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

带薪家事假与幼儿呼吸道感染的预防

基本信息

批准号：
10709908
负责人：
Katherine Ahrens
金额：
$ 7.39万
依托单位：
UNIVERSITY OF SOUTHERN MAINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-23 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10709908
关键词：
1 year old 5 year old Accident and Emergency department Accounting Acute Admission activity Age Automobile Driving Birth Black race Bronchiolitis Caring Child Child Care Child Health Childhood Code Communities Contracts Control Groups Coughing Country Day Care Diagnosis Disparity Disparity population Eligibility Determination Emergency Care Emergency department visit Ethnic Origin Ethnic Population Family Family Leave Family Policy Fever Health Hispanic Home Hospital Costs Hospital Records Hospitalization Hospitals Income Infant Infection Insurance Insurance Coverage International Classification of Diseases Interruption Latinx Life Low income Lower Respiratory Tract Infection Maine Maryland Measures Modeling Mothers Neighborhoods New Hampshire New York Newborn Infant Outcome Parental Leave Parents Pneumonia Policies Policy Analysis Policy Maker Politics Prevention Proxy Race Records Respiratory Tract Infections Respiratory syncytial virus Risk Factors Seasons Series Socioeconomic Status Specific qualifier value State Government Time Time Series Analysis Vermont Visit Woman Work access disparities acute care associated symptom design disparity reduction ethnic disparity experience high risk hospitalization rates improved indexing infant infection infection rate neighborhood disadvantage prevent racial disparity racial population socioeconomic disadvantage socioeconomic disparity statistics transmission process trend uptake

项目摘要

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.

抽象的急性呼吸道感染，如细支气管炎和肺炎，是紧急情况的主要原因美国儿童就诊和住院的次数占急诊科就诊和住院次数的比例，占急诊护理就诊次数的五分之一。出去- 家庭日托是幼儿感染的一个公认的危险因素，也是推动婴儿感染的一个关键因素早期日托面临的问题是缺乏带薪家庭假，50% 的美国女性没有带薪家庭假福利。 2018年，纽约州出台了全美最全面的育儿假政策，提供多达8天的育儿假几周的带薪休假，使新妈妈能够推迟重返工作岗位，直到新生儿至少 8 岁几周大，从而推迟了户外儿童保育的开始。我们建议评估这项政策是否有助于减少呼吸道感染的急性护理（急诊就诊或住院）率年幼的婴儿（8 周以下）。我们将进行受控中断时间序列分析来衡量纽约带薪探亲假对小婴儿呼吸道感染急症护理的影响，使用东北部其他州作为对照。我们关注纽约州的带薪休假，因为当时 2018年1月1日出台，纽约拥有全国最慷慨的政策，资格最广泛标准和最高采用率，最大限度地提高发现政策好处的机会。我们将获得全付款人 2015 年 10 月至 2 月纽约州 8 周以下婴儿的出院和急诊就诊记录 2020 年，以及 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。我们将使用以下方法确定呼吸道感染的紧急护理情况国际疾病分类 (ICD)-10 诊断编码。我们将实施时间序列分析使用负二项式回归，使用谐波解释呼吸道感染的强季节性函数或指示变量。我们将使用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）和童年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这些感染的急症护理中现有的差异。这些发现对于考虑实施或扩大带薪家庭假政策的决策者来说可能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政策制定者的共同优先事项。