Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
J Epidemiol Community Health. 2021 Aug;75(8):788-793. doi: 10.1136/jech-2020-214260. Epub 2021 Jan 27.
While evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban-rural lines remains unexplored. The objective of this study was to examine the associations between county-level structural racism (racial inequity in educational attainment, median household income and jail incarceration) and infant mortality and heterogeneity between urban and rural areas.
Using linked live birth/infant death data provided by the National Center for Health Statistics, we calculated overall and race-specific 2013-2017 5-year infant mortality rates (IMRs) per 1000 live births in every county. Racially stratified and area-stratified negative binomial regression models estimated IMR ratios and 95% CIs associated with structural racism indicators, adjusting for county-level confounders. Adjusted linear regression models estimated associations between structural racism indicators and the absolute and relative racial inequity in IMR.
In urban counties, structural racism indicators were associated with 7%-8% higher black IMR, and an overall structural racism score was associated with 9% greater black IMR; however, these findings became insignificant when adjusting for the region. In white population, structural racism indicators and the overall structural racism score were associated with a 6% decrease in urban white IMR. Both absolute and relative racial inequity in IMR were exacerbated in urban counties with greater levels of structural racism.
Our findings highlight the complex relationship between structural racism and population health across urban-rural lines and suggest its contribution to the maintenance of health inequities in urban settings.
尽管有证据表明，在县级婴儿死亡率方面存在着相当大的种族不平等，但城乡之间结构性种族主义的作用仍未得到探索。本研究的目的是检验县级结构性种族主义（教育程度、家庭中位数收入和监禁率方面的种族不平等）与婴儿死亡率之间的关系，并检验城乡之间的异质性。
利用国家卫生统计中心提供的活产/婴儿死亡关联数据，我们计算了每个县 2013-2017 年每千例活产的总体和特定种族的 5 年婴儿死亡率（IMR）。种族分层和区域分层负二项回归模型估计了与结构性种族主义指标相关的 IMR 比值和 95%置信区间，同时调整了县级混杂因素。调整后的线性回归模型估计了结构性种族主义指标与 IMR 绝对和相对种族不平等之间的关系。
在城市县，结构性种族主义指标与黑人 IMR 高出 7%-8%相关，而整体结构性种族主义得分与黑人 IMR 高出 9%相关；然而，当调整区域因素时，这些发现变得无统计学意义。在白人人口中，结构性种族主义指标和整体结构性种族主义得分与城市白人 IMR 降低 6%相关。城乡结构性种族主义水平较高的县，IMR 的绝对和相对种族不平等加剧。
我们的研究结果突显了城乡之间结构性种族主义与人口健康之间的复杂关系，并表明其对城市环境中健康不平等的维持做出了贡献。
