Poverty, urban-rural classification and term infant mortality: a population-based multilevel analysis

Area of Science:

• Public Health
• Epidemiology
• Sociomedical Sciences

Background:

• U.S. term infant mortality rates exceed those in many developed nations.
• Socio-environmental factors, including low socioeconomic status and rurality, are linked to higher infant mortality.
• The independent effects of poverty and urban-rural classification on term infant mortality require further investigation.

Purpose of the Study:

• To estimate the independent effect of county-level poverty on term infant mortality.
• To determine the independent effect of urban-rural classification on term infant mortality.
• To differentiate the impact of contextual factors from individual-level factors on term infant mortality.

Main Methods:

• Utilized linked 2013 birth-infant death files from the National Center for Health Statistics (NCHS).
• Classified counties into poverty and urban-rural groups.
• Employed bivariate and multilevel logistic regression models to assess term infant mortality odds, controlling for individual and county-level variables.

Main Results:

• A total of 2,551,828 term births were analyzed, with an overall term mortality rate of 2.1 per 1000 births.
• Increased county poverty and rurality were associated with higher odds of term infant mortality.
• After adjusting for individual maternal characteristics, high poverty and rural non-core counties remained significantly associated with increased term infant mortality risk.

Conclusions:

• High poverty and very rural counties show an independent association with term infant mortality.
• Interventions should target contextual factors like economic environment and healthcare access, in addition to individual factors.
• Addressing socioeconomic and geographic disparities is crucial for reducing term infant mortality.