This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dzakpasu, S.
Right arrow Articles by Allen, A. C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Dzakpasu, S.
Right arrow Articles by Allen, A. C.
Related Collections
Right arrow Premature & Newborn
Right arrow Infectious Disease & Immunity

PEDIATRICS Vol. 106 No. 1 July 2000, p. e5

ELECTRONIC ARTICLE:
The Matthew Effect: Infant Mortality in Canada and Internationally

Received Jul 28, 1999; accepted Feb 7, 2000.

Susie Dzakpasu*, K. S. Joseph*, Dagger , Michael S. Kramer§, and Alexander C. AllenDagger

From the * Bureau of Reproductive and Child Health, Laboratory Centre for Disease Control, Ottawa, Canada; Dagger  Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynecology and Pediatrics, Dalhousie University, Halifax, Canada; and § Departments of Pediatrics and Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Canada.

Objective.  To examine whether the magnitude of improvement in the health status of a population over time is dependent on the previous health status of that population.

Design and Setting.  A study of infant mortality rates in Canada's 12 provinces and territories between the periods 1961-1965 and 1991-1995, and of infant mortality rates in 133 countries between 1960 and 1995.

Main Outcome Measures.  Spearman's rank correlations, relative risks, and risk differences to measure the relationship between infant mortality in the 1960s and changes in infant mortality between the 1960s and 1990s.

Results.  In Canada, regional rankings based on infant mortality rates in 1961-1965 were strongly correlated (inversely) with rankings based on the percent change in infant mortality between 1961-1965 and 1991-1995 (correlation coefficient = -.85). In contrast, internationally, rankings based on infant mortality rates in 133 countries in 1960 were positively correlated with percent change between 1960 and 1995 (correlation coefficient = .56). Regional differences in infant mortality rates, measured using relative risks, declined in Canada (highest relative risk: 4.2, compared with Ontario in the 1960s; highest relative risk: 2.2, compared with Ontario in the 1990s) but increased globally (highest relative risk: 5.0, compared with industrialized countries in 1960; highest relative risk: 15.1, compared with industrialized countries in 1995).

Conclusions.  Canadian regions with higher infant mortality rates in 1961-1965 achieved larger improvements compared with regions with initially lower infant mortality rates. The pattern observed within Canada is unlike the pattern observed internationally.  Key words:  infant mortality, Canada, health status, industrialized countries, international.