No abstract

In this paper, Weibull unobserved heterogeneity (frailty) survival models are utilized to analyze the determinants of infant and child mortality in Kenya. The results of these models are compared to those of standard Weibull survival models. The study particularly examines the extent to which child survival risks continue to vary net of observed factors and the extent to which nonfrailty models are biased due to the violation of the statistical assumption of independence. The data came from the 1998 Kenya Demographic and Health Survey. The results of the standard Weibull survival models clearly show that biodemographic factors are more important in explaining infant mortality, while socioeconomic, sociocultural and hygienic factors are more important in explaining child mortality. Frailty effects are substantial and highly significant both in infancy and in childhood, but the conclusions remain the same as in the nonfrailty models. Copyright Springer Science+Business Media B.V. 2007Determinants of infant and child mortality, Mortality differentials, Unobserved heterogeneity, Frailty, Sub-Saharan Africa, Kenya,

This study applies multilevel logistic regression to Demographic and Health Survey data from 22 sub‐Saharan African countries to examine whether the relationship between child mortality and family structure, with a specific emphasis on polygyny, varies cross‐nationally and over time. Hypotheses were developed on the basis of competing theories on the relationship between child health and family structure. Although children of mothers in polygynous marriages are more likely to die than those of mothers in monogamous unions, the relationship is constant across time. Familial factors including education, socioeconomic status (SES), and urban residence accounted for most of the observed cross‐national variation associated with polygyny. Consequently, improving maternal education and household SES would greatly benefit child health in sub‐Saharan Africa.

BackgroundNumerous studies have examined associations between air pollution and pregnancy outcomes, but most have been restricted to urban populations living near monitors.ObjectivesWe examined the association between pregnancy outcomes and fine particulate matter in a large national study including urban and rural areas.MethodsAnalyses were based on approximately 3 million singleton live births in Canada between 1999 and 2008. Exposures to PM2.5 (particles of median aerodynamic diameter ≤ 2.5 μm) were assigned by mapping the mother’s postal code to a monthly surface based on a national land use regression model that incorporated observations from fixed-site monitoring stations and satellite-derived estimates of PM2.5. Generalized estimating equations were used to examine the association between PM2.5 and preterm birth (gestational age < 37 weeks), term low birth weight (< 2,500 g), small for gestational age (SGA; < 10th percentile of birth weight for gestational age), and term birth weight, adjusting for individual covariates and neighborhood socioeconomic status (SES).ResultsIn fully adjusted models, a 10-μg/m3 increase in PM2.5 over the entire pregnancy was associated with SGA (odds ratio = 1.04; 95% CI 1.01, 1.07) and reduced term birth weight (–20.5 g; 95% CI –24.7, –16.4). Associations varied across subgroups based on maternal place of birth and period (1999–2003 vs. 2004–2008).ConclusionsThis study, based on approximately 3 million births across Canada and employing PM2.5 estimates from a national spatiotemporal model, provides further evidence linking PM2.5 and pregnancy outcomes.CitationStieb DM, Chen L, Beckerman BS, Jerrett M, Crouse DL, Omariba DW, Peters PA, van Donkelaar A, Martin RV, Burnett RT, Gilbert NL, Tjepkema M, Liu S, Dugandzic RM. 2016. Associations of pregnancy outcomes and PM2.5 in a National Canadian Study. Environ Health Perspect 124:243–249; http://dx.doi.org/10.1289/ehp.1408995

Numerous studies have examined the association of air pollution with preterm birth and birth weight outcomes. Traffic-related air pollution has also increasingly been identified as an important contributor to adverse health effects of air pollution. We employed a national nitrogen dioxide (NO2) exposure model to examine the association between NO2 and pregnancy outcomes in Canada between 1999 and 2008. National models for NO2 (and particulate matter of median aerodynamic diameter <2.5µm (PM2.5) as a covariate) were developed using ground-based monitoring data, estimates from remote-sensing, land use variables and, for NO2, deterministic gradients relative to road traffic sources. Generalized estimating equations were used to examine associations with preterm birth, term low birth weight (LBW), small for gestational age (SGA) and term birth weight, adjusting for covariates including infant sex, gestational age, maternal age and marital status, parity, urban/rural place of residence, maternal place of birth, season, year of birth and neighbourhood socioeconomic status and per cent visible minority. Associations were reduced considerably after adjustment for individual covariates and neighbourhood per cent visible minority, but remained significant for SGA (odds ratio 1.04, 95%CI 1.02-1.06 per 20ppb NO2) and term birth weight (16.2g reduction, 95% CI 13.6-18.8g per 20ppb NO2). Associations with NO2 were of greater magnitude in a sensitivity analysis using monthly monitoring data, and among births to mothers born in Canada, and in neighbourhoods with higher incomes and a lower proportion of visible minorities. In two pollutant models, associations with NO2 were less sensitive to adjustment for PM2.5 than vice versa, and there was consistent evidence of a dose-response relationship for NO2 but not PM2.5. In this study of approximately 2.5 million Canadian births between 1999 and 2008, we found significant associations of NO2 with SGA and term birth weight which remained significant after adjustment for PM2.5, suggesting that traffic may be a particularly important source with respect to the role of air pollution as a risk factor for adverse pregnancy outcomes.

We used data from the 1991-2006 Canadian Census Mortality and Cancer Follow-up Study to compare all-cause mortality for immigrants with that of the Canadian-born population. The study addressed two related questions. First, do immigrants have a mortality advantage over the Canadian-born? Second, if immigrants have a mortality advantage, does it persist as their duration of residence increases? The analysis fitted sex-stratified hazard regression models for the overall sample and for selected countries of birth (UK, China, India, Philippines, and the Caribbean). Predictors were assessed at baseline. Mortality was lower among immigrants than the Canadian-born even after adjusting for a selected group of socio-demographic and socio-economic factors. The mortality differences persisted even after long residence in Canada, but appeared to be dependent on the age of the individual and the country of origin. Interpreted in light of known explanations of immigrant mortality advantage, the results mostly reflect selection effects.

Background: Immigrants, a fast-growing population in Canada, score below the national average in health literacy, but the reasons behind the low scores are largely unknown. Also, there is a need to understand the long-term impact of immigration by examining health literacy by generational status. Objective: To examine health literacy differentials in Canada, comparing immigrants and non-immigrants; as well as immigrant sub-groups by their region of origin, recency of arrival and generational status. Methods: A cross-sectional multi-stage representative sample of 22,818 respondents from the Canadian component of the 2003 International Adult Literacy and Skills survey. Data were collected in the home of each respondent. We used descriptive statistics and logistic regression in this study. Results: Fewer immigrants (24%) than non-immigrants (44%) had the requisite health literacy level. After controlling for selected factors, health literacy was still significantly lower for immigrants compared to non-immigrants (OR = 0.51; 95% CI = 0.37 – 0.70). For the immigrant sub-groups and by generations, initial differences that were observed, disappeared after controlling for selected factors. Overall, health literacy was associated with economic, education, and literacy-related factors, but the association with literacy practices at home and at work was stronger for the immigrants than the non-immigrants. Conclusion: Education and literacy practices at home and at work are important determinants of the population’s health literacy; however, education is more likely to be associated with acquisition, while literacy practices are more likely associated with maintenance of health literacy. This adds to our understanding of the factors associated with health literacy, by immigrant and generational status, and shows how different segments of the population in Canada process health information.

Random-effect models have been useful in demonstrating how unobserved factors are related to infant or child death clustering. Another potential hypothesis is state dependence whereby the death of an older sibling affects the risk of death of a subsequent sibling. Probit regression models incorporating state dependence and unobserved heterogeneity are applied to the 1998 Demographic and Health Survey (DHS) data for Kenya. We find that mortality risks of adjacent siblings are dependent: a child whose preceding sibling died is 1.8 times more likely to die. After adjusting for unobserved heterogeneity, the death of the previous child accounts for 40% of child death clustering. Further, eliminating state dependence would reduce infant mortality among second-and higher-order births by 12.5%.