The European Journal of Public Health Advance Access published online on December 26, 2007
The European Journal of Public Health, doi:10.1093/eurpub/ckm125
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Neonatal and postneonatal mortality by maternal education—a population-based study of trends in the Nordic countries, 1981–2000
Annett Arntzen1, Laust Mortensen2, Ole Schnor2, Sven Cnattingius3, Mika Gissler4 and Anne-Marie Nybo Andersen2,5
1 Faculty of Social Science, Vestfold University College, PO Box 2243, N-3303 Tønsberg, Norway
2 National Institute of Public Health, Øster Farimagsgade 5A, DK-1399 Copenhagen K, Denmark
3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281 S-17177 Stockholm, Sweden
4 STAKES, National Research and Development Centre for Welfare and Health, PO Box 220, FIN-00531 Helsinki, Finland
5 Department of Epidemiology, University of Southern Denmark, JB Winsløw Vej 9B, DK-500 Odense, Denmark
Correspondence: Annett Arntzen, Faculty of Social Science, Vestfold University College, PO Box 2243, N-3303 Tønsberg, Norway, tel: +47 33031201, fax: +47 33031105, e-mail: annett.arntzen{at}hive.no
Received May 29, 2007 , accepted December 3, 2007
Background: This study examined changes in the educational gradients in neonatal and postneonatal mortality over a 20-year period in the four largest Nordic countries. Methods: The study populations were all live-born singleton infants with gestational age of at least 22 weeks from 1981 to 2000 (Finland 1987–2000). Information on births and infant deaths from the Medical Birth Registries was linked to information from census statistics. Numbers of eligible live-births were: Denmark 1 179 831, Finland 834 299 (1987–2000), Norway 1 017 168 and Sweden 1 971 645. Differences in mortality between education groups were estimated as risk differences (RD), relative risks (RR) and index of inequality ratio (RII). Results: Overall, rates of infant mortality were in Denmark 5.9 per 1000 live-births, in Finland 4.2 (1987–2000), in Norway 5.3 and in Sweden 4.7. Overall the mortality decreased in all educational groups, and the educational level increased in the study period. The time-trends differed between neonatal and postneonatal death. For neonatal death, both the absolute and relative educational differences decreased in Finland and Sweden, increased in Denmark, whereas in Norway a decrease in absolute differences and a slight increase in relative differences occurred. For postneonatal death, the relative educational differences increased in all countries, whereas the absolute differences decreased. Conclusions: All educational groups experienced a decline in infant mortality during the period under study. Still, the inverse association between maternal education and RR of postneonatal death has become more pronounced in all Nordic countries.
Keywords: educational level, neonatal mortality, Nordic countries, postneonatal mortality, time-trends