Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Apr 3;6(4):e239646. doi: 10.1001/jamanetworkopen.2023.9646.
Infant mortality in the United States is highest among peer nations; it is also inequitable, with the highest rates among Black infants. The association between tax policy and infant mortality is not well understood.
To examine the association between state-level tax policy and state-level infant mortality in the US.
DESIGN, SETTING, AND PARTICIPANTS: This state-level, population-based cross-sectional study investigated the association between tax policy and infant mortality in the US from 1996 through 2019. All US infant births and deaths were included, with data obtained from the National Center for Health Statistics. Data were analyzed from November 28, 2021, to July 9, 2022.
State-level tax policy was operationalized as tax revenue per capita and tax progressivity. The Suits index was used to measure tax progressivity, with higher progressivity indicating increased tax rates for wealthier individuals.
The association between tax policy and infant mortality rates was analyzed using a multivariable, negative binomial, generalized estimating equations model. Since 6 years of tax progressivity data were available (1995, 2002, 2009, 2012, 2014, and 2018), 300 state-years were included. Adjusted incidence rate ratios (aIRRs) were calculated controlling for year, state-level demographic variables, federal transfer revenue, and other revenue. Secondary analyses were conducted for racial and ethnic subgroups.
There were 148 336 infant deaths in the US from 1996 through 2019, including 27 861 Hispanic infants, 1882 non-Hispanic American Indian or Alaska Native infants, 5792 non-Hispanic Asian or Pacific Islander infants, 41 560 non-Hispanic Black infants, and 68 666 non-Hispanic White infants. The overall infant mortality rate was 6.29 deaths per 1000 live births. Each $1000 increase in tax revenue per capita was associated with a 2.6% decrease in the infant mortality rate (aIRR, 0.97; 95% CI, 0.95-0.99). An increase of 0.10 in the Suits index (ie, increased tax progressivity) was associated with a 4.6% decrease in the infant mortality rate (aIRR, 0.95; 95% CI, 0.91-0.99). Increased tax progressivity was associated with decreased non-Hispanic White infant mortality (aIRR, 0.95; 95% CI, 0.91-0.99), and increased tax revenue was associated with increased non-Hispanic Black infant mortality (aIRR, 1.04; 95% CI, 1.01-1.08).
In this cross-sectional study, an increase in tax revenue and the Suits index of tax progressivity were both associated with decreased infant mortality. These associations varied by race and ethnicity. Tax policy is an important, modifiable social determinant of health that may influence state-level infant mortality.
美国的婴儿死亡率在同类国家中最高；而且，这一比率存在不平等现象，其中非裔婴儿的死亡率最高。税收政策与婴儿死亡率之间的关联尚未得到充分理解。
在美国，检验州级税收政策与州级婴儿死亡率之间的关联。
设计、地点和参与者：本项基于人群的州级横断面研究在美国，调查了税收政策与婴儿死亡率之间的关联。研究包括了 1996 年至 2019 年期间的所有美国婴儿出生和死亡数据，数据来源于国家卫生统计中心。数据分析于 2021 年 11 月 28 日至 2022 年 7 月 9 日进行。
州级税收政策表现为人均税收和税收累进性。苏茨指数用于衡量税收累进性，较高的累进性表示对较富裕个人的税率提高。
采用多变量负二项式广义估计方程模型分析税收政策与婴儿死亡率之间的关联。由于有 6 年的税收累进性数据（1995 年、2002 年、2009 年、2012 年、2014 年和 2018 年），本研究共纳入了 300 个州年。在控制了年份、州级人口统计学变量、联邦转移收入和其他收入等因素后，计算了调整后的发病率比值比（aIRR）。此外，还进行了种族和民族亚组的二次分析。
在美国，1996 年至 2019 年期间共有 148336 例婴儿死亡，其中包括 27861 例西班牙裔婴儿、1882 例非西班牙裔美洲印第安人或阿拉斯加原住民婴儿、5792 例非西班牙裔亚洲或太平洋岛民婴儿、41560 例非西班牙裔黑人婴儿和 68666 例非西班牙裔白人婴儿。总体婴儿死亡率为每 1000 例活产婴儿 6.29 例死亡。人均税收收入每增加 1000 美元，婴儿死亡率就会降低 2.6%（aIRR，0.97；95%CI，0.95-0.99）。苏茨指数（即税收累进性增加）增加 0.10，婴儿死亡率就会降低 4.6%（aIRR，0.95；95%CI，0.91-0.99）。税收累进性增加与非西班牙裔白人婴儿死亡率降低相关（aIRR，0.95；95%CI，0.91-0.99），而人均税收增加与非西班牙裔黑人婴儿死亡率增加相关（aIRR，1.04；95%CI，1.01-1.08）。
在这项横断面研究中，人均税收收入增加和苏茨指数税收累进性增加均与婴儿死亡率降低相关。这些关联因种族和民族而异。税收政策是影响州级婴儿死亡率的一个重要的、可改变的社会决定因素。
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