Widening socioeconomic disparities in US childhood mortality, 1969-2000

Objectives. We examined the extent to which area socioeconomic inequalities in overall and cause-specific mortality among US children aged 1-14 years changed between 1969 and 2000. Methods. We linked a census-based deprivation index to US county mortality data from 1969 to 2000. We used Poisson and log-linear regression and inequality indices to analyze temporal disparities. Results. Despite marked declines in child mortality, socioeconomic gradients (relative mortality risks) in overall child mortality increased substantially during the study period. During 1969-1971, children in the most deprived socioeconomic quintile had 52%, 13%, 69%, and 76% higher risks of all-cause, birth defect, unintentional injury, and homicide mortality, respectively, than did children in the least deprived socioeconomic quintile. The corresponding relative risks increased to 86%, 44%, 177%, 159%, respectively from 1998-2000. Conclusions. Dramatic reductions in mortality among children in all socioeconomic quintiles represent a major public health success. However, children in higher socioeconomic quintiles experienced much larger declines in overall, injury, and natural-cause mortality than did those in more deprived socioeconomic quintiles, which contributed to the widening socioeconomic gap in mortality. Widening disparities in child mortality may reflect increasing polarization among deprivation quintiles in material and social conditions.