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Ethnic differences in total and cause-specific infant mortality in the Netherlands


Dr E.-J.W.M. Troe, Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands. E-mail:


We examined ethnic differences in infant mortality and the contribution of several explanatory variables. Data of Statistics Netherlands from 1995 to 2000 were studied (1 178 949 live borns). Proportional hazard analysis was used to show ethnic dif­ferences in total and cause-specific infant mortality. Obstetric, demographic and ­geographical variables, and socio-economic status were considered as possible determinants. The four major ethnic minority groups showed an elevated risk of infant mortality, ranging from 1.28 in Turkish infants to 1.50 in Antillean/Aruban infants. In the early neonatal period, risks were elevated for Surinamese (hazard ratio [HR] 1.48, 95% confidence intervals [CI] 1.23, 1.78) and Antilleans/Arubans (HR 1.43, 95% CI 1.06, 1.92). In the post-neonatal period, risks were only elevated for Turkish (HR 2.20, 95% CI 1.80, 2.69) and Moroccan infants (HR 2.06, 95% CI 1.67, 2.55). Surinamese and Antillean/Aruban infants had an elevated risk of dying from perinatal causes (HR 1.62, 95% CI 1.33, 1.98 and 1.69, 95% CI 1.24, 2.29 respectively), Turkish and Moroccan infants had an elevated risk of dying from congenital anomalies (HR 1.42, 95% CI 1.16, 1.73 and 1.46, 95% CI 1.20, 1.79 respectively).

Inequalities  as  a  result  of  socio-economic  position  and  demographic  factors,  such as marital status and maternal age, partially explain the ethnic differences in infant mortality. We conclude that ethnic minority groups in the Netherlands have a higher infant mortality than the native population, which in part seems preventable by reducing inequalities in socio-economic status. Marital status and age of the mother are important other risk factors of infant mortality.