# Food Insecurity, Walkability, and Social Determinants of Health: A Cross-Sectional, County-Level Study of Associations with Maternal and Infant Mortality in the United States

## TL;DR

This study explores how factors like food insecurity and walkability are linked to higher maternal and infant mortality rates in the US.

## Contribution

The study uses structural equation modeling to show direct and indirect links between social determinants and mortality rates.

## Key findings

- Food insecurity and decreased walkability are directly linked to both maternal and infant mortality.
- Infant mortality is associated with increased food assistance, mental distress, and lower education and income levels.
- Maternal mortality is connected to distance to obstetric care and lower marriage rates.

## Abstract

Background: Compared to other high-income countries, US women face higher maternal and infant mortality rates. Methods: This study used structural equation modeling (SEM) to examine cross-sectional, county-level associations between structural and intermediary social determinants of health (SDOHs) and maternal and infant mortalities, based on the World Health Organization’s Commission on Social Determinants of Health framework. Results: Our findings suggest maternal mortality may be linked to increased food insecurity, food assistance, distance to obstetric care, and decreased walkability and marriage rates. Our modeling also points toward a connection between infant mortality and increased food insecurity, food assistance, Black race, mental distress, and decreased walkability, education, and income. SEM revealed significant direct and indirect effects of these SDOHs. Notably, food insecurity and walkability had direct associations with both maternal and infant mortality in both SEM models. Conclusions: The findings underscore the need for policy, practice, and research efforts to address key SDOHs and reduce mortality disparities in the US.