Improving Survival, Enduring Disparities: Infant and Child Mortality in a Small Southern Town, 1915-2015

Abstract

Despite substantial improvements in public health and medical care in the United States during the twentieth century, inequalities in health outcomes have persisted across populations. These disparities are shaped by interactions between biological factors and social determinants of health, including race, public policy, and structural inequality. This study examines long-term patterns of infant and child mortality in Ayden, North Carolina, a small rural Southern community, between 1915 and 2015. Data were drawn from the Ayden Mortality Dataset, a demographic database containing vital records for more than 9,000 individuals who lived, died, or were buried in Ayden during the study period. Logistic regression models were used to examine the likelihood of infant death (under age one) and child death (ages 1–17) as a function of race, sex, death year, and historical period (Jim Crow versus post–Jim Crow). Based on previous research, I predicted that mortality would decline over time, males would experience higher mortality risk than females, and racial disparities would decrease following the end of the Jim Crow era while remaining present due to persistent structural inequalities. Results indicate that infant and child mortality declined substantially across the twentieth century, consistent with broader improvements in public health, living conditions, and access to medical care. Contrary to expectations, no significant differences in mortality were observed between males and females. However, persistent racial disparities were evident throughout the study period. Black individuals experienced significantly higher odds of infant and child mortality than White individuals, even as mortality declined for both groups. Among infants, racial disparities widened following the end of Jim Crow because mortality declined more rapidly among White infants than among Black infants. Among children, Black individuals consistently experienced higher mortality risk regardless of historical period. These findings demonstrate that dramatic improvements in population health can coexist with enduring inequalities and highlight the lasting influence of structural factors on survival outcomes across generations.