Department of Obstetrics and Gynecology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
J Perinatol. 2024 Dec;44(12):1724-1731. doi: 10.1038/s41372-024-02048-5. Epub 2024 Jul 16.
To use a novel measure of systemic racism to examine its relationship with Non-Hispanic Black (NHB) to Non-Hispanic White (NHW) racial disparities in infant mortality across U.S. counties.
In this cross-sectional study, a composite, multi-dimensional measure of systemic racism at the county level was developed using confirmatory factor analysis based on indicators across five dimensions of systemic racism. Using linear regression analysis, we examined the relationship between the systemic racism factor scores and the NHB to NHW racial disparities in county-level infant mortality rates. Additionally, we performed a multi-level analysis of infant mortality, with births nested within counties by running a random intercept model that controlled for factors at both the individual and county levels to take into account the clustered nature of the data.
There were 325 counties that met inclusion criteria for the county level analysis and 1181 counties for the individual level analysis. Each one standard deviation increase in the Systemic Racism Index was associated with an increase of 10.4% in the Non-Hispanic Black to Non-Hispanic White infant mortality rate ratio at the county level (aOR 1.104, 95% CI [1.061-1.148]). After controlling for individual level clinical factors and county level factors, each one standard deviation increase in the systemic racism index score was associated with a decrease of 3.5% in the NHW infant mortality rate (aOR 0.965, 95% CI [0.943-0.988]).
Systemic racism is significantly associated with differences between counties in the magnitude of their Non-Hispanic Black to Non-Hispanic White racial disparities in infant mortality rates.
利用一种新的系统性种族主义衡量标准，检验其与美国各县非西班牙裔黑人（NHB）与非西班牙裔白人（NHW）之间婴儿死亡率种族差异的关系。
在这项横断面研究中，使用基于系统性种族主义五个维度指标的验证性因子分析，开发了一种县级系统性种族主义的综合多维衡量标准。我们使用线性回归分析，检验了系统性种族主义因子得分与县级婴儿死亡率中非西班牙裔黑人与非西班牙裔白人种族差异之间的关系。此外，我们通过运行控制个体和县级因素的随机截距模型，对婴儿死亡率进行了多层次分析，将出生嵌套在县级中，以考虑到数据的聚类性质。
有 325 个县符合县级分析的纳入标准，1181 个县符合个体水平分析的纳入标准。系统性种族主义指数每增加一个标准差，与县级非西班牙裔黑人与非西班牙裔白人婴儿死亡率比率增加 10.4%相关（比值比 1.104，95%置信区间 [1.061-1.148]）。在控制个体水平临床因素和县级因素后，系统性种族主义指数得分每增加一个标准差，与 NHW 婴儿死亡率降低 3.5%相关（比值比 0.965，95%置信区间 [0.943-0.988]）。
系统性种族主义与各县之间非西班牙裔黑人与非西班牙裔白人之间婴儿死亡率种族差异的程度显著相关。
