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Journal of Epidemiology and Community Health is pleased to make
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two weeks

*Global health inequalities: an international comparison *


J P Ruger, Department of Epidemiology and Public Health, Yale
University
School of Medicine, Graduate School of Arts and Sciences, School
of Law,
New Haven, Connecticut, USA

H-J Kim, Department of Social Welfare, Gyeongsang National
University,
Jinju, South Korea

*Journal of Epidemiology and Community Health 2006;60:928-936;
doi:10.1136/jech.2005.041954*

Available online at:
http://jech.bmj.com/cgi/content/full/60/11/928?ijkey=XkAYYVRG6pO1M&keytype=ref&siteid=bmjjournals




*Objective*: To study cross-national inequalities in mortality
of adults
and of children aged <5 years using a novel approach, with
clustering
techniques to stratify countries into mortality groups (better-off,
worse-off, mid-level) and to examine risk factors associated with
inequality.


*Design*, setting and participants: Analysis of data from the World
Development Indicators 2003 database, compiled by the World Bank.


*Main outcome measures*: Adult and child mortality among countries
placed into distinct mortality categories by cluster analysis.


*Results:* 29 countries had a high adult mortality (mean
584/1000; range
460/1000 to 725/1000) and 23 had a high child mortality (mean
207/1000,
range 160/1000 to 316/1000). All these countries were in western
and
sub-Saharan Africa and Afghanistan. Bivariate analyses showed that
relative to countries with low child mortality, those with high
child
mortality had significantly higher rates of extreme poverty
(p<0.001),
populations living in rural areas (p<0.001) and female illiteracy
(p<0.001), significantly lower per capita expenditure on healthcare
(p<0.001), outpatient visits, hospital beds and doctors, and
lower rates
of access to improved water (p<0.001), sanitation (p<0.001) and
immunisations. In multivariate analyses, countries with high adult
mortality had a higher prevalence of HIV infection (odds ratio
per 1%
increase 18.6; 95% CI 0.3 to 1135.5). Between 1960 and 2000,
adult male
mortality in countries with high mortality increased at >4 times
the
rate in countries with low mortality. For child mortality, the
worse-off
group made slower progress in reducing <5 mortality than the
better-off
group.


*Conclusions:* Inequalities in child and adult mortality are
large, are
growing, and are related to several economic, social and health
sector
variables. Global efforts to deal with this problem require
attention to
the worse-off countries, geographic concentrations, and adopt
multidimensional approaches to development



*      *      *     *
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