Murosko Daria, Passarella Molly, Montoya-Williams Diana, Mehdipanah Roshanak, Lorch Scott
The Children's Hospital of Philadelphia.
University of Michigan.
Res Sq. 2024 Nov 11:rs.3.rs-5306929. doi: 10.21203/rs.3.rs-5306929/v1.
Infant mortality (IM), or death prior to the first birthday, is a key public health metric that increases with neighborhood structural inequities. However, neighborhood exposures shift as communities undergo gentrification, a pattern of neighborhood change defined by increasing affluence (in wealth, education, and housing costs). Gentrification has inconsistent associations with infant health outcomes like IM, which may be due to differing relationships between its composite measures and such outcomes. We designed a retrospective cohort analysis of all births and deaths from 2010-2019 across 4 metropolitan areas in Michigan to determine how gentrification and its neighborhood-change components are associated with risk of IM, using multilevel multivariable logistic regression models. Among 672,432 infants, 0.52% died before 1 year. IM was not associated with gentrification overall. However, in unadjusted models, odds of IM were 40% and 15% lower for infants living in tracts in the top quartile increase in household income and college completion, respectively, compared to infants from tracts with the least amount of change. Odds of IM were conversely increased 29% in infants from tracts with the most increases in rent, though these differences were attenuated when adjusting for individual social factors. Indicators of increasing community affluence, which are often combined to define gentrification, have opposing relationships with IM. Policies and interventions that address rising housing costs may reduce IM.
婴儿死亡率（IM），即一岁前死亡，是一项关键的公共卫生指标，会随着社区结构不平等的加剧而上升。然而，随着社区经历绅士化进程，社区暴露情况会发生变化，绅士化是一种社区变化模式，其定义为富裕程度（财富、教育和住房成本方面）不断提高。绅士化与婴儿健康结果（如婴儿死亡率）之间的关联并不一致，这可能是由于其综合指标与这些结果之间的关系不同所致。我们设计了一项回顾性队列分析，研究2010年至2019年密歇根州4个大都市地区所有出生和死亡情况，以确定绅士化及其社区变化组成部分与婴儿死亡率风险之间的关联，采用多级多变量逻辑回归模型。在672,432名婴儿中，0.52%在1岁前死亡。总体而言，婴儿死亡率与绅士化无关。然而，在未调整的模型中，与变化最小的地段的婴儿相比，家庭收入和大学毕业率处于前四分位数增长地段的婴儿，其婴儿死亡率的几率分别低40%和15%。相反，租金涨幅最大的地段的婴儿，其婴儿死亡率的几率增加了29%，不过在调整个体社会因素后，这些差异有所减弱。通常综合起来定义绅士化的社区富裕程度增加指标，与婴儿死亡率存在相反的关系。应对住房成本上升的政策和干预措施可能会降低婴儿死亡率。
