Racial residential segregation and child mortality in the southern United States at the turn of the 20th century

A growing body of research considers racial residential segregation to be a form of systemic racism and a fundamental cause of persistent racial disparities in health and mortality. Historical research examining the impact of segregation on health and mortality, however, is limited to a few studies with poor data and inconsistent results. In this study, we examine the association between racial residential segregation and child mortality in the South at the turn of the 20th century. We rely on the new IPUMS 1900 and 1910 complete-count databases to estimate child mortality in the 5 years before each census and construct segregation measures at the census enumeration district (ED), the lowest level of geography consistently available in the census. We calculate the proportion of households headed by Black individuals in each ED, and the Sequence Index of Segregation (SIS), which is based on the racial sequencing of household heads within each district. We construct models of child mortality for rural and urban areas, controlling for a wide variety of demographic and socioeconomic variables. The results indicate that proportion Black and SIS were strongly and positively associated with the mortality of Black children in most models and in both rural and urban areas. Proportion Black was also positively but more moderately correlated with the mortality of White children, while SIS was not correlated or negatively correlated. These results suggest that racial segregation was a long-standing fundamental cause of race disparities in health and mortality in the United States.