Inequality, Health Infrastructure, and Spatial Context: Understanding Pathways to Variations in the Causal Determinants of Race-Specific Mortality Rates

Previous research examines the ecological relationship between income inequality and mortality, and results are inconclusive. This analysis builds upon these findings by implementing a spatially weighted path analysis to better understand the mediating relationships of economic and social inequality, health infrastructure, and mortality. In the analysis, overall and race-specific mortality rates are combined with local health infrastructure data, income inequality and racial segregation data, and a series of ecological controls to undertake this examination. Ultimately, findings show that income inequality is a stronger determinant of mortality than is segregation, for whites and blacks, regardless of the existing health infrastructure. We also find racial disparities in the direct effect of local health infrastructure on mortality. In contrast to previous literature suggesting no association between income inequality and mortality after accounting for race and model sophistication, we argue that the significance of the relationship persists using race-specific, spatially weighted path models. © 2012 Copyright Taylor and Francis Group, LLC