Race matters more than income when it comes to maternal and infant health outcomes in the U.S., and even the highest-income American families have worse outcomes than poorer Swedish ones.
That’s the conclusion University of Michigan business professor Sarah Miller and her team reached in a new study. They used health and birth records, linked to income information from the IRS, to gain a picture of how income affects birth outcomes in California. They also compared it to a similar dataset from Sweden.
Their research found that to a certain extent, income is protective: the highest-income Americans living in California had the lowest rates of infant and maternal mortality. That’s despite the fact that many have the highest-risk pregnancies and less-healthy infants at birth.
Miller said that initially came as a surprise. “What we saw was actually that in a lot of cases, the higher-income families were having less healthy babies in some dimensions,” she said. “They were more likely to have pre-term babies, more likely to have very low birth-weight babies.”
Miller said that’s likely because many of the highest-income moms are older on average, and more likely to have non-single births such as twins and triplets.
But the research found that income isn’t nearly as protective for Black families. The disparity in outcomes by race persist even for the highest-income Black moms and babies. “The differences in health outcomes between non-Hispanic Black and non-Hispanic white families were much bigger than the differences between rich and poor families,” Miller said.
“We see that even the very richest non-Hispanic black families are having worse health outcomes than the very poorest non-Hispanic white families. So that difference across race was just a lot bigger than the differences we were seeing by income,” she said.
The research also found that the richest Americans living in California had worse birth outcomes than much poorer Swedish counterparts. Miller’s team had theorized that perhaps the wealthiest Americans would have better outcomes, but that didn’t turn out to be the case.
“What we found instead was actually that the differences in health outcomes between the U.S. and Sweden didn't go away as income went up,” Miller said. “Even if you looked at the point of the distribution where the California health outcomes were the best, they were still worse than the poorest outcomes among the Swedish families.”
Miller’s paper is only descriptive, and doesn’t theorize why any of these conclusions are true, only that the data strongly supports them. Nor does it attempt to prescribe policies that could address these disparities.
Nonetheless, Miller said other research points toward some solutions. Sweden, for example, has lifetime universal health care coverage, whereas in the U.S. nearly half of all births are covered by Medicaid — which only covers the patient during pregnancy and birth.
As for the ongoing disparity between Black and white patients regardless of income, research points to a combination of factors involving systemic racism. For example, Black women are more likely to live in areas with high rates of air pollution, and are more likely to receive substandard medical care.
Miller said there likely isn’t one single or simple solution to address these disparities. And ironically, she noted, the U.S. actually has some of the best and most advanced neo-natal technologies and health care in the world: “We have we have a lot of tools at our disposal, but it just seems like they're not they're not reaching everyone.”
