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. 2021 Aug;75(8):788-793.
doi: 10.1136/jech-2020-214260. Epub 2021 Jan 27.

Structural racism, racial inequities and urban-rural differences in infant mortality in the US

Dovile Vilda  1 , Rachel Hardeman  2 , Lauren Dyer  3 , Katherine P Theall  3 , Maeve Wallace  3
Affiliations

Structural racism, racial inequities and urban-rural differences in infant mortality in the US

Dovile Vilda et al. J Epidemiol Community Health. 2021 Aug.

Abstract

Background: While evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban-rural lines remains unexplored. The objective of this study was to examine the associations between county-level structural racism (racial inequity in educational attainment, median household income and jail incarceration) and infant mortality and heterogeneity between urban and rural areas.

Methods: Using linked live birth/infant death data provided by the National Center for Health Statistics, we calculated overall and race-specific 2013-2017 5-year infant mortality rates (IMRs) per 1000 live births in every county. Racially stratified and area-stratified negative binomial regression models estimated IMR ratios and 95% CIs associated with structural racism indicators, adjusting for county-level confounders. Adjusted linear regression models estimated associations between structural racism indicators and the absolute and relative racial inequity in IMR.

Results: In urban counties, structural racism indicators were associated with 7%-8% higher black IMR, and an overall structural racism score was associated with 9% greater black IMR; however, these findings became insignificant when adjusting for the region. In white population, structural racism indicators and the overall structural racism score were associated with a 6% decrease in urban white IMR. Both absolute and relative racial inequity in IMR were exacerbated in urban counties with greater levels of structural racism.

Conclusions: Our findings highlight the complex relationship between structural racism and population health across urban-rural lines and suggest its contribution to the maintenance of health inequities in urban settings.

Keywords: health inequalities; infant mortality; urbanisation.

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Conflict of interest statement

Competing interests: None declared.

References

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