Nutrition and Social Disadvantage as Risk Factors for Mortality Among School-Age Children: Regional Differences in...

To assess the structure and regional variation in mortality among school-aged children in Kazakhstan from 2015 to 2024, and to determine its association with dietary patterns and socio-economic factors.

An ecological inter-regional analysis was conducted using official statistical data of the Republic of Kazakhstan. Mortality rates among children aged 6-17 years, the distribution of death causes according to ICD-10, indicators of consumption of major food product groups, and poverty levels were examined. Linear mixed-effects regression with a random intercept for region and fixed effects for year and covariates, and spatial description of regional trends were applied.

Variation in school-age mortality across regions and calendar years was evident, with external causes predominating, followed by diseases of the nervous system, neoplasms, and diseases of the circulatory and respiratory systems in the mortality structure. In the multivariable linear mixed-effects model, none of the dietary or socioeconomic predictors showed statistically significant independent associations with mortality (all p > 0.05), and the calendar year was not significant (p = 0.180). Model explanatory power was very low (marginal R² = 0.017; conditional R² = 0.020; ICC = 0.005), and residuals demonstrated significant temporal autocorrelation (p < 0.001).

The mortality structure among school-aged children is shaped by a complex interplay of medical, social, and behavioral determinants. Dietary and socioeconomic indicators showed only weak ecological associations with mortality and did not retain independent effects after multivariable adjustment, underscoring the multifactorial nature of regional mortality patterns and the need for multisectoral action, including improved access to nutritious foods, enhanced social well-being, and strengthened health system capacity.