Temporal and geographical trends in infant, neonatal and post-neonatal mortality in Italy between 1991 and 2009

Background: Infant mortality is a key indicator of child and population health. The aim of this study is to analyse the trends in infant mortality rates (IMRs) and their components (neonatal mortality rates-NMRs and post-neonatal mortality rates-PNMRs) from 1991 to 2009 both at the national level and across the three Italian large geographical macro-areas (North, Center, South). Methods: Using data extracted from the Health for All-Italy database, IMRs, NMRs and PNMRs were calculated for the 19 Italian Regions and 2 Autonomous provinces for the years 1991-2009. Relative risks and attributable fractions were calculated for Southern and Central Italy compared with Northern Italy. Temporal trends were analysed using the robust polynomial Poisson regression models. Results: During the study period there was a 54% decline in IMR (from 7.72/1000 to 3.55/1000), a 57% decline in NMR (from 5.87/1000 to 2.55/1000) and a 46% decline in PNMR (from 1.85/1000 to 1/1000). In particular, we found a strong decline in IMRs and NMRs from 1991 to 2000/2001, and a weaker decline starting from 2002/2003. Moreover, we found a slight decrease in PNMRs until 2001/2002, and no significant variations starting from 2003. Despite these reductions, important geographical variations persisted: in 2006-2009, the most recent data available, the excess of infant mortality in Southern Italy compared with the North was 27%. Conclusions: During the period 1991-2009 Italy experienced a significant decline in IMRs, NMRs and PNMRs. We observed the same pattern for the temporal trends of these indicators across the North, the Center and South of Italy. Despite this decline, geographical disparities persisted.