A district-based analysis of stillbirth and infant mortality rates in Italy: 1989-93

Despite a substantial decline in stillbirth and infant mortality rates in Italy during the last century, there are still large differences between the north and south of the country. This paper analyses the geographical distribution of these rates in the period 1989-93 in terms of biological and social indicators with the aim of identifying possible sources for these differentials. Numbers of stillbirths, infant deaths and deliveries were available in an aggregate form by categories of biological and social factors for each of the 95 Italian administrative districts ('province') operative at the time. Substantial differences in stillbirth (SB) and infant mortality (IM) rates were found across geographical areas, with the lower rates found in the richer and more industrialised north and the higher ones in the more deprived south. Negative binomial regression models were used to study the geographical variations in these rates in terms of biological and social factors. The latter showed strong and significant effects on both SB and IM rates, even after controlling for biological factors. The effects of the biological factors, birthweight and maternal parity in particular, however, were found to differ across geographical areas. Further studies to investigate whether these results may be explained by differentials in health care should be considered.