From 1996 through 2019, the US experienced higher infant mortality rates compared to other similar countries. The overall infant mortality rate was 6.29 deaths per 1000 live births, based on National Center for Health Statistics data. This issue is particularly significant among Black infants.
A recent study published in JAMA Network Open suggests that tax policy may affect infant mortality rates. The study analyzed state-level tax policy and its association with infant mortality rates in the US from 1996 through 2019. The findings indicated that higher tax revenue and progressivity were associated with reduced infant mortality rates after controlling for other factors.
The study found that each $1000 increase in tax revenue per capita was associated with a 2.6% decrease in the infant mortality rate. Additionally, an increase of 0.10 in the Suits index, which measures tax progressivity, was associated with a 4.6% decrease in the infant mortality rate. These findings suggest that tax policy is an important, modifiable social determinant of health that may influence state-level infant mortality.
Using a multivariable, negative binomial, generalized estimating equations model, the study focused on the association between tax policy and infant mortality rates. The analysis controlled for the year, state-level demographic variables, federal transfer revenue, and other revenue. Secondary analyses were conducted for racial and ethnic subgroups. The findings varied by race and ethnicity, with increased tax progressivity associated with decreased non-Hispanic White infant mortality and increased tax revenue associated with increased non-Hispanic Black infant mortality.
The study’s sensitivity analyses suggest that compared with tax revenue, tax progressivity may have a less robust association with infant mortality. However, there was limited variation in tax progressivity among states. Most of the 300 state years studied had regressive taxes, indicating that there may have been inadequate variation in the Kakwani index of tax progressivity to detect an association between this index and infant mortality.
Exploratory analyses suggest that there may be a minimum level of tax revenue necessary for a negative association between tax progressivity and infant mortality. If total tax revenue is inadequate, even a highly progressive tax system would not likely translate into increased government funding for programs associated with decreased infant mortality. Therefore, increasing tax progressivity without also increasing tax revenue may not contribute to decreased infant mortality.
The findings from this study have important implications for policymakers and healthcare professionals. Tax policy is a modifiable social determinant of health that may influence infant mortality rates. The study’s findings suggest that increasing tax revenue and tax progressivity may be associated with decreased infant mortality rates. However, the findings varied by race and ethnicity, indicating that policymakers should consider different populations’ specific needs and circumstances when developing tax policies.
Overall, the study suggests that tax policy may be an important, modifiable social determinant of health that may influence infant mortality rates in the US. The findings have important implications for policymakers and healthcare professionals, highlighting the need to consider different populations’ specific needs and circumstances when developing tax policies.
