Mortality inequalities in times of economic growth: time trends in socioeconomic and regional inequalities in under 5 mortality in Indonesia, 1982-1997.

STUDY OBJECTIVE To examine time trends in socioeconomic and regional inequalities in under 5 mortality in Indonesia during almost two decades of economic growth. DESIGN Under 5 mortality was calculated for the total population and for subgroups by maternal education, household wealth, rural/urban residence, and island group, using the 1987, 1991, 1994, and 1997 Indonesian Demographic and Health Surveys. Inequalities were calculated using Cox proportional hazards analysis. SETTING Indonesia, 1982-1997. Main PARTICIPANTS 18,205, 33,907, 39,433, and 37,533 children respectively, aged under 5 years, born to women included in the above mentioned surveys. MAIN RESULTS Under 5 mortality declined substantially during the 1980s and 1990s. Educational inequalities in under 5 mortality decreased, although not statistically significantly, from a hazard ratio of 2.00 (95%CI 1.60, 2.50) to 1.52 (95%CI 1.27, 1.82). Inequalities between urban and not electrified rural areas increased, from 1.84 (95%CI 1.48, 2.28) to 2.18 (95%CI 1.70, 2.80). Inequalities between the Outer Islands and the central islands of Java/Bali increased from 1.16 (95%CI 0.92, 1.46) to 1.43 (95%CI 1.17, 1.74). Irregular time trends were seen for inequalities by household wealth. Trends in health care use were fairly similar for the low and high educated. CONCLUSIONS These results for education show that socioeconomic inequalities in under 5 mortality do not inevitably rise in times of rapid economic growth. Widening or narrowing of health inequalities in times of economic growth might depend on how equally this growth is distributed.