Neighborhood Level Disadvantage, Race/Ethnicity and Infant Mortality in Washington DC

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This study examines the effects of neighborhood level disadvantage and individual level characteristics such as race/ethnicity on infant mortality. Social determinants of health theory and ecological theory were used to construct a neighborhood advantage index for Washington DC. Secondary analyses were conducted using linked birth/death certificate and census data from the DC State Center for Health Statistics. Live births (55,938) and infant deaths (607) occurring in Washington DC from 2001-2007 were examined. Multilevel modeling techniques were utilized to determine the relationship between individual and neighborhood level factors on infant mortality. The research questions were: (a) Do women who are comparable on factors such as maternal education and marital status experience different rates of infant mortality by race? (b) Do women living in areas of high disadvantage experience higher rates of infant mortality than women living in areas of low disadvantage? (c) Does the effect of race/ethnicity on infant mortality change if the mother lives in a place of high disadvantage versus low disadvantage? (d) Does having an infant born preterm or low birth weight increase the risk of infant mortality? Whites have the lowest rates of infant mortality (2.8/1000), followed by Hispanics (7.4/1000), with Blacks having the highest rates (15.2/1000) after adjusting for age, education, and marital status. These findings are consistent with previous research affirming a relationship between race/ethnicity and infant mortality. Infants born in disadvantaged neighborhoods are 1.63 times more likely to die before their first birthday than those born in advantaged neighborhoods. The odds for infant mortality compared to Whites decreases especially for Blacks (5.39 to 3.10; 42% change), living in disadvantaged communities even when race/ethnicity was interacted with the neighborhood disadvantage index. This suggests that disadvantage has different consequences for different race/ethnicity populations living in those neighborhoods. The importance of place (disadvantaged or advantaged neighborhood) in relation to infant mortality at the neighborhood level in addition to improving individual level factors is discussed for program development and policymakers. Implications for health disparities, maternal and child health, social support and future public health research are presented.