BACKGROUND Enhanced understanding of spatial social polarization as a determinant of infant mortality is critical to efforts aimed at advancing health equity. Our objective was to identify associations between spatial social polarization and risk of infant death. METHODS We conducted a cross-sectional analysis of all birth records issued to non-Hispanic (NH) Black and White women in Wayne County, MI, from 2010 to 2013 (n = 84 159), including linked death records for deaths occurring at less than 1 year of age. Spatial social polarization was measured in each Census tract of maternal residence (n = 599) using the Index of Concentration at the Extremes (ICE)-a joint measure of racial and economic segregation-estimated from American Community Survey 2009-2013 data. Log-Poisson regression models quantified relative risk (RR) of infant death (all-cause and cause-specific) associated with tertiles of the index, adjusting for maternal demographic characteristics and tract-level poverty. RESULTS The crude infant-mortality rate was more than 2-fold higher among NH Black infants compared with NH Whites (14.0 vs 5.9 deaths per 1000 live births). Half of the 845 infant deaths (72% NH Black, 28% NH White) occurred in tracts in the lowest tertile of the ICE distribution, representing areas of relative deprivation. After adjustments, risk of death among infants in the lowest tertile was 1.46 times greater than those in the highest tertile (adjusted infant-mortality rate = 3.7 deaths per 1000 live births in highest tertile vs 5.4 deaths per 1000 live births in lowest tertile, relative risk = 1.46, 95% confidence interval = 1.02, 2.09). Patterns of associations with the index differed by cause of death. CONCLUSIONS These findings suggest efforts to support equitable community investments may reduce incidents of death and the disproportionate experience of loss among NH Black women.

中文翻译：

---

底特律的特权与剥夺：婴儿死亡率和极端人群的集中指数。

背景技术对空间社会两极分化作为婴儿死亡率的决定因素的加深理解对于旨在促进健康平等的努力至关重要。我们的目标是确定空间社会两极化与婴儿死亡风险之间的关联。方法我们对2010年至2013年向密西根州韦恩县的非西班牙裔（NH）黑人和白人妇女发布的所有出生记录进行了横断面分析（n = 84 159），包括因死亡而死亡的相关死亡记录。超过1岁。使用“极端集中指数”（ICE），这是种族和经济隔离的联合指标，根据美国社区调查2009-2013数据估算，在每个孕产妇人口普查区域（n = 599）中测量了空间社会两极分化。Log-Poisson回归模型对与该指数的三分位数相关的婴儿死亡（所有原因和特定原因）的相对危险度（RR）进行了量化，并根据母亲的人口统计学特征和地区贫困状况进行了调整。结果与NH Whites相比，NH Black婴儿中的婴儿死亡率比NH Whites高出2倍以上（每1000例活产中有14.0例死亡，而5.9例死亡）。845例婴儿死亡中有一半（72％NH黑色，28％NH白色）发生在ICE分布最低的三分位数区域，代表相对贫困地区。调整后，最低三分位数婴儿的死亡风险是最高三分位数婴儿的1.46倍（调整后的婴儿死亡率=最高三分位数的婴儿每千名活产婴儿有3.7例死亡，而最低三分位数的婴儿每千名活产婴儿有5.4例死亡，相对风险= 1.46，95％置信区间= 1.02，2.09）。与该指数相关的模式因死亡原因而异。结论这些发现表明，支持公平的社区投资的努力可以减少NH Black妇女中的死亡事件和不成比例的损失经历。