摘要：Objectives. The purpose of the present study was to compare the associations of state-referenced and federal poverty measures with states’ infant and child mortality rates. Methods. Compressed mortality and Current Population Survey data were used to examine relationships between mortality and (1) state-referenced poverty (percentage of children below half the state median income) and (2) percentage of children below the federal poverty line. Results. State-referenced poverty was not associated with mortality among infants or children, whereas poverty as defined by national standards was strongly related to mortality. Conclusions. Infant and child mortality is more closely tied to families’ capacity for meeting basic needs than to relative position within a state’s economic hierarchy. During infancy 1– 5 and throughout childhood, 2– 6 poverty has been found to be an important predictor of risk for mortality from leading causes of death at these ages, including perinatal conditions, 2, 5 congenital anomalies, 2, 3 motor vehicle injuries, 2, 3 and homicide, 2, 3, 5 as well as from all causes combined. 1– 6 Child poverty has usually been defined in relation to the federal poverty line, either directly through comparisons of reported income with established poverty thresholds 7 or indirectly by assessments of eligibility for means-tested governmental assistance programs. The federal poverty line, an absolute measure of childhood deprivation that provides a common standard for all US children, was originally designed to represent roughly 3 times the average cost of the least expensive nutritionally adequate food plan, as determined by the Department of Agriculture. 8 The federal poverty standard has been criticized for its incorporation of outdated assumptions about economies of scale in food consumption and the cost of food relative to housing, as well as its failure to take into account taxes, job-related expenses, and the value of noncash benefits 9, 10 ; however, it remains the official benchmark for defining economic deprivation among both children and adults. 7 Over the past 10 years, substantial research and policy interest has focused on the concept of “relative deprivation” and its implications for health. 11 This approach suggests that, between and within rich countries, “relative” rather than absolute levels of income are most important in terms of influencing public health. 12, 13 This focus on relative deprivation has played out amid heightened interest in income inequality among children 14 as well as among the population more generally, 15, 16 and the relative deprivation concept has informed the idea that poverty may be more appropriately conceptualized and measured relative to local rather than national conditions. If relative deprivation occurs via psychosocial mechanisms involving perceptions of relative disadvantage, then this idea makes sense, in that individuals are perhaps more likely to perceive local conditions as most relevant to them. Indeed, Rainwater and colleagues argued that using a locally referenced poverty standard brings the definition of a poverty line closer to the social reality of the lives of the people being studied . . . [and] takes into account variations in the cost of living, differences in consumption bundles, and relevant differences in social understanding of what consumption possibilities mean for social participation and social activities. 17 Indexing child poverty to geographically proximate economic conditions may well be effective in capturing social exclusion relative to others living in a particular area; however, it is not clear how children’s poverty status, defined in this way, might be related to their health. In this study, we examined the association between state-level child and infant mortality rates and 2 measures of child poverty, one referenced to a local state standard and another referenced to the federally defined poverty standard.
