Levels of Urbanization and Parental Education in Relation to the Mortality Risk of Young Children.
BACKGROUND
The establishment of the National Health Insurance program in Taiwan in 1995 effectively removed the financial barrier to access health care services of Taiwanese people. This population-based cohort study aimed to determine the independent and joint effects of parental education and area urbanization on the mortality risk among children under the universal health insurance coverage in Taiwan since 1995.


METHODS
We linked 1,501,620 births from 1996 to 2000 to the Taiwan Death Registry to estimate the neonatal, infant, and under-five mortality rates, according to the levels of parental education and urbanization of residential areas. We used a logistic regression model that considers data clustering to estimate the independent and joint effects.


RESULTS
Lower levels of parental education and area urbanization exerted an independent effect of mortality on young children, with a stronger magnitude noted for areas with lower levels of urbanization. Children whose parents had lower levels of education and who were born in areas with lower levels of urbanization experienced the highest risk for neonatal (odds ratio (OR) = 1.60, 95% CI = 1.46-1.76), infant (OR = 1.58, 95% CI = 1.48-1.70), and under-five (OR = 1.71, 95% CI = 1.61-1.82) mortality.


CONCLUSIONS
Even with universal health insurance coverage, lower levels of area urbanization and parental education still exerted independent and joint effects on mortality in young children. This finding implies the inadequate accessibility to health care resources for children from socially disadvantaged families and less urbanized areas.
['Fang|Hsin-Sheng|HS|', 'Chen|Wei-Ling|WL|', 'Chen|Chiu-Ying|CY|', 'Jia|Chun-Hua|CH|', 'Li|Chung-Yi|CY|', 'Hou|Wen-Hsuan|WH|']
D044466:Asians D002648:Child D046688:Child Mortality D015331:Cohort Studies D005260:Female D007722:Health Knowledge, Attitudes, Practice D006801:Humans D007223:Infant D007226:Infant Mortality D016015:Logistic Models D008297:Male D009313:National Health Programs D016017:Odds Ratio D010290:Parents D012042:Registries D013624:Taiwan D014507:Urbanization
cohort studies under-five mortality infant mortality neonatal mortality socioeconomic status