Typical indicators of neighborhood change used to define gentrification have opposing associations with infant mortality

Infant mortality (IM), or death prior to the first birthday, is a key public health metric that increases with neighborhood structural inequities. However, neighborhood exposures shift as communities undergo gentrification, a pattern of neighborhood change defined by increasing affluence (in wealth, education, and housing costs). Gentrification has inconsistent associations with infant health outcomes like IM, which may be due to differing relationships between its composite measures and such outcomes. We designed a retrospective cohort analysis of all births and deaths from 2010-2019 across 4 metropolitan areas in Michigan to determine how gentrification and its neighborhood-change components are associated with risk of IM, using multilevel multivariable logistic regression models. Among 672,432 infants, 0.52% died before 1 year. IM was not associated with gentrification. Census tracts with greater increases in income and education had lower rates of IM, but tracts with greater increases in rent costs had higher rates of IM. In unadjusted models, odds of IM were 40% and 15% lower for infants living in tracts in the top quartile increase in household income and college completion, respectively, compared to infants from tracts with the least amount of change. Odds of IM were also increased 29% in infants from tracts with the most increases in rent, though these differences were attenuated when adjusting for individual social factors. Indicators of increasing community affluence have opposing relationships with IM. Policies and interventions that address rising housing costs may reduce IM.