{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:07:06Z","timestamp":1791810426329,"version":"4.3.4"},"reference-count":40,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T00:00:00Z","timestamp":1611705600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL085631"],"award-info":[{"award-number":["R01HL085631"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL085631-S2"],"award-info":[{"award-number":["R01HL085631-S2"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL085631-S3"],"award-info":[{"award-number":["R01HL085631-S3"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2021,1,6]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>While evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban\u2013rural 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using linked live birth\/infant death data provided by the National Center for Health Statistics, we calculated overall and race-specific 2013\u20132017 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In urban counties, structural racism indicators were associated with 7%\u20138%\u2009higher 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our findings highlight the complex relationship between structural racism and population health across urban\u2013rural lines and suggest its contribution to the maintenance of health inequities in urban settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2020-214260","type":"journal-article","created":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T13:21:01Z","timestamp":1611753661000},"page":"788-793","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Structural racism, racial inequities and urban\u2013rural differences in infant mortality in the US"],"prefix":"10.1136","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1763-3432","authenticated-orcid":false,"given":"Dovile","family":"Vilda","sequence":"first","affiliation":[{"name":"Mary Amelia Center for Women\u2019s Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Hardeman","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Dyer","sequence":"additional","affiliation":[{"name":"Mary Amelia Center for Women\u2019s Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine P","family":"Theall","sequence":"additional","affiliation":[{"name":"Mary Amelia Center for Women\u2019s Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maeve","family":"Wallace","sequence":"additional","affiliation":[{"name":"Mary Amelia Center for Women\u2019s Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,1,27]]},"reference":[{"key":"2025100702421252000_75.8.788.1","unstructured":"CDC . 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