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In this study we use a spatial regime framework to address the fundamental question: How do racial and economic forces intersect to generate spatial inequality in premature mortality? Prior work on mortality disparities emphasizes that groups experiencing cumulative disadvantage are often more likely to die prematurely and that rural areas suffer a higher mortality penalty. However, structural determinants, such as the flow of place-based economic resources shaped by uneven development and structural racism, are largely underexplored. We investigate these potentially crucial structural dimensions underlying the well-established spatial inequalities in premature mortality using novel measures of economic trade. We aim to answer the question: Does the intensity and directionality of the relationship between economic resource retention and premature death vary by the structural racism of place? This research provides new insights into the racialized structural determinants of patterns in premature mortality in the US and contributes to a growing body of empirical literature that examines how forces of structural racism contribute to adverse health, social, and economic outcomes.