State and county level income inequality and infant mortality risk: The moderating role of race and socioeconomic status

 描述（由申请人提供）：本R15申请的目的是研究美国州和县一级的背景收入不平等对婴儿出生死亡率风险的影响。由于来自非洲裔美国人和低社会经济（SES）群体的婴儿更有可能在一岁之前死亡，我们将评估所涉及的机制是否在种族和SES群体之间存在差异。婴儿死亡率是每1 000名活产婴儿死亡人数的估计数。衡量人口预期寿命的最重要和最有力的指标之一是婴儿死亡率。它反映了母亲和新生儿健康的经济和社会条件、社会环境、个人生活方式以及卫生系统的特点和效力。2011年，美国约有24，000名婴儿死亡，导致每1，000名活产婴儿中有6.1名在一岁生日前死亡。与其他经合组织国家相比，这一比率很高。与白色美国人相比，黑人、西班牙裔和美洲原住民的婴儿死亡率更高。此外，婴儿死亡率在低社会经济群体中高于中等和高社会经济群体。除了个人特征之外，健康框架的社会决定因素认为，人们出生、成长、生活、工作和年龄的条件对健康和福祉起着重要作用。因此，需要解决背景暴露以及个人水平因素。例如，收入不平等或美国州或县等地区的财富分配可能会对婴儿死亡率产生影响。由于大多数调查收入不平等对婴儿死亡率作用的研究都采用了生态研究设计，因此结果可能会有偏差。此外，背景收入不平等可能对不同种族和社会经济群体的婴儿死亡率产生不同的影响。收入不平等可能对非洲裔美国人产生更不利的影响，并可能解释为什么与白色美国人相比，这一人口群体的婴儿死亡率更高。我们提出了以下具体目标：1）研究背景收入不平等和婴儿死亡风险之间的因果关系; 2）确定联系背景收入不平等和婴儿死亡风险的机制。 收入不平等和婴儿死亡风险; 3）测试背景收入不平等对不同种族和社会经济地位群体婴儿死亡风险的不同影响。为了实现这些目标，我们将使用出生率-死亡率相关数据进行新的统计方法。我们预计，该项目的研究结果将提高我们对导致婴儿死亡的原因和机制的理解。这项拟议的研究将产生有价值的知识，并将告知政策制定者和公共卫生专业人员制定和实施旨在降低婴儿死亡风险的政策和计划，特别是那些风险最大的婴儿，如来自非洲裔美国人或低社会经济地位背景的婴儿。

 DESCRIPTION (provided by applicant): The purpose of this R15 application is to study the impact of contextual income inequality, at the US state and county level, on the risk for infant birth mortality. Since infants from African-American and low socioeconomic (SES) groups are more likely to die before their first birthday, we will evaluate whether the mechanisms involved differ across racial and SES groups. The infant mortality rate (IMR) is an estimate of the number of infant deaths for every 1,000 live births. One of the most important and powerful measures of life expectancy in a population is infant mortality. It is a reflection of the economic and social conditions on the health of mothers and newborns, the social environment, individual lifestyles as well as the characteristics and effectiveness of health systems. In 2011, around 24,000 infants died in the United States, resulting in an IMR of 6.1 deaths occurring before the first birthday per 1,000 live births. This rate is high in comparison to other OECD countries. IMR are higher among Blacks, Hispanics, and Native Americans, in comparison to White Americans. Also, IMR are higher among low socioeconomic groups than among moderate and high socioeconomic groups. On top of individual characteristics, the social determinants of health framework posit that the conditions in which people are born, grow, live, work, and age, play an important role in health and well-being. Therefore, contextual exposures, as well as individual level factors need to be addressed. For example, income inequality, or the distribution of wealth in an area such as a US state or county, can play a role in infant mortality. Since most of the studies that investigate the role of income inequality on infant mortality have utilized the ecological study design, results might be biased. Furthermore, contextual income inequality might have a differential impact on infant mortality across racial and socioeconomic groups. Income inequality might have a more detrimental effect on African-Americans and might explain why the IMR is higher among this population group in comparison to White Americans. We propose the following specific aims: 1) To examine the causal association between contextual income inequality and risk for infant mortality; 2) To identify the mechanisms that link contextual income inequality and risk for infant mortality; 3) to test for differential effects of contextual income inequality on risk for infant mortality across racial and SES groups. To achieve these aims, we will conduct novel statistical methods using birth-mortality linked data. We anticipate that findings from this project will improve our understanding of the causes of and mechanisms leading to infant mortality. The proposed study will generate knowledge that is valuable and will inform policy makers and public health professionals to develop and implement policies and programs aimed at lowering the risk for infant mortality, especially among those at greatest risk such as those from African-American or low SES backgrounds.