# Nutrition and Social Disadvantage as Risk Factors for Mortality Among School-Age Children: Regional Differences in Kazakhstan

## TL;DR

This study examines how nutrition and social disadvantage affect child mortality in Kazakhstan, finding that these factors have weak links and that mortality is influenced by many complex factors.

## Contribution

The study highlights the multifactorial nature of child mortality in Kazakhstan and the limited independent impact of dietary and socioeconomic factors.

## Key findings

- Mortality among school-aged children in Kazakhstan is primarily due to external causes and diseases of the nervous system.
- Dietary and socioeconomic factors showed weak ecological associations with mortality and no independent effects after adjustment.
- Model explanatory power was low, and residuals showed significant temporal autocorrelation.

## Abstract

Objective: To assess the structure and regional variation in mortality among school-aged children in Kazakhstan from 2015 to 2024, and to determine its association with dietary patterns and socio-economic factors. Materials and Methods: An ecological inter-regional analysis was conducted using official statistical data of the Republic of Kazakhstan. Mortality rates among children aged 6–17 years, the distribution of death causes according to ICD-10, indicators of consumption of major food product groups, and poverty levels were examined. Linear mixed-effects regression with a random intercept for region and fixed effects for year and covariates, and spatial description of regional trends were applied. Results: Variation in school-age mortality across regions and calendar years was evident, with external causes predominating, followed by diseases of the nervous system, neoplasms, and diseases of the circulatory and respiratory systems in the mortality structure. In the multivariable linear mixed-effects model, none of the dietary or socioeconomic predictors showed statistically significant independent associations with mortality (all p > 0.05), and the calendar year was not significant (p = 0.180). Model explanatory power was very low (marginal R2 = 0.017; conditional R2 = 0.020; ICC = 0.005), and residuals demonstrated significant temporal autocorrelation (p < 0.001). Conclusions: The mortality structure among school-aged children is shaped by a complex interplay of medical, social, and behavioral determinants. Dietary and socioeconomic indicators showed only weak ecological associations with mortality and did not retain independent effects after multivariable adjustment, underscoring the multifactorial nature of regional mortality patterns and the need for multisectoral action, including improved access to nutritious foods, enhanced social well-being, and strengthened health system capacity.