OBJECTIVES: This study examines the interplay of social determinants of health (SDOH), healthcare status resources (HSR), and environmental (ENV) factors in shaping infant mortality rate (IMR) disparities across Gulf Cooperation Council (GCC) nations. STUDY DESIGN: A retrospective time-series design (1990-2022) used secondary datasets from international organizations, including the World Bank and Global Economy. METHODS: The study analyzed IMR in relation to SDOH, HSR, and ENV factors using Partial Least Squares Structural Equation Modeling (PLS-SEM), Measurement Invariance of Composites Models (MICOM), and PLS Multigroup Analysis (PLS-MGA) used to dissect temporal and cross-national variabilities. RESULTS: The GCC-wide model delineates a cascading effect: SDOH → ENV → HSR → IMR. SDOH, driven by GDP, fertility rate, and life expectancy, emerged as the primary determinant. HSR-IMR effects were pronounced in Bahrain and Oman, while Kuwait exhibited dominant ENV-IMR influence. Qatar led in SDOH-to-IMR impact, whereas the UAE's ENV effects varied. SDOH exerted the strongest negative IMR influence, peaking in the UAE (-0.938, p < 0.001) and lowest in Oman (-0.834, p < 0.001). Kuwait's HSR impact was non-significant (-0.034, p = 0.639), while pairwise PLS-MGA underscored stark cross-national heterogeneity. CONCLUSIONS: Findings highlight the primacy of SDOH and call for longitudinal inquiries into disparities in healthcare access and environmental stressors across the GCC. To achieve significant reductions in IMR, GCC nations must implement targeted socio-economic policies to improve maternal health outcomes.
Saidi et al. (2026) studied this question.