Child and adolescent deaths by socioeconomic status in a high-income country: a cohort study

Abstract

Objective: To study time trends in mortality <18 years by parental education and household income.

Design: Cohort study with individual-level sociodemographic variables and cause of death data. We estimated HRs for child death adjusted for sex, birth year and country background.

Setting: Norway, a high-income country with free access to healthcare.

Participants: All individuals under 18 years of age living in Norway and regardless of country of birth were included, yielding 3 015 222 individuals.

Exposures: Maternal and paternal education, and standardised household income.

Main outcome measures: Death <18 years, in four age groups and for 11 categories of causes of death.

Results: The child mortality rate declined from 74.7 to 19.4 per 100 000 person-years between 1990 and 2022. The adjusted HR (aHR) was 1.55 (95% CI 1.48 to 1.63) for the lowest and 1.23 (1.18 to 1.28) for the intermediate, compared with the highest level of maternal education. The aHR comparing low and high maternal education increased from 1.51 in the first to 1.60 in the second half of the observation period (p(interaction)=0.001). The aHR for low versus high maternal education was highest for age 1-11 months 2.33 (2.08 to 2.61) and weakest for 5-17 years 1.17 (1.07 to 1.27), and significantly increased across causes of death except for suicide and cancer. Paternal education yielded similar associations with mortality compared with maternal education. Household income was inversely associated with mortality, particularly for the lowest third.

Conclusion: We observed significant differences in mortality by parental education and income in all age categories <18 years and for most causes of death.

Keywords: Adolescent; Cot death; EPIDEMIOLOGY; PUBLIC HEALTH.