Abstract
Little is known regarding how family racial structure and income intersect to produce health outcomes. We assessed infant health outcomes (weeks gestation and first year infant mortality rates (IMR)) by family racial structure (specific race group affiliation, and whether multiracial), examining the degree to which income (insurance type as proxy) interacts with family racial composition to predict infant health outcomes. This cross-sectional study utilized secondary data analysis of birth records and linked infant birth/death records spanning a 14 year period (2006–2019) for a single U.S. county. Income was dichotomized into low income and high income based upon insurance type. Race and ancestry data from infant, maternal, and paternal sources were combined into six pan-ethnic categories (Black, Asian, White, Native-American, Latino, and Middle Eastern). We used Generalized Estimating Equation to obtain the associations between a composite race x multiracial x income predictor and outcomes (infant death, weeks gestation), accounting for repeated mother births. Findings reveal that infants with Black heritage have the worst outcomes (12.34 IMR). Multiracial infants (20.5% of the population) tend to be from higher income families than monoracial minority infants. Looking further, we find that this translates to better outcomes depending on racial group and multiraciality. Multiracial higher-income Black families have substantially better outcomes (2.85 IMR) than their single Black race (12.63 IMR) or lower income multiracial peers (16.16 IMR). Single race White families also see health gains with higher income (3.60 IMR versus 6.02 IMR). Other minority race families, whether single or multiracial, see little health gain with higher income; instead, whether this group is multiracial or not is the determining feature (being single-race rather than multiracial is associated with better outcomes (0.97 IMR versus 5.39 IMR)).
Highlights
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Questions remain regarding the pace of minority/multiracial families’ socioeconomic integration, and how race, multiraciality and socioeconomic status are linked to health.
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Multiracial families have higher income than single race minority families, but lower income compared to single race White families.
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Higher income is associated with better infant health for single race White families and multiracial Black families, but not for single-race Black families or other non-Black minority race families (Asian, Latino, Middle Eastern, Native American).
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Non-Black minority race families have better outcomes if they share the same race than if they are multiracial.
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Overall, Black race families fare the worst, with lower incomes, higher prematurity, and more infant deaths.
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The exception to the pattern above for Black families is that Black families who are multiracial and higher -income achieve health equity (have outcomes equivalent to White-majority families).
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Notes
Infant mortality rate is the number of infant deaths (age under 1) per 1000 births
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C.L.K. led the writing of the manuscript, the statistical analysis and the interpretation of study findings. K.C. helped conduct the literature review. J.P. assisted with data collection. T.B., B.O’.R. and D.L. contributed to the conceptualization of the study and interpretation of study findings.
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Funding for this study comes from the United Way of the Battle Creek and Kalamazoo Region and a HRSA Healthy Start Grant from the Kalamazoo County Health and Community Services Health Babies Health Start program.
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The study was conducted in accordance with Helsinki Declaration as revised in 2013. Permission and access to the birth records data were provided by the Michigan Department of Health and Human Services’ Vital Statistics. Institutional Review Board approval was provided by the Michigan Department of Health and Human Services (IRB # 201703-13-EA) and Western Michigan University Homer Stryker MD School of Medicine (IRB #1017-0179) Institutional Review Boards.
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Kothari, C.L., Corbit, K., Presberry, J. et al. Race, Multiraciality, Income, and Infant Mortality: Markers of Racial Equity. J Child Fam Stud 31, 689–702 (2022). https://doi.org/10.1007/s10826-022-02246-9
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DOI: https://doi.org/10.1007/s10826-022-02246-9