ArticleJournal of epidemiology and community health2021
Structural racism, racial inequities and urban-rural differences in infant mortality in the US.
Article in Journal of epidemiology and community health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Structural racism as a fundamental cause of health inequities: a scoping review.International journal for equity in health · 2025Pooled it
- Investigating the Relationship Between Highly Collaborative Local Health Jurisdictions and County-Level Perinatal Health Outcomes.Maternal and child health journal · 2026Article
- The Association Between Structural Disadvantage and Adverse Birth Outcomes: Analyzing Preterm Birth and Low Birth Weight Using the Structural Racism Effect Index.Journal of racial and ethnic health disparities · 2026Article
- A Standard Measure of Structural Racism, Do We Have One? Can We Have One? A Narrative Review of Commonly Used Measures and Domains of Use.Journal of racial and ethnic health disparities · 2025Review
- Reducing inequalities using an unbiased machine learning approach to identify births with the highest risk of preventable neonatal deaths.Population health metrics · 2025Article
- Ethnoracial inequities in social stressors and patterns of alcohol use in a population of United States transgender Veterans.Social science & medicine (1982) · 2025Article
- Structural Racism in Cervical Cancer Care and Survival Outcomes: A Systematic Review of Inequities and Barriers.Current epidemiology reports · 2025Review
- Associations among parental mental health, lifestyle factors and infant mortality in rural and urban mothers.Frontiers in public health · 2025Article
- Black:white inequities in infant mortality across the 69 most populous US cities, 2018-2021.Frontiers in public health · 2025Article
- Association between infant mortality and community social vulnerability in the USA: a cross-sectional study.BMJ public health · 2025Article
- Influence of structural racism on cancer health disparities: Tailoring measures relevant to multiple myeloma.Cancer · 2024Article
- Instruments for racial health equity: a scoping review of structural racism measurement, 2019-2021.Epidemiologic reviews · 2024Article
- A Model for Engaging Citizen Scientists: A Community-Partnered Research Collaboration to Address Inequities for Black Birthing People.Maternal and child health journal · 2024Article
- Association of birth and periodontal disease in Bolivia, Chile and ColombiaBiomedica : revista del Instituto Nacional de Salud · 2024Article
- Patterns and predictors of change in relationship status among Black mothers over 16 weeks postpartum.Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) · 2024Article
- Variations in antibiotic prescribing among children enrolled in North Carolina Medicaid, 2013-2019.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- Structural Racism, Mass Incarceration, and Racial and Ethnic Disparities in Severe Maternal Morbidity.JAMA network open · 2024Article
- State-Level Indicators of Structural Racism and Severe Adverse Maternal Outcomes During Childbirth.Maternal and child health journal · 2024Article
- Structural Racism and Well-Being Among Young People in the U.S.American journal of preventive medicine · 2023Article
- Study design and protocol for Nourishing Beginnings, an integrated service delivery model addressing food insecurity and social needs of low-income pregnant individuals.Contemporary clinical trials · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundWhile evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban-rural lines remains unexplored. The objective of this study was to examine the associations between county-level structural racism (racial inequity in educational attainment, median household income and jail incarceration) and infant mortality and heterogeneity between urban and rural areas.
methodsUsing linked live birth/infant death data provided by the National Center for Health Statistics, we calculated overall and race-specific 2013-2017 5-year infant mortality rates (IMRs) per 1000 live births in every county. Racially stratified and area-stratified negative binomial regression models estimated IMR ratios and 95% CIs associated with structural racism indicators, adjusting for county-level confounders. Adjusted linear regression models estimated associations between structural racism indicators and the absolute and relative racial inequity in IMR.
resultsIn urban counties, structural racism indicators were associated with 7%-8% higher black IMR, and an overall structural racism score was associated with 9% greater black IMR; however, these findings became insignificant when adjusting for the region. In white population, structural racism indicators and the overall structural racism score were associated with a 6% decrease in urban white IMR. Both absolute and relative racial inequity in IMR were exacerbated in urban counties with greater levels of structural racism.
conclusionsOur findings highlight the complex relationship between structural racism and population health across urban-rural lines and suggest its contribution to the maintenance of health inequities in urban settings.
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