Separate and unequal: Structural racism and infant mortality in the US
Abstract
We examined associations between state-level measures of structural racism and infant mortality among black and white populations across the US. Overall and race-specific infant mortality rates in each state were calculated from national linked birth and infant death records from 2010 to 2013. Structural racism in each state was characterized by racial inequity (ratio of black to white population estimates) in educational attainment, median household income, employment, imprisonment, and juvenile custody. Poisson regression with robust standard errors estimated infant mortality rate ratios (RR) and 95% confidence intervals (CI) associated with an IQR increase in indicators of structural racism overall and separately within black and white populations. Across all states, increasing racial inequity in unemployment was associated with a 5% increase in black infant mortality (RR=1.05, 95% CI=1.01, 1.10). Decreasing racial inequity in education was associated with an almost 10% reduction in the black infant mortality rate (RR=0.92, 95% CI=0.85, 0.99). None of the structural racism measures were significantly associated with infant mortality among whites. Structural racism may contribute to the persisting racial inequity in infant mortality.
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State-level racism has been established as an important predictor of Black individuals' health and healthcare, and obesity risk may be impacted by structural racism.
“State-level racism has been established as an important predictor of Black individuals' health and healthcare, and [13,15] obesity risk may be impacted by structural racism.”
From Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents (2025) · cites this paper as [13]
Structural racism operates at multiple geospatial levels, including the state-level.
“Structural racism operates at multiple geospatial levels [10,13], including the state-level.”
From Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents (2025) · cites this paper as [13]
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Sociodemographic factors associated with tracheostomy and mortality in bronchopulmonary dysplasia
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Supporting the Family After the Death of a Child or Adolescent
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Structural Racism and Well-Being Among Young People in the U.S.
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Self-citationAbortion Restrictiveness and Infant Mortality: An Ecologic Study, 2014-2018
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Racial disparities in the development of comorbid conditions after preterm birth: A narrative review
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Schmidt, I. M., Shohet, M., Serrano, M., Yadati, P., Menn‐Josephy, H., Ilori, T. O., Eneanya, N. D., Manchanda, E. C. C., & Waikar, S. S. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08035-4 · Cited by 16 · see citing works
- Authors
- Wallace, M., Crear-Perry, J., Richardson, L., Tarver, M., & Theall, K.
- Affiliations
- Tulane University (US)
- Institute of Women and Ethnic Studies (US)
- Corresponding author
- Wallace, Maeve
- Venue
- Health & Place
- Publisher
- Elsevier BV
- Published
- 2017-05
- Volume
- 45
- Pages
- 140-144
- ISSN
- 1353-8292 (ISSN-L)
- OpenAlex
- W2598043244
- Cited by
- 243
- References
- 28
- Citations by year
- 2026: 18 · 2025: 19 · 2024: 46 · 2023: 37 · 2022: 41 · 2021: 43 · 2020: 21 · 2019: 12 · 2018: 4 · 2017: 1
- FWCI
- 26.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health & Place (publishedVersion)
- PubMed (publishedVersion)
- Funders
- W.K. Kellogg Foundation (P3032230)
- Frost Foundation
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- structural racism, infant mortality, racial inequity, racial disparities, unemployment, educational attainment, household income, incarceration, juvenile custody, United States
- MeSH terms
- Black or African American, Education, Female, Humans, Income, Infant, Infant Mortality, Infant, Newborn, Male, United States, White People, Health Status Disparities, Racism
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