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

Abstract

Background Infant mortality is considered an important and sensitive health indicator in several countries, especially in underdeveloped and developing countries. Most of the factors influencing infant mortality are interrelated and are the result of social issues. Therefore, this study performed a parallel investigation of the influence of the MHDI on the macro-region of residence and maternal education on infant mortality in a capital in the extreme south of Brazil. Methods It is a retrospective cohort study with data on births and deaths in the first year of live for the period of 2000-2017. The association between the independent variables and the outcome was done by bivariate analysis through simple Poisson regression. The variables that can potentially be considered confusing were used in a multiple Poisson regression for robust variances - adjusted model. Results The study included 311361 children, of whom 2271 died. 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). In relation to other related factors, maternal age; number of Prenatal Care Consultations; gestational age, weight, gender and Apgar Index (5th minute) of the newborn showed association with IM (p<0.001). Conclusions Although the HDI is considered a good predictor of infant mortality by some authors, the analyses of the present study did not present an association between the MHDI and death in the first year of life after adjustments for the other variables. Unlike the MHDI, maternal education under eight years of study maintained an association with infant death, proving to be a social determinant with relevant impact on infant mortality. Thus, it is concluded that maternal education, individually, is higher than the MHDI to assess the outcome of infant mortality and is easily accessible information.