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Original Articles
- Socioeconomic and Regional Disparities in Under-five Mortality in Indonesia: Insights From Indonesia’s 2020 Census
- Asep Hermawan
- J Prev Med Public Health. 2026;59(3):258-266. Published online March 20, 2026
- DOI: https://doi.org/10.3961/jpmph.25.763
- 2,222 View
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Abstract
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Supplementary Material - Objectives
This study examined district-level and municipality-level socioeconomic determinants of the under-five mortality rate (U5MR) to inform equitable policies aimed at achieving Sustainable Development Goal (SDG) 3.2.
Methods
An ecological cross-sectional study was conducted using data from 514 districts and municipalities in Indonesia. U5MR estimates were obtained from Statistics Indonesia and calculated using the indirect Trussell method based on the 2020 Population Census Long Form. Poverty rate, mean years of schooling, gross regional domestic product per capita, and total fertility rate (TFR) were analyzed using bivariate and multivariable ordinary least squares regression with robust standard errors. To account for spatial dependence, a spatial autoregressive (SAR) model was additionally applied. Spatial mapping was used to illustrate geographic variation.
Results
U5MR ranged from 10.7 to 75.8 deaths per 1000 live births across districts and municipalities. Higher TFR (β=13.21, p<0.001) and higher poverty rates (β=0.61, p<0.001) were associated with higher U5MR, whereas higher educational attainment was associated with lower U5MR (β=−0.79, p=0.001). The association between poverty and mortality was stronger in rural districts than in municipalities (interaction β=−0.30, p=0.06). The SAR model identified significant spatial dependence and demonstrated improved model fit. Spatial clustering revealed an east-west divide, with the highest mortality observed in Papua and East Nusa Tenggara.
Conclusions
Fertility, poverty, and educational attainment are key predictors of child survival in Indonesia, with districts in eastern regions bearing disproportionate burdens. Policy efforts should prioritize family planning, maternal education, and targeted support for socioeconomically disadvantaged districts to accelerate progress toward achieving SDG 3.2 by 2030. -
SummaryKey Message
Socioeconomic inequalities remain important determinants of under-five mortality in Indonesia at the district and municipality levels. Higher poverty and fertility rates were associated with increased mortality, whereas higher educational attainment was associated with lower mortality. Equity-oriented and geographically targeted interventions, particularly in disadvantaged eastern districts, are essential to accelerate progress toward Sustainable Development Goal 3.2.- Causes of Child Mortality (1 to 4 Years of Age) From 1983 to 2012 in the Republic of Korea: National Vital Data
- Seung Ah Choe, Sung-Il Cho
- J Prev Med Public Health. 2014;47(6):336-342. Published online November 7, 2014
- DOI: https://doi.org/10.3961/jpmph.14.024
- 14,823 View
- 99 Download
- 1 Crossref
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Abstract
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- Objectives
Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea.
Methods
Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012.
Results
The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012).
Conclusions
In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention. -
Summary
Citations
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- Child mortality of twins and singletons among late preterm and term birth: a study of national linked birth and under-five mortality data of Korea
Young Shin Kim, Minku Kang, Young June Choe, Joohon Sung, Ji Yeon Lee, Seung-Ah Choe
European Journal of Pediatrics.2022; 181(5): 2109. CrossRef
English Abstract- The Effects of the Parents' Social Class on Infant and Child Death among 1995-2004 Birth Cohort in Korea.
- Mia Son, Juhwan Oh, Yong Jun Choi, Jeong Ok Kong, Jisook Choi, Eunjeong Jin, Sung Tae Jung, Se Jin Park
- J Prev Med Public Health. 2006;39(6):469-476.
- 3,558 View
- 51 Download
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Abstract
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- OBJECTIVES
To investigate the effect of parents' social class on infant and child mortality rates among the birth cohort, for the period of transition to and from the Koran economic crisis 1995-2004. METHODS: All births reported to between 1995 and 2004 (n=5,711,337) were analyzed using a Cox regression model, to study the role of the social determinants of parents in infant and child mortality. The results were adjusted for the parents' age, education and occupation, together with mother's obstetrical history. RESULTS: The crude death rate among those under 10 was 3.71 per 1000 births (21,217 deaths among 5,711,337 births) between 1995 and 2004. The birth cohorts from lower educated parents less than elementary school showed higher mortality rates compared with those from higher educated parents over university level (HR:3.0 (95%CI:2.8-3.7) for father and HR:3.4 (95%CI:3.3-4.5) for mother). The mother's education level showed a stronger relationship with mortality among the birth cohort than that of the fathers'. The gaps in infant mortality rates by parents' social class, and educational level became wider from 1995 to 2004. In particular, the breadth of the existing gap between higher and lower parents' social class groups has dramatically widened since the economic crisis of 1998. DISCUSSIONS: This study shows that social differences exist in infant and child mortality rates. Also, the gap for the infant mortality due to social class has become wider since the economic crisis of 1998. -
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