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

• 批准号: 10592901
• 负责人: Katherine Ahrens
• 金额: $ 7.38万
• 依托单位: UNIVERSITY OF SOUTHERN MAINE
• 依托单位国家: 美国
• 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/10592901
• 关键词: 1 year old; 5 year old; Accident and Emergency department; Accounting; Acute; Age; Automobile Driving; Birth; Black race; Bronchiolitis; Caring; Child; Child Health; Childhood; Code; Communities; Contracts; Control Groups; Coughing; Country; Diagnosis; Disadvantaged; Eligibility Determination; Emergency Care; Emergency department visit; Ethnic Origin; Ethnic group; Evaluation; 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; Politics; Prevention; Proxy; Race; Records; Respiratory Tract Infections; Respiratory syncytial virus; Risk Factors; Series; Socioeconomic Status; Specific qualifier value; State Government; Time; Time Series Analysis; Vermont; Visit; Woman; Work; acute care; associated symptom; design; disparity reduction; experience; high risk; hospitalization rates; improved; indexing; infant infection; infection rate; neighborhood disadvantage; prevent; racial and ethnic; racial and ethnic disparities; racial disparity; socioeconomic disadvantage; socioeconomic disparity; statistics; transmission process; trend; uptake

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.

摘要 毛细支气管炎和肺炎等急性呼吸道感染是导致紧急情况的主要原因。 美国儿童的部门(ED)就诊和住院，占急性护理事件的五分之一。出局- 居家日托是幼儿感染的一个公认的危险因素，也是推动 早期日托缺乏带薪家庭假，50%的美国女性没有带薪家庭假福利。 2018年，纽约州推出了全国最全面的育儿假政策，提供了高达8 几周的带薪假期，使新妈妈能够推迟到新生儿至少8岁才能返回工作岗位 几个星期大了，因此推迟了离家育儿的开始。我们建议评估这项政策是否 有助于降低#年呼吸道感染的急性护理(急诊或住院)比率 婴幼儿(8周以下)。我们将进行受控中断时间序列分析，以衡量 纽约带薪家庭假对婴幼儿呼吸道感染急性护理的影响 使用东北部的其他州作为对照。我们关注纽约州的带薪休假，因为在它的时候 简介2018年1月1日，纽约州拥有全国最慷慨的政策，最广泛的资格 标准和最高的吸纳率，最大限度地增加了发现政策效益的机会。我们将获得所有付款人 纽约州8周大婴儿≤的出院和急救就诊记录，2015年10月-2月 2020年，以及来自4个没有带薪家庭假的控制州的类似记录：新罕布夏州， 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急性护理情况 国际疾病分类(ICD)-10诊断编码。我们将实施我们的时间序列分析 使用负二项回归，使用调和来解释呼吸道感染的强烈季节性 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-种族、保险类型(作为家庭收入的替代指标)和儿童机会指数的五分之一 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 美国带薪休假对儿童呼吸道感染影响的证据，以及引入带薪家庭 休假减少或加剧了这些感染在急性护理方面的现有差异。这些发现 可能对考虑在#年实施或扩大带薪探亲假政策的政策制定者特别有用 他们的状况，因为改善儿童健康是不同政治意识形态的政策制定者的共同优先事项。