Infant mortality and income in 4 world cities: New York, London, Paris, and Tokyo

Abstract

Objectives: We investigated the association between average income or deprivation and infant mortality rate across neighborhoods of 4 world cities.

Methods: Using a maximum likelihood negative binomial regression model that controls for births, we analyzed data for 1988-1992 and 1993-1997.

Results: In Manhattan, for both periods, we found an association (.05% significance level) between income and infant mortality. In Tokyo, for both periods, and in Paris and London for period 1, we found none (5% significance level). For period 2, the association just missed statistical significance for Paris, whereas for London it was significant (5% level).

Conclusions: In stark contrast to Tokyo, Paris, and London, the association of income and infant mortality rate was strongly evident in Manhattan.

FIGURE 1—

Box plots of neighborhood infant mortality rate distributions for London, Manhattan, Paris, and Tokyo for (a) 1988–1992 and (b) 1993–1997, showing differences in spread and symmetry in the distribution of neighborhood infant mortality rates for the 4 cities. Note. The common vertical axis is the neighborhood infant mortality rate. The thick middle horizontal line across the full rectangle is at the median neighborhood rate on the vertical axis. The upper and lower horizontal lines of the full rectangle are at the 75th and 25th percentile rates, respectively. The remaining 2 horizontal lines, the whiskers, are at the largest and smallest rates of the distribution on the vertical axis, unless there are rates a substantial distance from the others. Such rates are outliers, and a box plot represents them as dots. For inner London, we included each of the 14 boroughs (Camden, City of London, Hackney, Hammersmith and Fulham, Haringey, Islington, Kensington and Chelsey, Lambeth, Lewisham, Newham, Southwark, Tower Hamlets, Wandsworth, and Westminster); for Manhattan, each of the 10 subborough units used by the Housing and Vacancy Survey (Greenwich Village/Financial District, Lower East Side, Chinatown, Stuyvesant Town/Turtle Bay, Upper West Side, Upper East Side, Morningside Heights/Hamilton Heights, Central Harlem, East Harlem, and Washington Heights/Inwood; for Paris, each of the well-known 20 arrondissements (1–20); and for inner Tokyo each of the 11 ku: Chiyoda, Chuo, Minato, Shinjuku, Bunkyo, Taito, Sumida, Koto, Shibuya, Toshima, and Arakawa. Source. The birth and death data on which these rates were based are available from the authors. London: Office of National Statistics, birth registration and linked mortality files, number of live births (1990–1997), population < 1 year of age and number of infant deaths (1988–1997). Manhattan: Data were extracted from birth and death files, Division of Vital Statistics, Department of Health and Mental Hygiene. Paris: 1988–1992 number of live births and infant deaths are from “La santé de la mère et de l’Enfant à Paris,” Département des Affaires Sanitaires et Sociales, Ville de Paris, July 2000. For the period 1993–1997, data were provided by Eric Jougla, Institut Nationale Scientifique d’Etudes et de Recherches Médicales (INSERM). Tokyo: 1988–1992 data are from Tokyo Eiseikyoku (1993), Annual Report on Health in Tokyo. Data on 1993–1997 are from Fiscal Year 2000 Report of the Bureau of Public Health, Tokyo Metropolitan Government, 2000.

FIGURE 1—

Box plots of neighborhood infant mortality rate distributions for London, Manhattan, Paris, and Tokyo for (a) 1988–1992 and (b) 1993–1997, showing differences in spread and symmetry in the distribution of neighborhood infant mortality rates for the 4 cities. Note. The common vertical axis is the neighborhood infant mortality rate. The thick middle horizontal line across the full rectangle is at the median neighborhood rate on the vertical axis. The upper and lower horizontal lines of the full rectangle are at the 75th and 25th percentile rates, respectively. The remaining 2 horizontal lines, the whiskers, are at the largest and smallest rates of the distribution on the vertical axis, unless there are rates a substantial distance from the others. Such rates are outliers, and a box plot represents them as dots. For inner London, we included each of the 14 boroughs (Camden, City of London, Hackney, Hammersmith and Fulham, Haringey, Islington, Kensington and Chelsey, Lambeth, Lewisham, Newham, Southwark, Tower Hamlets, Wandsworth, and Westminster); for Manhattan, each of the 10 subborough units used by the Housing and Vacancy Survey (Greenwich Village/Financial District, Lower East Side, Chinatown, Stuyvesant Town/Turtle Bay, Upper West Side, Upper East Side, Morningside Heights/Hamilton Heights, Central Harlem, East Harlem, and Washington Heights/Inwood; for Paris, each of the well-known 20 arrondissements (1–20); and for inner Tokyo each of the 11 ku: Chiyoda, Chuo, Minato, Shinjuku, Bunkyo, Taito, Sumida, Koto, Shibuya, Toshima, and Arakawa. Source. The birth and death data on which these rates were based are available from the authors. London: Office of National Statistics, birth registration and linked mortality files, number of live births (1990–1997), population < 1 year of age and number of infant deaths (1988–1997). Manhattan: Data were extracted from birth and death files, Division of Vital Statistics, Department of Health and Mental Hygiene. Paris: 1988–1992 number of live births and infant deaths are from “La santé de la mère et de l’Enfant à Paris,” Département des Affaires Sanitaires et Sociales, Ville de Paris, July 2000. For the period 1993–1997, data were provided by Eric Jougla, Institut Nationale Scientifique d’Etudes et de Recherches Médicales (INSERM). Tokyo: 1988–1992 data are from Tokyo Eiseikyoku (1993), Annual Report on Health in Tokyo. Data on 1993–1997 are from Fiscal Year 2000 Report of the Bureau of Public Health, Tokyo Metropolitan Government, 2000.