Urban-rural and regional differences in infant mortality in Taiwan

We analyzed data from death certificates for all infant deaths in Taiwan from 1981 to 1988. During this 8-year period, the crude infant mortality rate decreased from 8.9 to 5.3 per 1000 live births. Deaths due to infectious diseases, which constituted a major fraction of this mortality, also declined from 3.4 to 1.2 per 1000 live births. While infant deaths due to nearly all causes declined, deaths due to injury and accidents rose from 0.62 to 0.71 per 1000 live births, and the sudden infant death rate rose from 0.13 to 0.46. Notable geographic differences included a high death rate in the small islands off the coast and in the eastern mountainous counties (9.1-11.2/1000 live births); this rate was twice that in Taipei (4.5/1000 live births). In addition, the level of urbanisation was also an important determinant of death rate; urban areas had much lower rates than rural areas. The highest rate (15.4) was persistently observed in the rural areas where the aboriginal tribes reside. This differential rate between urban and rural areas was most prominent for the vaccine-preventable diseases; the aboriginal areas had rates that were 12.9 times those in the cities. Moreover, since neonatal deaths are severely under-reported in Taiwan, especially in less urbanized areas, our data presumably underestimate the urban-rural health differences. Our findings identify high risk areas for various causes of infant death, and indicate that more targeted intervention such as improving education and health care as well as environmental hygiene in some specific areas may be warranted.