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: 9895598
• 负责人: Laura R Wherry
• 金额: $ 29.26万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895598
• 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; Newborn Infant; 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 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; 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 来自不利家庭的儿童在出生时的健康状况明显较差，成人结果较差，而且还 出生时健康状况不佳的影响似乎跨越几代人。鉴于这些模式，已经假设 改善早期健康健康的干预措施可能会产生高回报，并有助于打破代际周期 劣势。尽管该主题的公共健康显然重要，但很少有研究可以帮助我们了解长期 在出生时达到健康的影响，以及在美国早期干预的作用。该项目建议提供 使用一个新颖的数据集在这方面的新证据，该数据集将在加利福尼亚出生的所有人之间链接出生记录 1960年和2014年向大规模，联邦调查和行政数据提供有关以后生活死亡率，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 在美国的此类数据集将在其覆盖范围和范围方面保持前所未有。使用此新数据集，我们将 通过比较，估计出生时健康对成人残疾，死亡率和经济结果的长期影响 出生体重不同的双胞胎的结果（AIM 1）。此估计策略可以调整任何未观察到的 特定于家庭特定的特征可能会估算出出生时健康对结局的因果影响的估计。 生活。使用类似的识别技术，我们提出了出生时健康际影响的首次分析 关于长期健康和经济成果（AIM 2）。我们将估计母亲的出生体重对 她的孩子的结果，无论是出生时还是在生活中。这将提供有关对她影响的新信息 一生的儿童死亡率风险，残疾和成就。我们还将探索驾驶的不同机制 母亲在出生时健康的代际影响。对于两个目标1和2，我们将获得总体估计值 种族，种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 允许我们在这些亚组中产生精确的估计，并将提供有关其作用的重要新信息 早期生活在解释某些弱势群体的持续健康和社会经济差异方面。最后， 我们将研究使用案例来研究早期干预在改变出生和长期结局中的潜在作用 大规模增强产前护理计划的研究。我们建议评估A的短期和长期影响 全州干预措施针对加利福尼亚的低收入孕妇，从中受益的儿童 在子宫内进行干预（AIM 3）。为了确定这种干预的影响，我们将使用自然实验方法 这利用了该计划在各个县的交错实现以及接触的结果变化 该程序。这将是对这个大规模，公开资助的计划的首次严格评估，据我们所知 尽管广泛使用这些计划，但对增强产前护理计划的长期影响的唯一评估 计划作为促进处境不利人群中婴儿健康的政策工具。根据此提出的分析 研究将为旨在更好地理解和减轻长期的政策制定者提供新的和可行的信息 期限对早期健康状况的不平等影响。