An Ecological Examination of Maternal and Infant Health Outcomes by the Presence of Community Health Centers in Local Health Department Jurisdictions

Expanding community health centers is one strategy proposed by the 2010 Patient Protections and Affordable Care Act to reduce infant mortality and prematurity by increasing access to health services. This study examines the association between CHC concentration and infant and neonatal mortality rates across 45 large (population = 250,000) LHD jurisdictions in 10 Midwestern states. We extracted variables from the 2010 Health Resources and Services Administration, the 2008 National Association of City and County Health Officials, the U.S. Census and the 2007 National Center for Health Statistics datasets. These variables included infant and neonatal mortality rates for each jurisdiction, physical location of CHCs, and percent poverty. Using logistic regression analyses, we examined the associations between the number of health centers and infant mortality and neonatal mortality rates. The study revealed large variations in CHC concentration across jurisdictions. Our study also found that CHC concentration was associated with neonatal mortality (p=.016) rate even after controlling for poverty rates within jurisdictions. Results suggest that public health practitioners and primary care providers should consider CHC concentration of large communities as important indicators when examining infant health outcomes. Future studies exploring intra-organizational factors, such as type and quality of infant health services offered by CHCs as well as training of personnel, and inter-organizational alliances existing between CHCs and LHDs are needed to gain better insight into the mechanisms that impact infant health outcomes