Health Disparities
Reduction of county-level socioeconomic inequity can partially remediate racial disparities in infant mortality and preterm birth Naria R. Z. Sealy* Naria Sealy Sealy Sealy Sealy Sealy Sealy Sealy University of Pennsylvania
Background: County-level inequities in socioeconomic indicators of structural racism may explain some of the racial disparities in infant mortality (IM) and preterm birth (PTB, <37 weeks’ gestation).
Methods: We used vital statistics (2018-2020) in 1427 US counties (n=6,070,978 Black and White births). Census data were used to calculate poverty inequity by dividing each county’s poverty rate for Black residents by the rate for White residents, dichotomized into excess Black poverty (ratio >1) vs. not (≤1). This was repeated for county-level income, education (proportion high school diploma), and unemployment. ICE race-income was dichotomized into privileged (>0) or disadvantaged (≤0). We estimated risk differences (RD) for Black-White disparities in IM and PTB. We used causal mediation models to estimate the IM and PTB inequity that would remain if Black disadvantage in each county-level structural racism indicator were eliminated; race as the exposure and socioeconomic structural racism indicators as the mediators (Figure 1). Inverse probability weighting accounted for mediator-outcome confounding (age, education, parity, payment method, urbanicity, hypertension and diabetes) and a linear probability model with robust standard errors estimated RDs (per 100 births) with 95% CI.
Results: There were 1,510,977 Black and 4,515,616 White births: the risk of IM was 0.9% vs. 0.4%, respectively (RD=0.53 [95% CI: 0.52, 0.55]), and the risk of PTB was 12% vs. 7%, respectively (RD=4.82 [4.76, 4.88]). Eliminating county-level Black disadvantage reduced the IM and PTB disparity for each indicator. Removal of excess Black poverty had the highest reductions in IM and PTB disparities: RD=0.24 (0.12, 0.37) and RD=3.20 (2.72, 3.67), respectively, corresponding to 34% and 55% of the disparities eliminated.
Conclusion: Policies focused on reducing county-level socioeconomic inequities driven by structural racism may substantially narrow racial disparities in IM and PTB.
