Disability-Adjusted life Years for Congenital anomalies among infants under five years: Why Do Socioeconomic Determinants Matter?

Objectives: Congenital anomalies include a range of functional or structural disorders that can occur as a single or a group of defects. Studies show that socioeconomic factors can affect the health status of societies considerably. Lower socioeconomic status may limit access to healthcare and contrarily increase the probability of risk factors of health among a population. Accordingly, the middle- and low-income countries are more likely to bear a higher burden of health conditions like congenital anomalies compared to the higher ones. This study aimed to identify the main socioeconomic determinants of Disability-Adjusted Life Years (DALY) resulting from congenital anomalies among infants under five years worldwide.     Methods and Materials: This study was a cross-sectional study that used the available data in 2017. Accordingly, the latest data were extracted from the international databases of the World Bank, the Institute for Health Metrics and Evaluation (IHME), and the United Nations Educational, Scientific and Cultural Organization (UNESCO). In the study, we analyzed data from 196 countries divided into six geographical regions such as Africa, Europe, America, the Eastern Mediterranean, the Western Pacific, and Southeast Asia. Data analysis was performed using the one-way analysis of variance (ANOVA) and the linear regression model. To identify the main determinants of the study, Gross Domestic Products (GDP) per capita, poverty rate, Domestic, private and external health expenditures per capita, mean years of schooling, and literacy rate were entered in the adjusted linear regression model. Stata version 15 was applied to analyze data.    Results: The lowest and the highest DALY was observed in Luxembourg (856.29 per 100,000 population) and Sudan (217,714 per 100,000 population) respectively. Also, the African and the European region had the highest (9392.78 ±4250.56) and the lowest mean (2969.11 ± 1961.64) of DALY. In Iran, DALY due to congenital anomalies for infants under five years was 7721.48 per 100,000 population, which was higher and lower than the mean of DALY in the Europe and the eastern Mediterranean region respectively. The results of linear regression analysis showed that mean years of schooling was the strongest predictor of DALY (-606.25 Confidence interval (CI) 95%: -831.24, -381.31, -831) in the present study. The poverty rate was the second major and positive predictor of DALY (59.79, CI 95%: 25.44, 94.14) among the study countries. GDP per capita and domestic health expenditures per capita were other determinants of DALY in this study. Besides, the results of one way ANOVA indicate that distribution of DALY between different income and educational groups is different so that DALY is more concentrated among the lower socioeconomic groups.  Conclusion: The results of this study showed that countries with higher mean years of schooling and lower poverty rate were more likely to have higher DALY due to congenital anomalies for infants under five years. Low-income countries, especially in sub –Sahara Africa and the Eastern Mediterranean region, bear a higher burden of disability and death due to congenital anomalies compared to high-income countries. Thus, the equitable distribution of healthcare services and educational infrastructures for deprived and low socioeconomic status groups should take into account by national health systems and international organizations.