Court-mandated redistricting and disparities in infant mortality and deaths of despair

Background: Health and health disparities vary substantially by geography, including geopolitical boundaries such as United States congressional districts. Every ten years congressional districts for the House of Representatives are redistricted, but occasionally the Courts step in and force states to redistrict gerrymandered congressional maps. Analyses of court mandated redistricting decisions often focus on the distribution of voters by political party and race, but less is known about how health and health disparities are distributed across congressional districts before and after redistricting. In this analysis, we examine how the magnitude of disparities varied between and within congressional districts in Pennsylvania, before and after the state Supreme Court of Pennsylvania’s decision ordering a redistricting in 2018 that produced less politically gerrymandered districts. Methods: Using georeferenced vital statistics data from 2013–2015 (before the redistricting), we explore levels of and disparities in infant mortality rates (IMR) and deaths of despair (DoD) using boundaries from before (Congresses 113–115) and after (Congress 116) this redistricting. Results: Using consistent mortality data (2013–2015) and boundaries from before and after the 2018 redistricting, we find that after redistricting disparities in infant mortality and deaths of despair between congressional districts were slightly wider for all educational groups except for those with less than a high school degree, and slightly narrower for all racial-ethnic groups other than for Hispanic and non-Hispanic White populations, compared with before redistricting. Conclusions: Understanding how disparities vary between and within districts after redistricting can inform our understanding of the relationships between geopolitical boundaries, election processes, and health disparities.