Socioeconomic instability and the availability of health resources: their effects on infant mortality rates in Macau from 1957-2006

Aim: To investigate the effects of socioeconomic instability and the availability of health resources on infant mortality rate. Background: In 1960, the infant mortality rate was 46·3 infants per 1000 live births in Macau but by 2006 it had declined to 2·7 infants per 1000 live births. Design: A retrospective design collecting yearly data for the Macau covering the period from 1957-2006. The infant mortality rate was the dependent variable and demographics, socioeconomic status and health resources are three main explanatory variables to determine the mortality rate. Methods: Regression modelling. Results: Results show that higher birth (Beta = 0·029, p = 0·004) and unemployment rates (Beta = -0·120, p = 0·036) and more public expenditure on health (Beta = -0·282, p < 0·001) were significantly more likely to reduce the infant mortality rate. Conclusions: These results indicate that the socioeconomically disadvantaged are at a significantly higher risk for infant mortality. In contrast, more public expenditure on health resources significantly reduces the risk for infant mortality. This study provides further international evidence that suggests that improving aspects of the healthcare system may be one way to compensate for the negative effects of social inequalities on health outcomes. Relevance to clinical practice: The implication of these results is that more effort, particularly during economic downturns, should be put into removing the barriers that impede access to healthcare services and increasing preventive care for the population that currently has less access to health care in communities where there is a scarcity of medical resources. In addition, efforts should be made to expand and improve the coverage of prenatal and infant healthcare programmes to alleviate regional differences in the use of health care and improve the overall health status of infants in Macau.