Rural vs. urban status and state and local expenditures on things not related to healthcare: Effect on infant mortality

December 21, 2020  |  General

A recent article in Pediatrics, the journal of the American Academy of Pediatrics, studies a particular aspect of a disturbing disparity many of us have known about or suspected for many years: a newborn’s chance of dying varies quite a bit with where it is born and who its mother is. It’s well known infant mortality varies 230% between states, with Mississippi having the highest rate at 8.3 deaths per 1,000 live births. Overall the deep South has the worst rates. It’s also well known infant mortality varies with socioeconomic status, with infants born to poorer mothers suffering a higher risk of death. A previous study identified rural location and low socioeconomic status with a higher infant mortality rate, but those two variables were bound together in that rural mothers tended to be poorer. A key issue is that rural counties have more limited access to healthcare and this would tend to drive up the infant mortality rate irrespective of socioeconomic status of the mother. This study tried to tease out those two factors.

The authors studied an enormous group — all births in the United States between 2014 and 2016 and linked them to infant death records at the county level. They used a somewhat complicated but easily understandable algorithm to adjust death rates independently for access to hospitals and socioeconomic status of the mothers. Their conclusions:

Higher infant mortality rates in rural counties are best explained by their greater socioeconomic disadvantage than more-limited access to health care or the greater prevalence of mothers’ individual health risks.

There is an additional interesting article on a related topic in the same issue of Pediatrics. It studies the effects of overall state and local expenditures on services not related to healthcare, what one might call quality of life things, and the effect on infant mortality. Previous evidence has suggested expenditures on non–healthcare services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Their conclusions:

Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall infant mortality rate. Investment in non–health care services was associated with lower infant mortality rates among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing infant mortality disparities.

Each incremental increase in overall state and local spending was associated with what one could call a dose-related improvement in infant mortality. That is a powerful finding. Their conclusion may offer some insight into why the deep South, where spending on these things is notoriously lower than other places in the country, has worse infant mortality rates even beyond the socioeconomic status of the mother. Correlation is not causation, of course, but I think these findings are quite intriguing. If we make life more civil and rewarding, we appear also to increase the chances of an infant living to enjoy it.

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