Biocultural and social determinants of ill health and early mortality in a New Mexican paediatric autopsy sample

Abstract

Illness and mortality have social origins, and infants and children are especially susceptible to the impacts of adverse social experiences. Early-life stress (ELS) - physiological disruptions suffered by a developing organism - is incorporated into human biology through embodiment. This paper examines whether children who lived and died in New Mexico (2011-2019) embodied social determinants of health. Data were collected from 780 postmortem computed tomography scans in conjunction with data from field notes and autopsy reports for individuals aged 0.5-20.99 years from New Mexico. Variables included in linear/logistic regressions are the per cent of families in poverty by ZIP code and year, housing type (trailer/mobile home, apartment, house), rural/urban residence areas, and race/ethnicity. Health outcome variables are age at death, respiratory conditions, growth stunting and arrest, and porous cranial lesions. Intersections of poverty, housing disparities, and race/ethnicity are examined to understand whether children from New Mexico incorporated ELS into their biology. Results Hispanic children have higher odds of growth stunting than non-Hispanic White children. Native American children die younger and have higher odds of respiratory diseases and porous lesions than Hispanic and non-Hispanic Whites. Rural/urban location does not significantly impact age at death, but housing type does. Individuals who lived in trailers/mobile homes had earlier ages at death. When intersections between housing type and housing location are considered, children who were poor and from impoverished areas lived longer than those who were poor from relatively well-off areas. Conclusions Children's health is shaped by factors outside their control. The children included in this study embodied experiences of social and ELS and did not survive to adulthood. They provide the most sobering example of the harm that social factors (structural racism/discrimination, socioeconomic, and political structures) can inflict.