State Social Expenditures and Preterm Birth and Low Birth Weight in the US.

Creator(s)

Lawrence Chang
Henry T. Puls, Children's Mercy HospitalFollow
Michael C. Monuteaux
Jeffrey D. Colvin, Children's Mercy HospitalFollow
Paul J. Chung
Lois K. Lee

Document Type

Response or Comment

Publication Date

12-1-2024

Identifier

DOI: 10.1001/jamapediatrics.2024.4267; PMCID: PMC11581729

Abstract

IMPORTANCE: Adverse birth outcomes in the US, including preterm birth and low birth weight, are strongly tied to socioeconomic disadvantage and disproportionately impact infants of Black mothers. Increasing investments in social programs represents a potential policy approach to addressing disparities in birth outcomes.

OBJECTIVE: To examine state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, ecological study was conducted among liveborn infants in the 50 US states between January 1, 2011, and December 31, 2019. Data analysis was performed from May 2022 to May 2024.

EXPOSURES: Yearly state and local government expenditures per low-income person on social programs in the following categories: state refundable Earned Income Tax Credit; cash assistance; childcare assistance; housing and community development; and public health.

MAIN OUTCOMES AND MEASURES: Yearly state-level rates of preterm birth (gestational age <37 >weeks) and low birth weight (<2500 >g).

RESULTS: From January 1, 2011, to December 31, 2019, there were 35.1 million live births in the US, of which 3.4 million (9.8%) were preterm and 2.8 million (8.1%) were low birth weight. Median (IQR) state social expenditures per low-income person were $1546 ($1074-$2323). Greater total state social expenditures were associated with lower overall rates of preterm birth (adjusted prevalence ratio [aPR] for every increase of $1000 per low-income person, 0.99; 95% CI, 0.97-0.999) but not with overall rates of low birth weight. In secondary analyses, greater state social expenditures were associated with lower preterm birth rates for infants of Black mothers (aPR, 0.96; 95% CI, 0.92-0.999). Greater state expenditures specifically on cash assistance (aPR, 0.64; 95% CI, 0.43-0.94) and housing and community development (aPR, 0.91; 95% CI, 0.84-0.98) were associated with lower preterm birth rates for infants of Black mothers.

CONCLUSIONS AND RELEVANCE: In this cross-sectional, ecological study, greater state-level expenditures on social programs were associated with reduced rates of preterm birth, particularly for infants of Black mothers. State and local governments may consider bolstering investments in cash assistance and housing and community development to address maternal and infant health disparities.

Journal Title

JAMA Pediatr

Volume

178

Issue

12

First Page

1345

Last Page

1353

MeSH Keywords

Humans; Infant, Low Birth Weight; Cross-Sectional Studies; United States; Premature Birth; Infant, Newborn; Female; Pregnancy; State Government; Male; Health Expenditures

Keywords

Cross-Sectional Studies; United States; Pregnancy; State Government; Health Expenditures

Comments

Comment on

• Optimizing Public Policies for Pregnancy and Infant Outcomes. Lorch SA, Peña MM, Montoya-Williams D.JAMA Pediatr. 2024 Dec 1;178(12):1250-1251. doi: 10.1001/jamapediatrics.2024.4264.PMID: 39401052 No abstract available.

Recommended Citation

Chang L, Puls HT, Monuteaux MC, Colvin JD, Chung PJ, Lee LK. State Social Expenditures and Preterm Birth and Low Birth Weight in the US. JAMA Pediatr. 2024;178(12):1345-1353. doi:10.1001/jamapediatrics.2024.4267