Document Type

Article

Publication Date

2026

Advisor

Jeannette Manger

Abstract

Introduction: Infant mortality continues to occur at alarming rates that differ among various groups and states. Despite this, there has been a lack of intersectional examination of risk- and protective-factors. Methods: We examine how smoking status, education level, primary care to population ratio, teen birth rates, and urban vs rural status impact infant mortality rates in Ohio, Kentucky, Michigan, and Indiana using County Health Rankings data. Results: Ohio was shown to have no significant difference between urban and rural infant mortality rates; however,  risk-and-protective factors did differ. In urban counties, high school completion, teen birth rates, and primary care ratios accounted for 44% of the variance in infant mortality. In rural Ohio counties, only the teen birth rate was statistically predictive and accounted for 8.5% of the variance. Infant mortality rates also did not differ between the four states (F=1.30, p=.28), despite our predicted risk factors differing, specifically in Kentucky, which has a higher teen birth rate, lower education rate, and more smoking (p< 0.001), but the same infant mortality rate. Conclusion:   Infant mortality is a nuanced topic and the product of multiple intersecting social determinants of health. The variation of predictive factors followed by an insignificant change in overall infant mortality rate indicates a need for targeted public health interventions focused on predictive factors specific to a community.

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