Paid Family Leave and Prevention of Respiratory Tract Infections in Young Infants

摘要 急性呼吸道感染，如细支气管炎和肺炎，是急诊的主要原因 在美国儿童中，急诊科（艾德）就诊和住院人数占急诊就诊人数的五分之一。出去- 家庭日托是幼儿感染这些疾病的一个公认的危险因素， 早期日托暴露是缺乏带薪家庭假，50%的美国妇女没有带薪家庭假福利。 2018年，纽约州推出了全美最全面的育儿假政策，提供多达8个 新妈妈们可以推迟到新生儿至少8岁时才重返工作岗位。 因此，推迟了家庭外儿童保育的开始。我们建议评估这项政策是否 有助于降低呼吸道感染的急诊就诊率（艾德就诊或住院）， 婴儿（8周以内）。我们将进行受控中断时间序列分析， 纽约带薪家庭假对幼儿呼吸道感染急性护理的影响， 以东北部其他州为对照。我们关注纽约州的带薪休假，因为在其 2018年1月1日，纽约拥有全国最慷慨的政策，具有最广泛的资格 标准和最高的采纳率，最大限度地提高发现政策效益的机会。我们将获得所有付款人 纽约州≤8周龄婴儿的出院和急诊就诊记录，2015年10月至2月 2020年，以及来自4个没有带薪家庭假的对照州的可比记录：新罕布什尔州， 缅因州佛蒙特州和马里兰州。我们将确定呼吸道感染的急性护理接触， 国际疾病分类（ICD）-10诊断编码。我们将实施时间序列分析 使用负二项回归，使用谐波解释呼吸道感染的强烈季节性 函数或指标变量。我们将使用一个类似的时间序列设计来检查差异的变化， 种族-民族、保险类型（作为家庭收入的代表）和儿童机会指数的五分位数 2.0（相对邻里劣势的全球衡量标准）。我们的研究结果可以提供高质量的 关于美国带薪休假对儿童呼吸道感染影响的证据，以及是否引入带薪家庭 减少或加剧了这些感染的急性护理遭遇中的现有差异。这些发现 可能对考虑实施或扩大带薪家事假政策的决策者特别有用， 他们的国家，因为改善儿童健康是具有不同政治意识形态的决策者的共同优先事项。

ABSTRACT Acute respiratory tract infections, such as bronchiolitis and pneumonia, are the leading cause of emergency department (ED) visits and hospitalizations in US children, accounting for one in 5 acute care encounters. Out- of-home daycare is a well-established risk factor for these infections in young infants, and a key factor driving early daycare exposure is lack of paid family leave, with 50% of US women having no paid family leave benefit. In 2018, New York State introduced the nation’s most comprehensive parental leave policy, providing up to 8 weeks’ paid leave, enabling new mothers to delay their return to work until their newborn infant is at least 8 weeks old and thus delaying the start of out-of-home childcare. We propose to evaluate whether this policy helped to reduce rates of acute care encounters (ED visits or hospitalizations) for respiratory tract infection in young infants (up to 8 weeks of age). We will conduct a controlled interrupted time series analysis to measure the effect of New York’s paid family leave on acute care encounters for respiratory tract infection in young infants, using other Northeastern states as controls. We focus on New York State’s paid leave because at the time of its introduction on Jan 1, 2018, New York had the most generous policy in the country, with the broadest eligibility criteria and the highest uptake rate, maximizing the chance of detecting policy benefits. We will obtain all-payer hospital discharge and emergency care visit records for infants ≤8 weeks old in New York State, Oct 2015- Feb 2020, as well as comparable records from 4 control states that do not have paid family leave: New Hampshire, Maine, Vermont, and Maryland. We will identify acute care encounters for respiratory tract infections using international classification of diseases (ICD)-10 diagnosis coding. We will implement our time series analysis using negative binomial regression, accounting for the strong seasonality of respiratory infections using harmonic functions or indicator variables. We will use a similar time series design to examine changes in disparities by race-ethnicity, insurance type (as a proxy for family income), and quintiles of the Childhood Opportunity Index 2.0 (a global measure of relative neighborhood disadvantage). Our study’s findings can provide high-quality evidence on the effects of US paid leave on child respiratory tract infections, and if the introduction of paid family leave reduced or exacerbated existing differences in acute care encounters for these infections. These findings may be particularly useful to policymakers considering implementing or expanding paid family leave policies in their state, as improving children’s health is a shared priority of policymakers with different political ideology.