Abstract
BackgroundUnited States state-level income inequality is positively associated with infant mortality in ecological studies. We exploit spatiotemporal variations in a large dataset containing individual-level data to conduct a cohort study and to investigate whether current income inequality and increases in income inequality are associated with infant and neonatal mortality risk over the period of the 2007–2010 Great Recession in the United States.MethodsWe used data on 16,145,716 infants and their mothers from the 2007–2010 United States Statistics Linked Infant Birth and Death Records. Multilevel logistic regression was used to determine whether 1) US state-level income inequality, as measured by Z-transformed Gini coefficients in the year of birth and 2) change in Gini coefficient between 1990 and year of birth (2007–2010), predicted infant or neonatal mortality. Our analyses adjusted for both individual and state-level covariates.ResultsFrom 2007 to 2010 there were 98,002 infant deaths: an infant mortality rate of 6.07 infant deaths per 1000 live births. When controlling for state and individual level characteristics, there was no significant relationship between Gini Z-score and infant mortality risk. However, the observed increase in the Gini Z-score was associated with a small but significant increase likelihood of infant mortality (AOR = 1.03 to 1.06 from 2007 to 2010). Similar findings were observed when the neonatal mortality was the outcome (AOR = 1.05 to 1.13 from 2007 to 2010).ConclusionsInfants born in states with greater changes in income inequality between 1990 and 2007 to 2010 experienced a greater likelihood of infant and neonatal mortality.
Highlights
United States state-level income inequality is positively associated with infant mortality in ecological studies
Data source Data were obtained from the U.S Cohort Linked Birth/Infant Death Data Files 2007–2010, which is provided by the National Center for Health Statistics (NCHS)
We observed that those infants born in states that experienced the greatest growth in income inequality between 1990 and their year of birth, were more likely to die before their first birthday or within the first 28 days of life
Summary
United States state-level income inequality is positively associated with infant mortality in ecological studies. Infant mortality is associated with the economic and social conditions that shape the health of mothers and newborns. These economic and social conditions include individual characteristics, such as the home environment and lifestyles. They include state-level characteristics, such as the quality and availability of medical care within the local. This rate is higher than the Organization for Economic Co-Operation and Development (OECD) average of four deaths per 1000 births [2]. The US IMR is more comparable to (or even higher than) rates in eastern Europe (e.g., Slovak Republic, Latvia, Russia) but has a lower rate than in upper-middleincome countries such as Chile, Turkey or Mexico [4]
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