecologically, any potential factors which may be responsible for existing geographical inequality in infant mortality at the Health Unit scale.
To achieve these goals an index of geographical inequality, essentially a weighted coefficient of variation, was first developed. This index was then compared to the provincial infant mortality rate to examine its temporal trend and to determine whether or not geographical inequalities in infant mortality have been declining in parallel to the mortality rate as a whole. Multi-variate analyses were then performed on selected etiological and ecological factors in order to identify significant factors responsible for Health Unit specific high infant mortality rates. They were used also to identify important ecological factors which may be responsible for the high prevalence rates of the more significant etiological factors leading to elevated infant mortality rates in specific Health Units. Using these results, interactive relationships amongst ecological determinants, etiological factors, and infant mortality rates were established.
These analyses established that regional variations in infant mortalities have not been reduced to the same degree as the provincial infant mortality rate. This is especially true of the post-neonatal mortality rate for which regional differences have increased during the past 10 years. This result leads to the conclusion that infant health status in specific Health Units has not improved in comparison to that in others. Multi-variate analysis suggests that the teenage birth rate is responsible for much of the regional inequality in post-neonatal mortality, and that family income level is the ecological factor which determines the prevalence of the teenage birth rate in specific Health Units. If this relationship is correct, it implies that the teenage birth rate should be reduced and the family economic condition should be improved, in order to mitigate regional inequalities in the infant mortality rate in British Columbia.
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Keywords
Infants, Mortality