Spatial inequalities in child mortality due to poverty related diseases and material deprivation in Argentina, 2017–2022

Abstract

Abstract Objectives: to analyze socio-territorial inequalities in child mortality due to poverty-related diseases in Argentina (2017–2022) and their association with household material deprivation (IPMH, 2022 Census), identifying critical territories through spatial analysis. Methods: subnational ecological study (n=527 departments/districts). MONEP rates in children under 5 years were calculated as the annual average of deaths from poverty-associated causes per 100,000 population aged 0–4 years. Thematic maps, global spatial autocorrelation (Moran’s I), local clusters (univariate and bivariate LISA), and spatial regression models (OLS/SAR/SEM/SDM) were estimated. Results: significant positive spatial autocorrelation was observed for both MONEP (I=0.568; p<0.001) and IPMH (I=0.824; p<0.001). Bivariate LISA identified high–high (HH) clusters in 40 departments (7.6%), as well as discordant HL (3.4%) and LH (8.7%) patterns. Spatial models substantially improved model fit compared with OLS; the SAR model was selected as the principal specification (AIC=4049.3) based on parsimony and spatial diagnostic tests. In this model, IPMH remained positively and significantly associated with MONEP (β=0.060; p=0.022), while strong spatial dependence was also detected (ρ=0.732; p<0.001). Decomposition of spatial effects revealed an indirect spillover effect of 0.151, more than double the direct effect (0.072). Conclusions: structural poverty is associated with higher child mortality from deprivation-related diseases, with territorially concentrated critical clusters. These findings support targeted interventions in HH areas and highlight the usefulness of subnational spatial analysis for evidence-based health planning.