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Instituto Nacional de Salud Pública

2026, Number 1

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salud publica mex 2026; 68 (1)

A multi-dimensional index of rurality in Chile and its association with infant and neonatal mortality

Flores-Angulo C, Marshall G, Ferreccio C, Ramis R, Gómez-Barroso D, Cerda J

Language: Spanish
References: 47
Page: 52-61
PDF size: 507.10 Kb.


ABSTRACT

Objective. To construct a multi-dimensional Index of Relative Rurality (IRR) for Chile and assess its association with infant and neonatal mortality. Materials and methods. A cross-sectional analysis was conducted using data from 343 municipalities. The IRR was calculated using four standardized components—population size, population density, urban population proportion, and travel time to servicerich areas—to reflect the complexity of rurality in Chile. Associations between the IRR and mortality outcomes were evaluated using negative binomial regression and generalized additive models. Results. A rurality threshold was identified at approximately IRR= 0.404, beyond which the risk of infant and neonatal mortality increased notably. Municipalities with IRR values ›0.50 showed elevated risks of infant mortality (RR: 1.18; 95%CI: 1.01,1.38) and neonatal mortality (RR: 1.27; 95%CI: 1.06,1.50), compared to more urban areas. While the official classification defined nearly half of municipalities as rural, the IRR captured a smaller, more specific subset of municipalities with higher mortality risk—particularly in southern macrozones. Conclusions. The IRR offers a more precise and data-driven approach to characterizing rurality and identifying health disparities. Its continuous design improves the detection of high-risk populations and challenges the overgeneralization of current classifications. These findings support the use of the IRR to inform targeted public health interventions and equitable policy planning.


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