Lifting Boats Not Closing Gaps: Child Health Outcomes in Distressed Cities 1992-2002

Background: Substantial evidence has shown that city residence is associated with higher rates of a number of negative health outcomes. However, information on how economic and population differences among US cities may be associated with poorer health outcomes and racial disparities for children (≤18 years) are sparse Objectives: To compare cause-specific morality and birth rates for children in economically distressed and non-distressed cities 1992-2002. Methods: Five census indicators were selected to categorize levels of economic distress for the 100 most populous cities in the United States in 1990 using a principal component analysis. We calculated cause-specific mortality and teen birth rates overall, and by race in distressed vs. non-distressed cities during two time periods - 1992 and 2002. We used poisson regression to calculate rate ratios for cause-specific mortality and birth rates between distressed and non-distressed cities between years, by race, and to compare differences between rates of change within city groups. Results: Despite improvements in health for children and youth between 1992 and 2002 in all cities across outcomes, disparities between city groups were maintained or widened over this period. While gaps in outcomes between whites and blacks persisted across all cities, living in a distressed city compounded the disparities in poor outcomes experienced by black children. Conclusion: While a strong economy in this period may have facilitated improvements in health outcomes for children in America's cities, these benefits did not close gaps between distressed and non-distressed cities.