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

出生时的健康状况和以后的生活结果：评估政策驱动的早期健康投资的回报

• 批准号: 10330104
• 负责人: Laura R Wherry
• 金额: $ 29.24万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10330104
• 关键词: Achievement; Adult; Automobile Driving; Birth; Birth Certificates; Birth Records; Birth Weight; California; Case Study; Censuses; Characteristics; Child; Child Mortality; Cost Analysis; Costs and Benefits; County; Data; Data Linkages; Data Set; Development; Disadvantaged; Early Intervention; Education; Effectiveness; Elderly; Ethnic Origin; Ethnic group; Evaluation; Exposure to; Family; Fetal health; Funding; Generations; Genetic; Health; Income; Individual; Inequality; Infant Health; Influentials; Infrastructure; Intervention; Investments; Knowledge; Life; Life Cycle Stages; Link; Long-Term Effects; Low Birth Weight Infant; Low income; Mothers; Natural experiment; Outcome; Parents; Pattern; Perinatal; Policies; Population; Poverty; Pregnant Women; Prenatal care; Productivity; Public Assistance; Public Health; Race; Research; Research Design; Role; Running; Services; Siblings; Socioeconomic Status; Subgroup; Surveys; Techniques; Theoretical model; Time; Twin Multiple Birth; United States; Variant; disability; disadvantaged population; early childhood; economic disparity; economic outcome; fetal; health disparity; health economics; health of the mother; human model; improved; in utero; intergenerational; intervention effect; labor force participation; lower income families; mortality; mortality risk; neonatal health; next generation; novel; offspring; prenatal; prenatal intervention; programs; public health intervention; service programs; socioeconomic disparity; therapy design; tool; transmission process

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.

抽象的 来自弱势家庭的儿童不仅出生时的健康状况明显较差，成年后的结局也较差，而且 出生时健康状况不佳的影响似乎会跨越几代人。鉴于这些模式，可以假设 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。尽管这个话题对公共卫生具有明显的重要性，但很少有研究可以帮助我们了解长期的 对出生时健康的影响以及早期干预在美国的作用。本项目拟提供 这方面的新证据使用了一个新颖的数据集，该数据集将在加利福尼亚州出生的所有个人的出生记录联系起来 1960 年和 2014 年大规模联邦调查和行政数据，其中包含有关晚年死亡率、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是前所未有的，无论是在覆盖范围还是范围上都是前所未有的。使用这个新数据集，我们将 通过比较来估计出生时健康状况对成年残疾、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果（目标 1）。该估计策略针对任何未观察到的情况进行调整 家庭特定特征可能会混淆出生时健康状况对以后结果的因果影响的估计 生活。使用类似的识别技术，我们提出了对出生时健康的代际影响的首次分析 长期健康和经济成果（目标 2）。我们将估计母亲出生体重对胎儿的影响 她的孩子在出生时和以后生活中的结果。这将提供有关对她的影响的新信息 儿童一生的死亡风险、残疾和成就。我们还将探索不同的驱动机制 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值 人口以及按种族、族裔和社会经济地位定义的亚群体。我们数据集的范围和大小将 使我们能够对这些亚组进行精确的估计，并将提供有关作用的重要新信息 早期生命健康可以解释某些弱势群体持续存在的健康和社会经济差异。最后， 我们将通过一个案例来研究早期干预在改变出生时健康和长期结果方面的潜在作用 对大规模、强化产前护理计划的研究。我们建议评估短期和长期影响 针对加州低收入孕妇的全州范围内的干预措施，以及从中受益的孩子 子宫内干预（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 充分利用了该计划在各县的交错实施以及由此产生的接触风险的变化 程序。这将是对这一大规模公共资助计划的首次严格评估，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 计划作为促进弱势群体婴儿健康的政策工具。根据本建议提出的分析 研究将为政策制定者提供新的、可操作的信息，旨在更好地理解和缓解长期影响 生命早期健康不平等的长期影响。