State- and county-level income inequality and infant mortality in the USA in 2010: a cohort study.
State- and county-level income inequality and infant mortality in the USA in 2010: a cohort study.
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2010 年美国州和县级收入不平等和婴儿死亡率：一项队列研究。
DOI：
10.1007/s00038-020-01388-1
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发表时间：
2020
影响因子：
4.6
通讯作者：
Pabayo,Roman
中科院分区：
文献类型：
--
作者：
Ehntholt,Amy;Cook,DanielM;Rosenquist,NatalieA;Muennig,Peter;Pabayo,Roman
目的：我们研究了州和县两级收入不平等与婴儿/新生儿死亡风险之间的关系，并测试了这种关系可能的中介因素。方法我们首先将州和县的基尼系数与美国生命统计2010年队列相关出生和婴儿死亡记录（n= 3,954,325）联系起来。然后，我们拟合多水平模型来检验收入不平等是否与婴儿/新生儿死亡率有关。县级因素作为潜在的中介进行了检验。结果：调整后的分析表明，县（而非州）的收入不平等与婴儿死亡率（OR 1.14, 95% CI 1.10, 1.18）和新生儿死亡率（OR 1.17, 95% CI 1.12, 1.23）的增加有关。我们的中介解释了这种变化的大部分。双变量分析揭示了3个县级指标——患者与医生比率、暴力犯罪率和性传播感染率——与婴儿和新生儿死亡率之间的关联。受过大学教育的成年人比例与新生儿死亡率降低有关。结论：获得医疗服务的地方差异、性传播疾病的发病率和犯罪率与婴儿死亡率有关，而大学教育的差异以及这些中介因素解释了新生儿死亡率。为了降低婴儿和新生儿死亡率，需要进行实验，以检验旨在减少收入不平等和改善医疗保健、治安和教育机会的政策的有效性。
ObjectivesWe examined the relationship between income inequality and the risk for infant/neonatal mortality at the state and county level and tested possible mediators of this relationship.MethodsWe first linked state and county Gini coefficients to US Vital Statistics 2010 Cohort Linked Birth and Infant Death records (n= 3,954,325). We then fit multilevel models to test whether income inequality was associated with infant/neonatal mortality. County-level factors were tested as potential mediators.ResultsAdjusted analyses indicated that income inequality at the county level—but not at the state level—was associated with increased odds of infant mortality (OR 1.14, 95% CI 1.10, 1.18) and neonatal death (OR 1.17, 95% CI 1.12, 1.23). Our mediators explained most of this variation. Bivariate analyses revealed associations between 3 county-level measures—patient-to-physician ratio, the violent crime rate, and sexually transmitted infection rate—and infant and neonatal mortality. Proportion of college-educated adults was associated with decreased odds for neonatal mortality.ConclusionsLocal variations in access to care, the rate of sexually transmitted disease, and crime are associated with infant mortality, while variations in college education in addition to these mediators explain neonatal mortality. To reduce infant and neonatal mortality, experiments are needed to examine the effectiveness of policies targeted at reducing income inequality and improving healthcare access, policing, and educational opportunities.