Affluent-Born White Mother's Descending Neighborhood Income and Infant Mortality: A Population-Based Study

Objectives To determine whether affluent-born White mother's descending neighborhood income is associated with infant mortality rates (< 365 day, IMR). Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of singleton births (1989-1991) to non-Latina White mothers (1956-1976) with an early-life residence in affluent neighborhoods (defined as the fourth quartile of income distribution). The breadth of descending neighborhood income was defined by mother's neighborhood income at the time of delivery. Results Infants of White mothers (n = 4890) who did not suffer descending neighborhood income by the time of delivery had a first-year mortality rate of 5.1/1,000. Infants of White mothers who experienced minor (n = 5112), modest (n = 2158), or extreme (n = 339) descending neighborhood income had IMR of 6.5/1,000, 14.4/1,000, and 11.8/1,000, respectively; RR [95% CI] = 1.3 [0.8, 2.1], 2.8 [1.7, 4.8], and 2.3 [0.8, 6.6], respectively. The incidence of young maternal age, inadequate prenatal care utilization, and cigarette smoking rose as descending neighborhood income increased, p < 0.01. In multilevel logistic regression models, the adjusted (controlling for selected individual-level co-variates) OR [95% CI] of infant mortality for White women with an early-life residence in affluent neighborhoods who subsequently experienced minor or modest to extreme (versus absent) descending neighborhood income equaled 1.0 [0.6, 1.8] and 2.1 [1.1, 3.8] respectively. Conclusions White mother's modest to extreme descending neighborhood income from early-life residence in affluent neighborhoods is associated with a twofold greater risk of infant mortality independent of selected biologic, medical, and behavioral characteristics.