Disparities of infant and neonatal mortality trends in Greece during the years of economic crisis by ethnicity, place of residence and human development index: a nationwide population study

Abstract

ObjectiveTo study trends of infant mortality rate (IMR) and neonatal mortality rate in Greece during the period 2004–2016 and explore the role of sociodemographic factors in the years of crisis.DesignNationwide individual data for live births and infant (0–11 months) deaths provided by the Hellenic Statistical Authority were examined using Poisson, joinpoint regression and interrupted time series (ITS) analyses.SettingGreece.ParticipantsAll infant deaths (n=4862) over the 13-year period, of which 87.2% were born to Greek mothers, and respective live births.Main outcome measuresEvolution of IMR (0–364 days), early (<7 days) neonatal mortality rate (ENMR), late (7–27 days) neonatal mortality rate (LNMR) and post neonatal (28–364 days) mortality rate (PNMR) trends, by maternal nationality, place of residence and Human Development Index (HDI).ResultsBy Poisson regression, overall, during the study period, among infants of Greek mothers, IMR and PNMR declined significantly (−0.9%; 95% CI −1.7% to −0.1% and −1.6%; −3.0% to −0.2% annually, respectively), although differentially by place of residence (IMRurban: −2.1%; −2.9% to −1.3%, IMRrural: +10.6%; 7.6% to 13.6%). By contrast, among infants of non-Greek mothers, the low starting IMR/ENMR/LNMR/PNMR increased significantly (max ENMR:+12.5%; 8.6% to 16.5%) leading to a non-significant time–trend pattern overall in Greece. The inverse associations of HDI with IMR, ENMR and PNMR were restricted to Greek mothers’ infants. Joinpoint regression analyses among Greek mothers’ infants indicated non-significant increasing trends of IMR and ENMR following the crisis (+9.3%, 2012–2016, p=0.07 and +10.2%, 2011–2016, p=0.06, respectively). By contrast, the high (+17.1%; 8.1% to 26.9%, p=0.002) IMR increases among non-Greek infants were restricted to 2004–2011 and equalised to those of Greek mothers’ infants thereafter. ITS analyses in preset years (2008, 2010, 2012) identified significantly increasing trends in IMR, LNMR and PNMR after 2012, and in ENMR after 2010, among Greek mothers’ infants.ConclusionsHDI and rural residence were significantly associated with IMR. The strongly decreasing IMR trends among Greek-mothers’ infants were stagnated after a lag time of ~4 years of crisis approximating the previously sharply increasing trends among non-Greeks.

Economic Crisis Impact and Social Determinants of Perinatal Outcomes and Infant Mortality in Greece

“…The dramatic deterioration of socio-economic conditions affected several aspects of the population’s health [ 5 , 6 , 7 ]. Adverse effects on perinatal parameters [ 8 , 9 , 10 ] and infant mortality have also been investigated [ 11 , 12 , 13 ]. Studies based on early data from Greece, had controversial findings, recording elevated stillbirth rates but not significant changes in infant mortality [ 8 , 11 ].…”

“…Studies based on early data from Greece, had controversial findings, recording elevated stillbirth rates but not significant changes in infant mortality [ 8 , 11 ]. Subsequent studies observed significant adverse effects on both perinatal parameters [ 9 , 10 ] and infant mortality [ 12 , 13 ], although they did not provide an estimation of the magnitude of that impact. Data from other affected European countries also found elevated low birth weight rates in the post-crisis period [ 14 , 15 ], but the findings of the impact on infant mortality remained controversial [ 15 , 16 , 17 ].…”

The influence of the Municipal Human Development Index compared to maternal education on infant mortality: a retrospective cohort study in the extreme south of Brazil

“…In recent years, different authors have investigated factors related to infant mortality and maternal-infant health conditions. Regarding the influence of socioeconomic factors, the literature has shown that there are differences according to the place studied [17][18][19]. In the present study, maternal education, individually and jointly analyzed with the MHDI, showed association with the outcome of infant death in the first year of life, particularly for children of mothers with lower maternal education (p < 0.001).…”

“…Research that assessed the influence of the HDI of the maternal home region, when at birth, on health outcomes, showed that this indicator when low is associated with worse outcomes with respect to child neuropsychomotor development [39,40] and also with higher infant mortality rates [19,41]. In a study with data from 188 countries, Ruiz and collaborators [41] found that IM was correlated with low HDI and low inequality-adjusted HDI, with the latter being more strongly correlated than the former (Z = 2.524, p = 0.012).…”

The influence of the Municipal Human Development Index and maternal education on infant mortality: a parallel investigation in a retrospective cohort study in the extreme south of Brazil

“…In recent years, different authors have investigated factors related to infant mortality and maternal-infant health conditions. Regarding the in uence of socioeconomic factors, the literature has shown that there are differences according to the place studied [17][18][19]. In the present study, maternal education, individually and jointly analyzed with the MHDI, showed association with the outcome of infant death in the rst year of life, particularly for children of mothers with lower maternal education (p<0.001).…”