Economic development and under-five mortality: a global longitudinal analysis of lagged effects and between-country...

Understanding the relationship between under-five mortality rate (U5MR) and economic development is essential for promoting global child health and advancing health equity. This study analyzed the spatiotemporal patterns of U5MR and its associations with macroeconomic indicators from 2000 to 2023.

Panel data from 158 countries were used to analyze to characterize the spatial distribution of U5MR in 2023 and regional trends in the average annual percent change (AAPC) of U5MR from 2000 to 2023. Spearman correlation analysis, lagged analysis, and panel Granger causality tests were conducted to evaluate the associations and directionality between the U5MR and gross domestic product (GDP), GDP per capita (GDPpc), GDP growth rate, and inflation.

In 2023, U5MR remained markedly higher in sub-Saharan Africa than in other regions. From 2000 to 2023, U5MR declined more rapidly in Africa and parts of Asia, whereas declines were slower in Europe and North America. Regional correlation indicated that the AAPC of U5MR was significantly negatively associated with the AAPCs of GDP and GDPpc in Asia (r_GDP = -0.505; r_GDPpc = -0.605) and Europe (r_GDP = -0.368; r_GDPpc = -0.619), and with the AAPCs of GDP in Africa (r_GDP = -0.374). No significant associations were observed in the North America, South America or Oceania. Lagged analyses showed that GDP and GDPpc maintained consistently negative associations with U5MR across all lag periods. In contrast, the significance of the associations of GDP growth rate and inflation with U5MR varied across lag periods. Granger causality tests confirmed a bidirectional relationship between GDPpc and U5MR at the optimal lag order of 4. However, the causal effect from GDPpc to U5MR is not robust to lag order selection. U5MR exerts a unidirectional Granger causal effect on inflation.

This study demonstrates that macroeconomic factors shape U5MR with significant regional disparities and heterogeneous lagged effects. Regional authorities should adopt differentiated strategies: prioritizing economic development in Asia, Europe, and Africa, while implementing health-focused improvement programs in North America, South America, and Oceania. Governments should maintain stable long-term economic and income growth, and increase sustained public investment in child health services and nutrition programs to lower U5MR. Given that lower U5MR drives economic growth, sustaining its decline is a long-term economic priority.

Clinical trial number: not applicable.