An assessment of spatial and socioeconomic determinants of infant mortality, and reliability of infant mortality data in Hermosillo, Mexico

This cross-sectional study conducted in Hermosillo, the capital of Sonora, Mexico, a state located in the Northwestern Border Region, used secondary data sources from Mexican governmental agencies to examine the completeness and accuracy of cause-of-death statements (CODS) of infant death certificates, as well as its impact on reliability of infant mortality statistics. We found that there are limitations in the quality of CODS in the study setting, which could lead to inappropriate interpretation of infant mortality statistics.; By means of spatial analysis we explored the spatial patterns of infant mortality at the census tract-level identified local clusters of high infant mortality rates in socially deprived census tracts. It was also observed that the highest infant mortality rates corresponded to census tracts with high level of social marginality. This finding might be explained by a contextual effect of socioeconomic status on the risk of individual infant death, as shown by multilevel modeling of a linked birth-death data set provided by Mexican governmental agencies. An independent effect of low birthweight and sex of newborn was also observed at the individual level. We emphasize that the overall level of infant mortality remains unacceptably high in Hermosillo, even in census tracts with low level of social marginality, so in the short and long terms it seems necessary to implement concerted efforts to reduce intra-urban disparities of infant mortality in the city.; Our results fill a gap in the understanding of spatial patterns of infant mortality as well as in the importance for improving the quality of infant mortality data in Mexico. The utility of incorporating analytic strategies such as spatial and multilevel analyses to the study of infant mortality has been shown. It also has been shown the importance of carrying out systematic study of small areas to identify variations in the distribution of risk factors and infant health outcomes. Our findings can help policy makers, researchers, and public health personnel to address a variety of activities in infant health programs and investigations at the local and state levels. Finally, this dissertation may foster discussions on intra-urban health disparities in Northern Mexico.