摘要：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. Mortality among US children aged 1–14 years has declined sharply over the past 3 decades, from a rate of 54.3 deaths per 100000 population in 1969 to 21.2 in 2002. 1 , 2 Conversely, 99.7% of children aged 1 year survived to age 15 in 2002, compared with 99.2% in 1969–1971 and 90.2% in 1900–1902. 3 Despite the overall improvement in child mortality over the long term, contemporary social disparities remain quite marked. Black children experience approximately twice the mortality rate of White, Asian, and Hispanic children, 1 , 2 and children in low-income families experience a higher mortality that is 2 to 3 times higher than their counterparts in high-income families. 4 Reducing and ultimately eliminating health inequalities, including those in childhood mortality, is one of the most important priorities of the US Department of Health and Human Services, as specified in Healthy People 2010 . 5 Documentation of health disparities between the least and most deprived groups can tell us the extent to which child mortality can be reduced. Monitoring such disparities over time allows us to track progress toward achieving the Healthy People 2010 objectives and to evaluate the role of specific social, behavioral, and public policy interventions in reducing childhood mortality. Because household socioeconomic data are not available in national mortality statistics, socioeconomic differentials in US child mortality cannot be readily examined. However, socioeconomic differentials can be analyzed by linking census socioeconomic data with child mortality statistics at the small-area level, such as counties. Although there are a few studies that have examined the substantial inverse association between socioeconomic status and child mortality, such analyses are rarely done in a temporal fashion. 4 , 6 – 8 No studies, to our knowledge, have analyzed how US child mortality rates have changed in recent decades in relation to area deprivation. In this study, we used a comprehensive area-deprivation index to examine the extent to which socioeconomic inequalities in overall and cause-specific mortality among US children aged 1–14 years changed between 1969 and 2000.
