Primary Submission Category: Health equity
Structural Racism and Cause-Specific Infant Mortality in Milwaukee County, Wisconsin
Authors: Jessica Bishop-Royse LaShawn Murray
Presenting Author: Jessica Bishop-Royse*
Racial inequities in infant mortality persist, despite absolute declines to 5.6 deaths/1,000 births in 2020. Non-Hispanic Black infants are over twice as likely to die in the first year of life than Non-Hispanic white infants. Low levels of infant death suggest that solutions to addressing racial inequities may lie in understanding the composition of causes of infant mortality. Much of the health equity literature has been devoted to understanding the individual-level infant and maternal characteristics associated with infant death and its racial inequities. Little research has investigated the role of structural racism in cause-specific infant mortality, much less investigated its concurrent impact with individual infant and maternal characteristics.
Our analyses examine the direct effect of structural racism on cause-specific infant mortality and whether this impact by individual infant and maternal factors. We examined linked birth and infant death files for infants born in Milwaukee County from 2016-2018. Index of Concentration at the Extremes (ICE) scores were calculated for maternal residential zip codes. Using updates to the Dollfus cause of death classification scheme proposed by Nakamura, we combined several causes that we believe have etiological pathways that may be comparable. Deaths due to prematurity related conditions, obstetric conditions, and birth asphyxia were combined (POCBA) into one group of causes while the remaining causes were combined into “other causes”.
Initial multinomial regression analysis found relative risk ratios that were higher for deaths due to other causes than deaths for prematurity, obstetric conditions, and birth asphyxia (POCBA) for infants whose mothers resided in areas with the most concentrated disadvantage. Covariates included infant race, maternal age, marital status, and education, as well as plurality and payment type. A model adjusted for only race found that black infants had higher RRR of deaths due to other causes than for POCBA causes. Fully adjusted multinomial logistic regression models found that ICE was significantly related to deaths due to prematurity, obstetric conditions, and birth asphyxia, but not to deaths of other causes. Interestingly, the association of infant race on risk of death due to both POCBA causes and other causes is ameliorated in the fully adjusted model.
These results suggest the continued influence of structural racism for infant health and survival in a hyper-segregated urban area like Milwaukee. These analyses also underscore the importance of measures of structural racism compared to individual maternal characteristics.