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

摘要 不仅来自弱势家庭的孩子出生时健康状况明显差，成年后的结果也差得多，而且 出生时健康状况不佳的影响似乎会代代相传。考虑到这些模式，有人认为 改善早期生活健康的干预措施可以产生高回报，并有助于打破 劣势。尽管这个话题对公共卫生具有明显的重要性，但几乎没有研究帮助我们理解长期的 在美国，出生时健康的影响和早期干预的作用。该项目建议提供 这方面的新证据使用了一个新的数据集，它将所有在加州出生的人的出生记录联系在一起 到1960年和2014年的大规模联邦调查和行政数据，以及关于晚年死亡、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，这将是第一次 这样的数据集在美国是史无前例的，无论是覆盖范围还是范围都是前所未有的。使用这个新的数据集，我们将 通过比较出生时健康对成人残疾、死亡率和经济结果的长期影响，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局(目标1)。此估计策略可针对任何未观察到的 家庭特有的特征，可能会混淆对出生时健康对稍后结局的因果影响的估计 生活。利用类似的鉴定技术，我们首次提出了出生时健康的代际影响的分析。 关于长期健康和经济成果(目标2)。我们将估计母亲出生体重对 无论是在出生时还是以后的生活中，她的孩子的结局都是如此。这将提供有关对她的影响的新信息 儿童的死亡风险、残疾和终生成就。我们还将探索不同的驱动机制 母亲出生时健康的代际影响。对于目标1和目标2，我们将获得总体估计数 人口和按种族、族裔和社会经济地位界定的亚群。我们数据集的范围和大小将 使我们能够在这些小组中生成准确的估计，并将提供有关以下方面的重要新信息 早期生命健康解释了某些弱势群体的持续健康和社会经济差异。最后， 我们将通过一个病例研究早期干预在改变出生时健康和长期结局方面的潜在作用。 研究大规模的、强化的产前保健计划。我们建议评估一项长期和短期影响 全州范围内针对加州低收入孕妇的干预措施，以帮助受益于此的儿童 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 这利用了该计划跨县交错实施的优势，以及由此导致的暴露于 这个项目。这将是对这一大规模的、由公共资金资助的项目的首次严格评估，据我们所知， 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 这些方案是促进弱势群体中婴儿健康的政策工具。在此项下提出的分析 这项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的 不平等对早期生命健康的长期影响。

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.