Maternal Education And Age: Inequalities In Neonatal Death

Abstract

OBJECTIVE: Evaluate the interaction between maternal age and education level in neonatal mortality, as well as investigate the temporal evolution of neonatal mortality in each stratum formed by the combination of these two risk factors. METHODS: A nonconcurrent cohort study, resulting from a probabilistic relationship between the Mortality Information System and the Live Birth Information System. To investigate the risk of neonatal death we performed a logistic regression, with an odds ratio estimate for the combinedvariable of maternal education and age, as well as the evaluation of additive and multiplicativeinteraction. The neonatal mortality rate time series, according to maternal education and age,was estimated by the Joinpoint Regression program.RESULTS: The neonatal mortality rate in the period was 8.09‰ and it was higher in newborns ofmothers with low education levels: 12.7‰ (adolescent mothers) and 12.4‰ (mother 35 years oldor older). Low level of education, without the age effect, increased the chance of neonatal deathby 25% (OR = 1.25, 95%CI 1.14–1.36). The isolated effect of age on neonatal death was higher foradolescent mothers (OR = 1.39, 95%CI 1.33–1.46) than for mothers aged ≥ 35 years (OR = 1.16,95%CI 1.09–1.23). In the time-trend analysis, no age group of women with low education levelspresented a reduction in the neonatal mortality rate for the period, as opposed to women withintermediate or high levels of education, where the reduction was significant, around 4% annually.CONCLUSIONS: Two more vulnerable groups – adolescents with low levels of education andolder women with low levels of education – were identified in relation to the risk of neonataldeath and inequality in reducing the mortality rate