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Explaining the Geography of Racial Disparities in US Infant Health

Laura McCallister Prichett, PhD, Department of Population and Family Health Sciences, The Johns Hopkins Bloomberg School of Public Health, Fourth Floor, 615 N. Wolfe St., Baltimore, MD 21205, (410) 435-0194, lprichet@jhsph.edu and David M. Bishai, MD MPH PhD, Bloomberg School of Public Health, Department of Population and Family Health Sciences, 615 N. Wolfe St Room E4622, Baltimore, MD 21205.

Objective: The objective of this paper is to explain geographic variation in the relative health disadvantage of African American infants. Methods: We formed a database of infant (IMR), neonatal (NMR), and post-neonatal mortality (PNMR) rates for whites and African American infants for each state with more than 400 African American births from 1994 to 2002. Data on state policies and attributes have been drawn from the “CQ State fact Finder”, which is electronically available for 1996-2004. We examine 75 state policy-related variables, reflecting many dimensions of the state including: population, economics, geography, government, federal aid, taxes, education, health, crime and welfare. We used bi-variate regression with state fixed effects models to identify any state policies that were correlated with the rate ratios of IMR, NMR, and PNMR. Variables showing strong correlation were entered into multivariate fixed effects models. Results: Overall racial infant mortality gradients were consistently higher in north central states than any other part of the US. We found that higher racial race gradients in infant health were narrowed in states that had higher administrative costs per AFDC/ TANF case, and a higher proportion of state population receiving TANF, and higher alcohol consumption. Racial gradients in infant health were increased in states with higher gross state economic product per capita, higher federal research and development spending. Conclusions: State policies can have an impact on racial gradients in infant health. Economic growth, in particular, appeared to be of more benefit to white infants.

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Factors Affecting Infant Health

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA