ArticleBMC pregnancy and childbirth2019
Poverty, urban-rural classification and term infant mortality: a population-based multilevel analysis.
Article in BMC pregnancy and childbirth, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers.
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Who cites it
43 citing papers in PubMed.
- Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas.Frontiers in public health · 2025Trial
- Influence of maternal age on birth and infant outcomes at 6 months: a cohort study with quantitative bias analysis.International journal of epidemiology · 2023Trial
- Infant Mortality Rates of Non-Hispanic White and African-American Term Births: The Effect of Acknowledged Fathers' Education.Maternal and child health journal · 2026Article
- The Impact of Race and Ethnicity on Congenital Diaphragmatic Hernia 1-Year Mortality.Pediatric pulmonology · 2025Article
- Safe sleep crib clinics: Promoting risk reduction strategies for sudden unexpected infant death.PEC innovation · 2025Article
- Preventing Infant Mortality Through Medicaid-Administered Prenatal Care Coordination: Evidence From Wisconsin.Health services research · 2025Article
- A Linear Regression Analysis of Factors Affecting Social Determinants of Health Indicators.Acta medica Philippina · 2025Article
- Preventable neonatal mortality in the state of São Paulo: a spatial approach.Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo · 2025Article
- Association between infant mortality and community social vulnerability in the USA: a cross-sectional study.BMJ public health · 2025Article
- Mortality rates in a cohort of infants attending immunization clinics in Uganda (2017-2019).PloS one · 2025Observational
- The risk factors of infant mortality in Somalia: evidence from the 2018/2019 Somali health & demographic survey.BMC pediatrics · 2024Article
- An Application of Social Vulnerability Index to Infant Mortality Rates in Ohio Using Geospatial Analysis- A Cross-Sectional Study.Maternal and child health journal · 2024Article
- Maternal opioid use disorder and infant mortality in Wisconsin, United States, 2010-2018.Preventive medicine · 2024Article
- Rural-urban disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- Early neonatal mortality and determinants in sub-Saharan Africa: Findings from recent demographic and health survey data.PloS one · 2024Article
- Perinatal health effects of herbicides exposures in the United States: the Heartland Study, a Midwestern birth cohort study.BMC public health · 2023Article
- Health insurance coverage and poverty status of postpartum women in the United States in 2019: an ACS-PUMS population-based cross-sectional study.BMC public health · 2023Article
- Article
- Spatial spillover impact of determinants on child mortality in Pakistan: evidence from Spatial Durbin Model.BMC public health · 2023Article
- Infant Mortality Trends and Determinants in Kazakhstan.Children (Basel, Switzerland) · 2023Article
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3 authors.
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Abstract
backgroundU.S. mortality rate of term infants is higher than most other developed countries. Term infant mortality is associated with exogenous socio-environmental factors. Previous research links low socioeconomic status and rurality with high infant mortality, but does not examine the effect of individual level factors on this association. Separating out the effect of contextual factors from individual level factors has important implications for targeting interventions. Therefore, we aim to estimate the independent effect of poverty and urban-rural classification on term infant mortality.
methodsWe used linked 2013 period cohort birth-infant death files from the National Center for Health Statistics (NCHS). Counties were assigned to low, medium and high poverty groups using US Census Bureau county-level percent of children ≤18 years living in poverty, and were classified based on NCHS urban-rural classification. Bivariate and multilevel logistic regression models were used to estimate odds of term infant death, accounting for individual and county level variables.
resultsThere were 2,551,828 term births in 2013, with an overall term mortality of 2.1 per 1000 births. Odds of term infant mortality increased from 1.4 (95% CI: 1.2, 1.6) to 1.8 (95% CI: 1.6, 2.0) comparing births over increasing county poverty to those in the lowest. The associations remained significant in the multivariable model, for highest poverty 1.3 (95% CI: 1.1, 1.5). Similarly, the odds of term infant mortality increased with increasing rurality, from 1.3 (95% CI: 1.2, 1.5) in medium metro counties to 1.7 (95% CI: 1.5, 2.0) in non-core counties compared to large fringe metro counties. However, only rural non-core counties remained statistically associated with increased risk of term infant mortality after adjusting for individual level maternal characteristics.
conclusionsHigh poverty and very rural counties remained associated with term infant mortality independent of individual maternal sociodemographic, health and obstetric factors. Interventions should focus on contextual factors such as economic environment and availability of health and social services in addition to individual factors to reduce term infant mortality.
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