Brechas que no cierran: Veinticinco años de inequidades sociodemográficas y territoriales en la mortalidad por desnutrición infantil en Colombia

Introduction: Childhood malnutrition is a priority global public health problem and a critical indicator of social inequity. In Colombia, despite an overall reduction in under-five mortality, significant territorial andsociodemographic gaps persist. Objective: To examine inequities in malnutrition-related mortality among children younger than five years in Colombia between 1997 and 2022, according to demographic, sociodemographic, andterritorial characteristics. Methods: A descriptive ecological study was conducted using official mortality and population data from the National Administrative Department of Statistics (DANE). A total of 11,934 deaths dueto nutritional deficiencies and nutritional anemias, coded according to the International Classification of Diseases (ICD-10: E40-E64, D50-D53), were analyzed. Specific and age-adjusted rates were calculated, relative risks wereestimated using Poisson regression models, and choropleth maps were developed to identify persistent territorial patterns. Results: During the study period, mortality rates decreased; however, marked inequalities persisted. Rateswere higher among children younger than one year, 40.5 per 100,000, than among children aged 1 to 4 years, 4.7 per 100,000, and higher in rural areas, 15.6 per 100,000, than in urban areas, 9.1 per 100,000. Departmentssuch as La Guajira, Vichada, Guainía, Amazonas, and Chocó, as well as rural areas of Bogotá, recorded rates far above the national average. Differences by sex were smaller, although they remained relatively stable throughoutthe 25-year study period. Conclusions: Malnutrition-related mortality among children younger than five years in Colombia showed persistent territorial inequalities during the study period, with higher rates in rural areas and indepartments historically more affected. These findings suggest the influence of socioeconomic, sociodemographic, and sociospatial determinants and highlight the need to strengthen intersectoral policies aimed at reducing territorialgaps and improving the conditions that support survival and adequate nutritional status in the child population.