Health at Birth and Later Life Outcomes: Evaluating the Returns to Policy-Driven Early Health Investments

摘要 来自弱势家庭的儿童不仅出生时健康状况明显较差，成年后的结果也较差， 出生时健康状况不佳的影响似乎会延续几代人。鉴于这些模式，有人假设， 改善生命早期健康的干预措施可以产生高回报，并有助于打破代际循环， 劣势尽管这一主题具有明确的公共卫生重要性，但几乎没有研究可以帮助我们了解长期的... 在美国，出生时健康的影响和早期干预的作用。该项目旨在提供 这方面的新证据使用了一个新的数据集，该数据集将出生在加州的所有个人的出生记录联系起来， 1960年和2014年的大规模联邦调查和行政数据，包括晚年死亡率，残疾， 教育程度、收入和收入以及对公共援助的依赖。据我们所知，这将是第一个 这样的数据集在美国，将是前所未有的，无论是在其覆盖面和范围。使用这个新的数据集，我们将 估计出生时健康对成年残疾、死亡率和经济结果的长期影响， 不同出生体重的双胞胎的结局（目标1）。该估计策略针对任何未观察到的 可能混淆出生时健康对后来结果的因果影响的估计的家庭特异性特征， 生活使用类似的识别技术，我们提出了出生时健康的代际效应的第一个分析 长期健康和经济成果（目标2）。我们将估计母亲出生体重对婴儿出生体重的影响。 她的孩子的结果，无论是在出生时和以后的生活。这将提供新的信息对她的影响 儿童的死亡风险、残疾和终生成就。我们还将探讨不同的机制， 母亲出生时健康状况的代际影响。对于目标1和2，我们将获得总体的估计数， 人口和由种族、民族和社会经济地位定义的亚组。我们数据集的范围和大小将 使我们能够在这些亚组中产生精确的估计，并将提供关于 生命早期的健康状况是某些弱势群体持续存在健康和社会经济差距的原因。最后， 我们将通过一个病例来研究早期干预在改变出生时健康状况和长期结果方面的潜在作用。 一项大规模的强化产前护理计划的研究。我们建议评估短期和长期的影响， 针对加州低收入孕妇的全州干预措施，以使儿童从中受益 在子宫内进行干预（目标3）。为了确定这种干预的效果，我们将使用自然实验方法 这利用了该计划在各县的交错实施以及由此产生的暴露于 节目这将是对这一大规模公共资助项目的首次严格评估，据我们所知， 这是对加强产前护理计划的长期影响的唯一评估，尽管这些计划被广泛使用， 作为政策工具的方案，以促进弱势群体的婴儿健康。根据本报告提出的分析 研究将为政策制定者提供新的可操作信息，以更好地了解和缓解长期存在的 早期生命健康不平等的长期影响。

ABSTRACT Not only do children from disadvantaged families have significantly worse health at birth and poorer adult outcomes, but the effects of poor health at birth appear to extend across generations. Given these patterns, it has been posited that interventions that improve early life health could yield high returns and help to break the intergenerational cycle of disadvantage. Despite the clear public health importance of this topic, little research exists to help us understand the long- reaching effects of health at birth and the role for early intervention in the United States. This project proposes to provide new evidence on this front using a novel dataset that links birth records for all individuals born in California between 1960 and 2014 to large-scale, federal survey and administrative data with information on later life mortality, disability, educational attainment, earnings and income, and reliance on public assistance. To our knowledge, this will be the first such dataset in the U.S. and will be unprecedented both in terms of its coverage and scope. Using this new dataset, we will estimate the long-term effects of health at birth on adult disability, mortality, and economic outcomes by comparing outcomes among twins born with different birth weights (Aim 1). This estimation strategy adjusts for any unobserved family-specific characteristics that might confound estimates of the causal impact of health at birth on outcomes later in life. Using a similar identification technique, we propose the first analysis of the intergenerational effects of health at birth on long-term health and economic outcomes (Aim 2). We will estimate the impact of a mother's birth weight on the outcomes of her children, both at the time of birth and later in life. This will provide new information on the effects on her child's mortality risk, disability, and achievement throughout life. We will also explore the different mechanisms driving the intergenerational effects of mother's health at birth. For both Aims 1 and 2, we will obtain estimates for the overall population and for subgroups defined by race, ethnicity, and socioeconomic status. The scope and size of our dataset will allow us to generate precise estimates across these subgroups and will provide important new information on the role of early life health in explaining persistent health and socioeconomic disparities for certain disadvantaged groups. Finally, we will examine the potential role for early intervention in altering health at birth and long-term outcomes using a case study of a large-scale, enhanced prenatal care program. We propose to evaluate the short- and long-term effects of a statewide intervention targeted to low-income pregnant women in California for the children who benefit from this intervention while in utero (Aim 3). To identify the effects of this intervention, we will use a natural experiment approach that takes advantage of the program's staggered implementation across counties and the resulting variation in exposure to the program. This will be the first rigorous evaluation of this large-scale, publicly-funded program and, to our knowledge, the only evaluation of the long-term effects of an enhanced prenatal care program, despite the widespread use of these programs as a policy tool to promote infant health among disadvantaged populations. The analyses proposed under this study will generate new and actionable information for policymakers aiming to better understand and mitigate the long- term impacts of inequalities in early life health.