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

州和县级收入不平等和婴儿死亡风险：种族和社会经济地位的调节作用

• 批准号: 8994651
• 负责人: Daniel Martin Cook
• 金额: $ 43.91万
• 依托单位: UNIVERSITY OF NEVADA RENO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-27 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8994651
• 关键词: Address; African American; Age; American Indian and Alaska Native; Area; Birth; Caucasians; Censuses; Cessation of life; Characteristics; Country; County; Data; Developed Countries; Ecological Bias; Economic Conditions; Economics; Education; Effectiveness; Environment; Epidemiology; Expenditure; Geographic state; Government; Health; Health Professional; Health system; Hispanics; Income; Individual; Inequality; Infant; Infant Health; Infant Mortality; Investigation; Knowledge; Lead; Life; Life Expectancy; Life Style; Link; Literature; Live Birth; Maternal Health; Measures; Mediator of activation protein; Methodology; Modeling; Morbidity - disease rate; Mothers; Native Americans; Newborn Infant; Not Hispanic or Latino; Outcome; Personal Satisfaction; Play; Policies; Policy Maker; Population; Population Group; Prenatal care; Public Health; Puerto Rican; Race; Research; Research Design; Risk; Role; Social Conditions; Social Environment; Socioeconomic Status; Source; Statistical Methods; Target Populations; Techniques; Testing; United States; Woman; Work; caucasian American; contextual factors; experience; improved; infant death; low socioeconomic status; mortality; novel; programs; public health relevance; segregation; social; social capital; social health determinants; socioeconomics

 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.

 描述(由申请人提供)：本R15申请的目的是研究美国州和县层面的背景收入不平等对婴儿出生死亡风险的影响。由于来自非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群体中有所不同。婴儿死亡率(IMR)是对每1000名活产婴儿死亡人数的估计。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。它反映了经济和社会条件对母亲和新生儿的健康、社会环境、个人生活方式以及卫生系统的特点和有效性的影响。2011年，美国约有24,000名婴儿死亡，导致每1,000名活产儿中有6.1人在一岁生日前死亡。与其他经合组织国家相比，这一比率很高。与美国白人相比，黑人、西班牙裔和美洲原住民的IMR更高。此外，低社会经济群体的IMR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假定，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层面的因素。例如，收入不平等，或美国某个州或县等地区的财富分配，可能会对婴儿死亡率起到一定作用。由于大多数调查收入不平等对婴儿死亡率的作用的研究都使用了生态研究设计，结果可能是有偏见的。此外，背景收入不平等可能会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裔美国人产生更有害的影响，并可能解释为什么与美国白人相比，这一群体的IMR更高。我们提出了以下具体目标：1)检查背景收入不平等与婴儿死亡率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阶层婴儿死亡风险的差异影响。为了实现这些目标，我们将使用与出生和死亡率相关的数据进行新的统计方法。我们期待这个项目的发现将提高我们对导致婴儿死亡的原因和机制的理解。拟议的研究将产生有价值的知识，并将为政策制定者和公共卫生专业人员提供信息，以制定和实施旨在降低婴儿死亡率的政策和计划，特别是那些风险最高的人，如非裔美国人或低SES背景的人。

项目成果

State-level income inequality and mortality among infants born in the United States 2007-2010: A Cohort Study.

2007-2010 年美国出生婴儿的州级收入不平等和死亡率：队列研究。

• DOI: 10.1186/s12889-019-7651-y
• 发表时间: 2019
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Pabayo,Roman;Cook,DanielM;Harling,Guy;Gunawan,Anastasia;Rosenquist,NatalieA;Muennig,Peter
• 通讯作者: Muennig,Peter

State- and county-level income inequality and infant mortality in the USA in 2010: a cohort study.

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
• 发表时间: 2020
• 期刊: International journal of public health
• 影响因子: 4.6
• 作者: Ehntholt,Amy;Cook,DanielM;Rosenquist,NatalieA;Muennig,Peter;Pabayo,Roman
• 通讯作者: Pabayo,Roman