Neighborhood Poverty and American Indian Infant Death: Are The Effects Identifiable?
Received 10 July 2007; accepted 27 February 2008. published online 27 May 2008.
Purpose
Poor living conditions are posited as an underlying cause of American Indian (AI) infant mortality, which is unusually high in the postneonatal period. We explore whether the effects of neighborhood poverty on AI infant death are identifiable by using observational data.
Methods
Vital records for infants born between 1990 and 1999 to AI women in a metropolitan area (n = 4751) are linked with tract-level poverty data. A counterfactual framework, an explicit causal contrast study design, and propensity score matching methods were used. For each comparison, we created exchangeable groups by matching infants with the same probability of exposure to poverty when one was exposed and the other was not.
Results
Our results suggest that neighborhood poverty has little effect on AI infant death outcomes. Importantly, the study design makes transparent the challenge of identifying appropriate analytic comparison groups in studies of neighborhood poverty and health.
Conclusions
Collecting additional data will likely not overcome the fact that AIs with a high probability of living in poverty rarely reside in low-poverty neighborhoods. Yet, some of them must if a meaningful counterfactual comparison is to be made and the effects of neighborhood poverty on AI infant death are to be identified.
aDivision of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis
bDivision of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
cSocial and Demographic Research Institute and Department of Sociology, University of Massachusetts-Amherst
Address correspondence to: Pamela Jo Johnson, MPH, PhD, State Health Access Data Assistance Center, School of Public Health, University of Minnesota, 2221 University Avenue, Suite 345, Minneapolis, MN 55414. Tel.: 612-624-1406; fax: 612-624-1493.
Financial support for this study was provided in part by a Minority Health Statistics Dissertation Fellowship granted to Pamela Jo Johnson by the Center for Excellence in Health Statistics (a collaboration between the Center for Health Statistics, Minnesota Department of Health and the School of Public Health, University of Minnesota) and by NHLBI grant R01-HL61573 (PI: J. Michael Oakes).
ABSTRACT