期刊
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH
卷 75, 期 8, 页码 788-793出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/jech-2020-214260
关键词
infant mortality; health inequalities; urbanisation
资金
- Robert Wood Johnson Foundation Center for Health Policy (Interdisciplinary Research Leaders program)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [R01HD092653, R01HD096070]
- National Heart, Lung and Blood Institute [R01HL085631, R01HL085631-S2, R01HL085631-S3]
The study reveals the complex relationship between structural racism and population health across urban-rural lines, exacerbating racial inequities in urban areas.
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.
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