142nd APHA Annual Meeting and Exposition

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Child and youth mortality in Baltimore City, the geography of disadvantage

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 5:15 PM - 5:30 PM

Stacey Lloyd, MPH , Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD
Amanda Latimore, PhD , Johns Hopkins School of Public Health, Baltimore, MD
Carlos Castillo-Salgado, MD, JD, MPH, DrPH , Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Adam Milam, PhD, MHS , Johns Hopkins School of Public Health, Baltimore, MD
Seema Iyer, PhD , The Jacob Francis Institute, University of Baltimore, Baltimore, MD
Philip Leaf, PhD , Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Audio (mp3) recording Recorded Presentation (mp4)
Background: The Baltimore City Health Department (BCHD) describes a 20-year difference in life expectancy between neighborhoods less than 5 miles apart. Premature mortality is associated with a large number of years of life lost and may drive some of the variation in life expectancy between neighborhoods.

Methods: By combining publically available data from the Baltimore Neighborhood Indicators Alliance and the 2010 United States Census, we explored patterns in child and youth mortality rates across the 55 Community Statistical Areas in Baltimore. With detailed area-level data from BCHD, we modeled the relationship between race, a composite indicator of neighborhood disadvantage, and mortality for children and youth. We used both Poisson and negative binomial regression models. We assessed spatial autocorrelation throughout the analysis, though no adjustments to the final models were required.

Results: For the period of 2008-2012, there was substantial variation in mortality rates by neighborhood for both children (0 to 21 per 10,000 oerson years [py], standard deviation = 2) and youth (0 to 32 per 10,000 py, standard deviation = 6). Areas with a high level of neighborhood disadvantage had  a mortality rate that was more than 2 times the mortality rate in neighborhoods with low disadvantage (child mortality rate ratio 2.2, 95% CI 1.2 to 4.2; youth mortality rate ratio 3.1, 95% CI 1.9 to 5.0). The relationship between neighborhoods racial composition and mortality rates was mostly explained by neighborhood disadvantage. Through an analysis of residuals, we identified neighborhoods with higher or lower mortality rates than would be expected based on patterns of child and youth mortality and disadvantage in the city. 

Discussion: Area-level data reveal patterns of notable inequalities in child and youth mortality rates within Baltimore. Further exploration of patterns identified in this analysis can inform community-level interventions that can be optimally responsive to the needs of the most vulnerable populations.

Learning Areas:

Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe intraurban variation in child and youth mortality in Baltimore Explain pattens in child and youth mortality in relation to an objective measure of neighborhood disadvantage.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD student at JHSPH and the lead author on an upcoming report on child and youth mortality in Baltimore.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4418.0: Health Geographies - Where Place Matters