Inequality trajectories in avoidable under-5 mortality in Colombia: A 23-year analysis of inequities (2000-2022)

Despite progress in Colombia's overall health indicators, substantial inequalities in avoidable under-five mortality persist across its regions. This study examines the trajectories of avoidable mortality rate in childhood (AMRC) across Colombian departments from 2000 to 2022, highlighting territorial inequalities and their socioeconomic determinants. A group-based trajectory analysis was applied to avoidable under-five mortality rates across 33 Colombian departments over a 23-year period. Additionally, multinomial logistic regression models were used to identify the socioeconomic, demographic, and health system factors associated with trajectory group membership. Three distinct mortality trajectories were identified: lower (57.6 % of departments), mid-range (30.3 %), and upper (12.1 %). Departments in the upper trajectory had consistently higher AMRC and were characterized by higher rates of unmet basic needs, poverty, rurality, illiteracy in women, and births to adolescent mothers. Despite overall declines in AMRC, relative inequalities between trajectory groups remained significant. Territorial inequalities in avoidable child mortality in Colombia are deeply rooted in socioeconomic determinants. Regions with higher poverty and less access to timely, quality healthcare experience higher avoidable mortality rates. These findings underscore the need for targeted policy interventions to address persistent health inequities.