Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981–1999
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
- Correspondence to: Dr T Blakely Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand; tblakelywnmeds.ac.nz
- Accepted 5 April 2005
Abstract
Background: Socioeconomic inequalities in child mortality are known to exist; however the trends in these inequalities have not been well examined. This study examines the trends in child mortality inequality between 1981 and 1999 against the background of the rapid and dramatic social and economic restructuring in New Zealand during this time period.
Methods: Record linkage studies of census and mortality records of all New Zealand children aged 0–14 years on census night 1981, 1986, 1991, 1996, each followed up for three years for mortality between ages 1–14 years. Socioeconomic position was measured using maternal education, household income, and highest occupational class in the household. Standardised mortality rates, rate ratios, and rates differences as well as regression based measures of inequality were calculated.
Results: Mortality in all socioeconomic groups fell between 1981 and 1999. Socioeconomic inequality in child mortality existed by all measures of socioeconomic position, however only trends by income suggested a change over time: the relative index of inequality increased from 1.5 in 1981–84 to 1.8 in 1996–99 (p trend 0.06), but absolute inequality remained stable (slope index of inequality 15/100 000 in 1981–84 and 14/100 000 in 1996–99.
Conclusions: Dramatic changes in income in New Zealand possibly translated into increasing relative inequality in child mortality by income, but not by education or occupational class. The a priori hypothesis that socioeconomic inequalities in child mortality would have increased in New Zealand during a period of rapid structural reform and widening income inequalities was only partly supported.
Footnotes
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Funding: Caroline Shaw acknowledges salary support from the Australasian Faculty of Public Health Medicine during the course of this research. The New Zealand census-mortality study was initially funded by the Health Research Council of New Zealand. The Ministry of Health New Zealand is now the primary funding agency for this study.
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Competing interests: none.
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Ethical approval: the programme of work of the New Zealand census mortality study has approval from the Wellington Ethics Committee (reference number 98/7).
