Regional variation in Black infant mortality: The contribution of contextual factors

Abstract

Background Compared to other racial/ethnic groups, infant mortality rates (IMR) are persistently highestamong Black infants in the United States, yet there is considerable regional variation. We examined state and county-level contextual factors that may explain regional differences in Black IMR and identified potential strategies for improvement. Methods and findings Black infant mortality data are from the Linked Birth/Infant Death files for 2009-2011. State and county contextual factors within social, economic, environmental, and health domains were compiled from various Census databases, the Food Environment Atlas, and the Area Health Resource File. Region was defined by the nine Census Divisions. We examined contextual associations with Black IMR using aggregated county-level Poisson regression with standard errors adjusted for clustering by state. Overall, Black IMR varied 1.5-fold across regions, ranging from 8.78 per 1,000 in New England to 13.77 per 1,000 in the Midwest. In adjusted models, the following factors were protective for Black IMR: higher state-level Black-White marriage rate (rate ratio (RR) per standard deviation (SD) increase = 0.81, 95% confidence interval (CI):0.70-0.95), higher state maternal and child health budget per capita (RR per SD = 0.96, 95% CI:0.92-0.99), and higher county-level Black index of concentration at the extremes (RR per SD = 0.85, 95% CI:0.81-0.90). Modeled variables accounted for 35% of the regional variation in Black IMR. Conclusions These findings are broadly supportive of ongoing public policy efforts to enhance social integration across races, support health and social welfare program spending, and improve economic prosperity. Although contextual factors accounted for about a third of regional

US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study

“…First, a recent analysis by the Pew Research Center found that Blacks (45%) are more likely to use Twitter for political activism, such as “encouraging others to take action about issues important to them,” compared to Whites (30%) and Hispanics (33%) [ 30 ]. Consequently, although a higher percentage of US adults use Facebook (69%) and YouTube (81%) compared to Twitter (23%), Blacks are more likely to not only use Twitter (29%) but also use it to advocate for political and social issues [ 30 , 31 ]. Additionally, increased use of Twitter for advocacy has been tied to recent current events of concern among Blacks in the United States, such the killing of unarmed Black men (eg, George Floyd) [ 30 , 31 ].…”

“…Consequently, although a higher percentage of US adults use Facebook (69%) and YouTube (81%) compared to Twitter (23%), Blacks are more likely to not only use Twitter (29%) but also use it to advocate for political and social issues [ 30 , 31 ]. Additionally, increased use of Twitter for advocacy has been tied to recent current events of concern among Blacks in the United States, such the killing of unarmed Black men (eg, George Floyd) [ 30 , 31 ]. Twitter has also been the social media platform of choice to advocate for #AmberIsaac, a Black woman who died following childbirth after high-risk symptoms were possibly missed due to COVID-19 restrictions on in-person prenatal care visits [ 32 ].…”

Structural Racism as an Environmental Justice Issue: A Multilevel Analysis of the State Racism Index and Environmental Health Risk from Air Toxics

“…The review stressed the importance of examining housing, criminal justice, and political system as forms of structural racism. Recent advances have improved the measurement and evaluation of structural racism, thus paving the way for a more nuanced understanding health disparities [18][19][20][21][22]. In one of the first of these studies, Lukachko et al [4] examined the influence of state-level structural racism using a novel measure: Black/white ratios of political participation, employment and job status, educational attainment, and judicial treatment.…”

County-level jail incarceration, community economic distress, rurality, and preterm birth among women in the US South

“…7 Factors like neighborhood characteristics, environmental factors, and rurality are also hypothesized to increase risk of preterm births. 7,[27][28][29] Rural residence is hypothesized to increase risk of preterm birth through contextual socioeconomic disadvantage, limited healthcare supply, and geographic isolation, but when controlled for these factors tend to attenuate, but not necessarily eliminate, the health disadvantage experienced by rural residents compared to their urban counterparts. 30,31 Similarly, the immigrant birthweight paradox, which is the epidemiologic finding that foreignborn women have lower rates of preterm birth compared to their US-born counterparts, is partially explained by residence in neighborhoods with a high concentration of other foreignborn residents.…”