Residential Segregation and Infant Mortality: A Multilevel Study Using Iranian Census Data
Nazari, S. S., Mahmoodi, M., Mansournia, M. A., Naieni, K. Holakouie, Iranian Journal of Public Health
Background: There is a great amount of literature concerning the effect of racial segregation on health outcomes but few papers have discussed the effect of segregation on the basis of social, demographic and economic characteristics on health. We estimated the independent effect of segregation of determinants of socioeconomic status on infant mortality in Iranian population.
Methods: For measuring segregation, we used generalized dissimilarity index for two group and multi group nominal variables and ordinal information theory index for ordinal variables. Sample data was obtained from Iranian latest national census and multilevel modeling with individual variables at level one and segregation indices measured at province level for socioeconomic status variables at level two were used to assess the effect of segregation on infant mortality.
Results: Among individual factors, mother activity was a risk factor for infant mortality. Segregated provinces in regard to size of the house, ownership of a house and motorcycle, number of literate individual in the family and use of natural gas for cooking and heating had higher infant mortality. Segregation indices measured for education level, migration history, activity, marital status and existence of bathroom were negatively associated with infant mortality.
Conclusion: Segregation of different contextual characteristics of neighborhood had different effects on health outcomes. Studying segregation of social, economic, and demographic factors, especially in communities, which are racially homogenous, might reveal new insights into dissimilarities in health.
Keywords: Residential segregation, Infant mortality, Generalized dissimilarity index, Information theory index
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One of the interesting issues in the fields of epidemiology and social science is the relation between the pattern of health outcomes and the context of where people live. During the past decade sociologists and epidemiologists have shown interest in how these contextual factors influence health. An important subset of these researches is concerned with whether differences in health outcomes like death, disease, having a risk factor among population subgroups like racial subgroups or groups defined by socioeconomic status or residential place are attributed to or at least associated with the patterns of racial, educational, marital, occupational residential segregation.
Most researchers in this field have investigated the effect of racial residential segregation on death outcomes so far. One of their common findings is that segregation is associated with black mortality (1-5). Some other studies have investigated the effect of racial residential segregation on non death outcomes like tuberculosis (6) , cardiovascular disease, early adolescence sexual activity (7-8), black homicide rate (9), poor self related health, high body mass index (10) , low birth weight (11- 12), health service use (13) and preterm birth in black population (14) .
Although most researches about segregation and health mention a negative effect, some show a positive effect of segregation (15-16).
Previous works on segregation had some limitations. First, segregation literature to date is mostly consisted of researches about racial segregation and the effect of segregation of socioeconomic and demographic factors on health outcomes has not been fully reviewed.
Second, most measuring instruments have been limited to calculating segregation between two categories of a variable. These indices are not appropriate for multi group nominal or ordinal variables. Third, the effect of segregation has been widely evaluated in western context and few studies have been performed in eastern societies.
This paper departs from theses traditions. With the help of the advanced methods of measuring segregation we measured segregation indices for multi group categorical and ordinal variables, using the national census data of one eastern country to evaluate the effect of segregation of markers of socioeconomic status on infant mortality. …