Executive Summary: “Inequality in Life and Death: What Drives Racial Trends in U.S. Child Death Rates?” by Janet Currie and V. Joseph Hotz

Health is one of the most fundamental aspects of well-being, and there are well-known inequalities in health status in the United States, especially between African Americans and others.  This paper focuses on the trends in and determinants of child death rates in the U.S. over the period 1980 to 1998.  Annual death rates of chil­dren 0 to19 fell sharply from117.6 deaths per 100,000 in 1980 to 71.0 per 100,000 in 1998.  But although the gap in overall death rates between black and non-black children narrowed over the same interval, the gap was still sizeable in 1998.  For example, as of 1998, black children were still twice as likely to die from unintentional injuries as white children. Fur­ther­more, this pattern of narrowing gaps did not hold across all causes of death. Among young children, the black-white gap in deaths rates due to auto accidents actually increased and, for al­most all ages, the racial gap in deaths due to intentional injuries, including those involving fire­arms, increased over this period.

We extend the previous literature on childhood death rates in three ways.  First, we look at how trends differ across causes of death, ages of children, and race. Second, our paper examines a variety of different hypotheses about determinants of these trends that have been identified in the literature, and assesses the robustness of their estimated effects to the inclusion various controls including state fixed ef­fects and state-specific trends.

Our third, and most innovative contribution is to ask whether the remaining unexplained variation in child mor­tality rates is primarily affected by child-specific factors, or whether trends can be explained by improvements in factors that also drive death rates among adults. For example, safer cars might be expected to benefit both adults and children, while the use of car seats would primarily affect young children. In order to address this question, we construct regression-adjusted death rates for 24 to 45 years old men, where the regression adjustments net out the effects of our measures of income, socioeconomic status and medical access. These “residual” measures of adult male death rates capture changes in medical technology, product safety/regulation, or health practices that affect both adults and children within a state, year, and race group.

We find that income and other measures of socio-economic status such as maternal educa­tion and employment are often important predictors of death rates and that inequality in levels of these variables can explain much of the gap in death rates for some ages and causes of death. However, it is more difficult to explain trends in death rates over time, or to explain the narrow­ing or broadening of the gap between black and non-black death rates with these measures. In con­trast, changes in the “male residuals” can explain much of the change in the gaps between black and non-black death rates. This finding suggests that the gap between black and non-black overall death rates narrowed because of factors that affected adults as well as children, rather than solely be­cause of factors impacting black and non-black children.