Life Chances: Infant Mortality, Institutions, and Inequality in the United States

Abstract

The dissertation explores variation in socio-demographic inequalities in infant mortality in the U.S. with three empirical chapters.

The first empirical chapter focuses on inequalities in the likelihood of infant mortality by maternal education. Drawing on vital statistics records, I begin by assessing variation in these disparities across states. In some states, infants born to mothers with less than twelve years of schooling are more than twice as likely to die as infants of mothers with four years of college or more. I then examine how variation in the magnitude of these inequalities is associated with key medical system institutions. I find that more widespread availability of neonatal intensive care is associated with reduced inequality. In contrast, greater supply of primary care is linked to slightly larger differences in infant mortality between mothers with low and high education.

In the second empirical chapter, I explore racial disparities in neonatal mortality by stratifying these gaps based on two generating mechanisms: 1) disparities due to differences in the distribution of birth weights, and 2) those due to differences in birth weight-specific mortality. For each state, I then calculate the relative contribution these mechanisms to disparities in neonatal mortality between whites and blacks. Two patterns emerge. In some states, racial disparities in neonatal mortality are entirely a product of differences in health at birth. In other states, differential receipt of medical care contributes to disparities in very low birth weight mortality between white and black neonates.

The third empirical chapter evaluates the relationship between local public health expenditures and socioeconomic inequalities in infant mortality. Drawing on local government expenditure data in a sample of large municipalities, I explore the extent to which health and hospital spending are associated with inequalities in county infant mortality rates between mothers with low and high levels of educational attainment. For white mothers, I find that hospital expenditures are negatively associated with educational inequalities in infant mortality, but that other health expenditures are positively associated with inequality. In contrast, local public health expenditures are not significant predictors of educational inequalities in infant mortality rates for black mothers.