The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.

The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.
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DOI:
10.1111/1475-6773.13288
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发表时间:
2020-10
影响因子:
3.4
通讯作者:
Lorch SA
Lorch SA
中科院分区:
医学3区
文献类型:
--
作者:
Montoya-Williams D;Passarella M;Lorch SA

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评估加州带薪家庭假对全州早产率、低出生体重率、新生儿后死亡率和婴儿总死亡率的影响。1999至2008年间,在加利福尼亚州(受探亲假政策影响的州)和两个未受影响的州(密苏里州和宾夕法尼亚州)发生的所有住院分娩的活生生和死亡证明(n=6、164、203)。我们使用差异差异法比较了加州2004年政策实施前后的婴儿健康结局比率与两个未实施带薪家庭假政策的州的比率。预先指定的分层分析检查了政策反应是否因母亲的特征而不同。条件回归模型使用与母亲在家庭休假前时期居住在加州的可能性相匹配的比较,然后被用作敏感性分析,以证实我们的发现。使用概率方法将活产记录与产妇和新生儿的住院记录进行匹配。只有单胞胎出生的孩子才被包括在内。如果婴儿胎龄是23周或大于44周,或者如果出生体重是异常值,则排除二联体。与未暴露的州相比,2004年后加州调整后的新生儿死亡率下降了12%(AOR为0.88,95%CI为0.80-0.97)。对其他结果没有显著影响。除了2004年后加州私人保险妇女出生体重低的几率增加外,种族/民族或保险状况对出生体重的影响没有差异。倾向得分匹配的敏感性模型中的点估计值与完全调整后的模型对所有四个结果的结果相似,但可信区间超过一个。加州实施带薪家庭假政策,在对产妇和新生儿因素进行调整后,新生儿死亡率下降了12%。
To evaluate the effect of paid family leave in California on statewide rates of preterm birth, low birthweight, postneonatal mortality, and overall infant mortality. Live birth and death certificates from all in‐hospital deliveries occurring in California (state exposed to the family leave policy) and two unexposed states (Missouri and Pennsylvania) from 1999 to 2008 (n = 6 164 203). We used a difference‐in‐differences approach to compare rates of infant health outcomes before and after implementation of the 2004 policy in California with rates in two states without paid family leave policies. Prespecified stratified analyses examined whether policy response differed by maternal characteristics. Conditional regression models using comparisons matched on a mother's likelihood of living in California in the pre–family leave period were then employed as sensitivity analyses to confirm our findings. Probabilistic methods were used to match live birth records to maternal and newborn hospital records. Only singleton births were included. Dyads were excluded if the infant gestational age was <23 weeks or greater than 44 weeks or if the birthweight was an outlier. Compared to the unexposed states, adjusted postneonatal mortality rates decreased by 12 percent in California after 2004 (aOR 0.88, 95% CI 0.80‐0.97). There were no significant effects on the other outcomes. There were no differences in the effect by race/ethnicity or insurance status except for increased odds of low birthweight among privately insured women in California after 2004. Point estimates in the propensity score–matched sensitivity models were similar to the results of the fully adjusted models for all four outcomes, but confidence intervals crossed one. Implementation of paid family leave policies in California was associated with a 12 percent reduction in postneonatal mortality after adjusting for maternal and neonatal factors.
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