A Multivariate Assessment of the Effects of Residence on Infant Mortality*

Abstract

This research examines the relationship between residence and infant mortality. The purpose of the study was to identify the effects of maternal residence on infant mortality, using a multivariate model which included both individual and county-level variables known to be associated with suboptimal birth outcome. Data on all births in Florida during 1987 were drawn from birth and infant death certificates. In addition, information concerning county sociodemographic structure and medical resources were gathered and linked to the individual records. After examining the distributions of selected risk variables across a five-category measure of residence (from most urban to most rural), a logit model was estimated to predict the odds of an infant death associated with maternal residence. At the bivariate level, rural residents were found to have increased odds of an infant death compared to residents of all other residence categories. Second, a logit model was estimated that controlled for the influence of important maternal, infant, and county risk characteristics. The results of this second, more fully specified model indicate that residence did not have an independent direct effect on infant mortality when the influence of the other risk factors was controlled. We conclude that although residence does not influence infant mortality directly, it does influence mortality indirectly through its association with key risk factors. In particular, because population characteristics and medical resources are differentially distributed across rural and urban areas, residence remains an important factor to be considered when predicting health outcomes. The implications of these findings for policy-makers and health planners, as well as for health services researchers, are also discussed.

Birth Outcomes and Infant Mortality by the Degree of Rural Isolation Among First Nations and Non-First Nations in Manitoba, Canada

“…A number of studies have examined the degree of rural isolation and birth outcomes using various measures of rural isolation, and the findings have been inconsistent 29,30,32,33 . No previous studies have examined whether the effects of rural isolation per se on birth outcomes may differ among Aboriginal and non‐Aboriginal populations.…”

“…A number of studies have examined the degree of rural isolation and birth outcomes using various measures of rural isolation, and the findings have been inconsistent. 29,30,32,33 No previous studies have examined whether the effects of rural isolation per se on birth outcomes may differ among Aboriginal and non-Aboriginal populations. Our results indicate that the degree of rural isolation may have some differential associations with the risks of adverse birth outcomes for First Nations and non-First Nations.…”

Delivery Complications Associated With Prenatal Care Access for Medicaid‐Insured Mothers in Rural and Urban Hospitals

“…Hospitals in non-MSAs were defined as rural. [19][20][21] Race or Ethnicity is defined as African American, non-Hispanic white (hereafter white), Hispanic, and Asian. 5,6,22,[25][26][27][28][29][30] These are categories reported by the NIS, which, aside from a small number of American Indians, provides no further details regarding race or ethnicity.…”

Community Remoteness, Perinatal Outcomes and Infant Mortality among First Nations in Quebec~!2009-12-02~!2010-04-12~!2010-07-06~!

“…Most studies reported that remoteness was associated with an elevated risk of adverse birth outcomes, but no or reverse associations were also observed in other studies in developed countries [18–23]. It is unclear whether these differential findings could be explained by the variable measures of remoteness, or by true differential associations in different regions due to different socioeconomic and heath care context associated with remoteness.…”

“…Several studies have examined the association between the degree of remoteness and birth outcomes in the general population of some regions in developed countries [18–23]. Most studies reported that remoteness was associated with an elevated risk of adverse birth outcomes, but no or reverse associations were also observed in other studies in developed countries [18–23].…”