Date of Conferral

7-3-2025

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Claire Robb

Abstract

The purpose of this quantitative, cross-sectional study was to examine whether social determinants interactively influence U.S. maternal and infant mortality rates. Grounded in the Social Ecological Model, this study analyzed secondary data from the Centers for Disease Control and Prevention’s National Vital Statistics System were analyzed using multivariable logistic regression. The final sample included 110,402 maternal deaths and 55,839 infant deaths, with inclusion criteria requiring complete data on race, education, age, marital status, gender (for infants), residency, and year of death. Exclusion criteria included non-U.S. resident deaths or missing demographic data. Results revealed statistically significant interaction effects: race/ethnicity with education (p = 0.045) and age (p = 0.004) on maternal mortality; and race/ethnicity with residency status on infant mortality (p < 0.001). Compared to White women, middle-aged Black (adjusted OR = 1.58, 95% CI [1.43, 1.74]) and Hispanic women (adjusted OR = 1.29, 95% CI [1.16, 1.43]) had significantly higher odds of maternal death, while odds were lower for Hispanic women with an undergraduate degree (adjusted OR = 0.83, 95% CI [0.68, 0.99]), p = 0.036). Infant mortality odds were also higher among in-state Black (adjusted OR = 1.69) 95% CI [1.59, 1.79], p < 0.001) and Hispanic (adjusted OR = 1.36, 95% CI [1.29, 1.44], p < 0.001) infants, but lower for out-of-state or foreign-born infants including Whites. These findings highlight the compounding effects of structural inequities and support the need for culturally responsive care, targeted interventions, and policy reforms to reduce preventable deaths in historically marginalized populations.

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