Environmental Determinants of Child Mortality in Rural China : A Competing Risks Approach

Jacoby and Wang use a competing risk model to analyze environmental determinants of child mortality using the 1992 China National Health Survey, which collects information on cause of death. Their primary question is whether taking into account of cause of death using a competing risk model, compared with a simple model of all causes of mortality, affects conclusions about the effectiveness of policy interventions. There are two potential analytical advantages in using cause of death information: (1) obtaining more accurate estimates and (2) validating causal relationships. Although the authors do not find significant differences between estimates obtained from the competing risk model and those from simpler hazard models, they do find evidence supporting the causal interpretations of the effect of access to safe water on child mortality. The authors' analysis also suggest that a respondent-based health survey can be used to collect relatively reliable information on cause of death. Modifying future demographic and health survey instruments to collect cause of death information inexpensively may be worthwhile for enhancing the analytical strength of the surveys.This paper - a joint product of Rural Development, Development Research Group, and the Environment Department - is part of a larger effort in the Bank to improve our understanding of the determinants of child mortality and provide policy advice to improve health outcomes in low-income countries