While ecological studies indicate that high levels of structural racism within US states are associated with elevated infant mortality rates, studies using individual-level data are needed.
To determine whether indicators of structural racism are associated with the individual odds for infant mortality among white and black infants in the US.
MethodsWe used data on 2,163,096 white and 590,081 black infants from the 2010 US Cohort Linked Birth/Infant Death Data Files. Structural racism indicators were ratios of relative proportions of blacks to whites for these domains: electoral (registered to vote and voted; state legislature representation), employment (civilian labor force; employed; in management; with a bachelor’s degree), and justice system (sentenced to death; incarcerated). Multilevel logistic regression was used to determine whether structural racism indicators were risk factors of infant mortality.
ResultsCompared to the lowest tertile ratio of relative proportions of blacks to whites with a bachelor’s degree or higher—indicative of low structural racism—black infants, but not whites, in states with moderate (OR = 1.12, 95% CI = 0.94, 1.32) and high tertiles (OR = 1.25, 95% CI = 1.03, 1.51) had higher odds of infant mortality.
ConclusionsEducational and judicial indicators of structural racism were associated with infant mortality among blacks. Decreasing structural racism could prevent black infant deaths.
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This study was funded by the National Institutes of Health Research, National Institute on Minority Health and Health Disparities 1R15MD010223-01. Roman Pabayo is supported by the Canada Research Chairs Program.
Author information Authors and AffiliationsUniversity of Alberta School of Public Health, Edmonton, Canada
Roman Pabayo
School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
Roman Pabayo, Amy Ehntholt & Daniel M. Cook
Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
Roman Pabayo & Amy Ehntholt
Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
Kia Davis
Weill Cornell Medical College, New York City, NY, USA
Sze Y. Liu
Mailman School of Public Health, Columbia University, New York City, NY, USA
Peter Muennig
Correspondence to Roman Pabayo.
Ethics declarations Conflict of InterestThe authors declare that they have no conflict of interest.
Ethical ApprovalThis article does not contain any studies with human participants or animals performed by any of the authors.
Additional information Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Research has taken place at the University of Nevada, Reno. Roman Pabayo is now at the University of Alberta, School of Public Health.
About this article Cite this articlePabayo, R., Ehntholt, A., Davis, K. et al. Structural Racism and Odds for Infant Mortality Among Infants Born in the United States 2010. J. Racial and Ethnic Health Disparities 6, 1095–1106 (2019). https://doi.org/10.1007/s40615-019-00612-w
Received: 18 February 2019
Revised: 28 June 2019
Accepted: 01 July 2019
Published: 15 July 2019
Issue Date: December 2019
DOI: https://doi.org/10.1007/s40615-019-00612-w
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