PDF(Pubmed)
Abstract：
BACKGROUND: The work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas.
METHODS: Yearly data from 35 countries in the Americas during 2000-2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques.
RESULTS: A positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country\'s Gini index during 2000-2019 is associated with a 0.27 (95% CI [- 0.04, 0.57], P =.09) increase in the neonatal mortality rate.
CONCLUSIONS: The analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000-2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance.
METHODS: Yearly data from 35 countries in the Americas during 2000-2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques.
RESULTS: A positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country\'s Gini index during 2000-2019 is associated with a 0.27 (95% CI [- 0.04, 0.57], P =.09) increase in the neonatal mortality rate.
CONCLUSIONS: The analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000-2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance.
摘要：
背景：世卫组织健康社会决定因素委员会的工作对于提供健康社会决定因素的概念框架至关重要。基于这个框架,这项研究评估了收入不平等作为美洲新生儿死亡率的决定因素的关系,并将其与可持续发展目标3.2(将新生儿死亡率降低至每1,000例活产中至少12例死亡)的实现联系起来.理由是评估收入不平等是否可以被视为影响美洲新生儿死亡率的社会因素。
方法：收集了2000-2019年美洲35个国家的年度数据。数据来源包括联合国机构间儿童死亡率小组新生儿死亡率估计(以每1000名活产儿新生儿死亡来衡量)和联合国大学世界发展经济学研究所的基尼系数(以0至100的等级来衡量)。这是一项生态学研究，采用线性回归模型，将新生儿死亡率（因变量）与基尼指数（自变量）相关联，同时控制影响新生儿死亡率的其他因素。使用面板数据技术获得了系数估计及其稳健的标准误差。
结果：在研究期间，在美洲国家发现收入不平等与新生儿死亡率之间存在正相关关系。特别是,分析表明，2000-2019年期间一国基尼系数的单位增长与0.27相关(95%CI[-0.04，0.57]，P=.09）新生儿死亡率增加。
结论：分析表明，在美洲，收入不平等可能与新生儿死亡率呈正相关。尽管如此，考虑到2000-2019年期间的估计值和基尼值和趋势不大,研究结果表明,支持该地区降低新生儿死亡率的再分配政策的范围可能有限.因此，提高国家卫生系统提供服务的覆盖面和质量以及减少卫生领域社会经济不平等的政策和干预措施至关重要。
方法：收集了2000-2019年美洲35个国家的年度数据。数据来源包括联合国机构间儿童死亡率小组新生儿死亡率估计(以每1000名活产儿新生儿死亡来衡量)和联合国大学世界发展经济学研究所的基尼系数(以0至100的等级来衡量)。这是一项生态学研究，采用线性回归模型，将新生儿死亡率（因变量）与基尼指数（自变量）相关联，同时控制影响新生儿死亡率的其他因素。使用面板数据技术获得了系数估计及其稳健的标准误差。
结果：在研究期间，在美洲国家发现收入不平等与新生儿死亡率之间存在正相关关系。特别是,分析表明，2000-2019年期间一国基尼系数的单位增长与0.27相关(95%CI[-0.04，0.57]，P=.09）新生儿死亡率增加。
结论：分析表明，在美洲，收入不平等可能与新生儿死亡率呈正相关。尽管如此，考虑到2000-2019年期间的估计值和基尼值和趋势不大,研究结果表明,支持该地区降低新生儿死亡率的再分配政策的范围可能有限.因此，提高国家卫生系统提供服务的覆盖面和质量以及减少卫生领域社会经济不平等的政策和干预措施至关重要。
