287 - Infant mortality increases in census tracts with neighborhood changes in wealth, education and housing

Poster Number: 287
Publication Number: 287.2205

Background: Infant mortality (IM), death prior to the first birthday, is a key public health metric that increases with neighborhood structural inequities such as income inequality, racial segregation and housing costs. However, neighborhood exposures are not stagnant: many urban communities undergo gentrification, a pattern of neighborhood change defined by increasing affluence (wealth, education and housing) over time. Changes in neighborhood exposures are linked to adverse infant health outcomes, but their association with IM has not been studied.

Objective: To determine the association of neighborhood-level change in wealth, education and housing costs, with IM.

Design/Methods: This retrospective cohort analysis merged linked birth-death certificates of all singleton births born between 22-43 weeks gestational age in Wayne County, Michigan from 2010 – 2020 with census tract American Community Survey and Census data. The exposure was the change in community-level wealth (median household income (MHI), education (percent college completion), and housing indicators (median rent, median home value) from 2000 to 2010. Multivariate logistic regression determined the association of quartiles of indicator change and IM, clustered at the census tract, adjusted for maternal and infant social and health factors.

Results: In this cohort of 240,725 live births, 1,574 died before 1 year (6.5 per 1000). Maternal and infant characteristics differed between the quartiles with the least and most change for most indicators of wealth, education and housing (Table 1). IM rates decreased with greater positive change in MHI and college completion, but IM rates increased with greater change in median rent and home values (Figure 1). In unadjusted models, odds of IM were 43% and 31% lower in tracts in the top quartile increase in MHI and college completion, respectively, compared to tracts with the least amount of change. However, odds of IM were increased 27% and 23% in tracts in the top quartile increase in rent and home values, respectively (Figure 2). Though these differences were partially explained by social factors, odds of IM remained 17% lower in tracts with the greatest increase in MHI in adjusted models.

Conclusion(s): Indicators of increasing community affluence have opposing relationships with IM, though further work is needed to explore the complex interactions between neighborhood-level factors that typically define gentrification. While community programs and policy directives on wealth and housing costs are potential targets to reduce IM, these interventions must account for changes in structural inequities over time.