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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2006.087320v1 97/9/1658    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Singh, G. K. Articles by Kogan, M. D. Search for Related Content PubMed PubMed Citation Articles by Singh, G. K. Articles by Kogan, M. D. Related Collections Geography Adolescent Health African Americans/Blacks Socioeconomic Factors Mortality Surveillance

Gopal K. Singh, PhD, MS, MSc and Michael D. Kogan, PhD

Gopal K. Singh and Michael D. Kogan are with the Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Md.

Correspondence: Requests for reprints should be sent to Gopal K. Singh, Maternal and Child Health Bureau, Health Resources and Services Administration, 5600 Fishers Lane, Room 18–41, Rockville, MD 20857 (e-mail: gsingh{at}hrsa.gov).

Objectives. We examined the extent to which area socioeconomic inequalities in overall and cause-specific mortality among US children aged 1–14 years changed between 1969 and 2000.

Methods. We linked a census-based deprivation index to US county mortality data from 1969 to 2000. We used Poisson and log-linear regression and inequality indices to analyze temporal disparities.

Results. Despite marked declines in child mortality, socioeconomic gradients (relative mortality risks) in overall child mortality increased substantially during the study period. During 1969–1971, children in the most deprived socioeconomic quintile had 52%, 13%, 69%, and 76% higher risks of all-cause, birth defect, unintentional injury, and homicide mortality, respectively, than did children in the least deprived socioeconomic quintile. The corresponding relative risks increased to 86%, 44%, 177%, 159%, respectively from 1998–2000.

Conclusions. Dramatic reductions in mortality among children in all socioeconomic quintiles represent a major public health success. However, children in higher socioeconomic quintiles experienced much larger declines in overall, injury, and natural-cause mortality than did those in more deprived socioeconomic quintiles, which contributed to the widening socioeconomic gap in mortality. Widening disparities in child mortality may reflect increasing polarization among deprivation quintiles in material and social conditions.

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