Economic Downturns and Inequities in Birth Outcomes: Evidence From 149 Million US Births

• Published in: American journal of epidemiology Vol. 188; no. 6; pp. 1092 - 1100
• Main Authors: Noelke, Clemens, Chen, Yu-Han, Osypuk, Theresa L, Acevedo-Garcia, Dolores
• Format: Journal Article
• Language: English
• Published: United States Oxford Publishing Limited (England) 01.06.2019; Oxford University Press
• Subjects: Adolescent; Adult; African Americans - statistics & numerical data; Birth; Continental Population Groups - statistics & numerical data; Economic conditions; Economic Recession - statistics & numerical data; Economics; Education; Educational Status; European Continental Ancestry Group - statistics & numerical data; Exposure; Female; Health Status; Health Status Disparities; Humans; Impact analysis; Infant, Low Birth Weight; Infant, Newborn; Macroeconomics; Middle Aged; Occupational health; Original Contributions; Pregnancy; Pregnancy Trimesters; Premature birth; Premature Birth - epidemiology; Premature Birth - ethnology; Regression analysis; Regression models; Statistical analysis; Unemployment; Unemployment - statistics & numerical data; United States; Variation; Young Adult; United States; United States > US; birth outcomes; recessions; racial/ethnic inequities; business cycles
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kwz042

Using birth certificate data for nearly all registered US births from 1976 to 2016 and monthly data on state unemployment rates, we reexamined the link between macroeconomic variation and birth outcomes. We hypothesized that economic downturns reduce exposure to work-related stressors and pollution while increasing exposure to socioeconomic stressors like job loss. Because of preexisting inequalities in health and other resources, we expected that less-educated mothers and black mothers would be more exposed to macroeconomic variation. Using fixed-effect regression models, we found that a 1-percentage-point increase in state unemployment during the first trimester of pregnancy increased the probability of preterm birth by 0.1 percentage points, while increases in the state unemployment rate during the second/third trimester reduced the probability of preterm birth by 0.06 percentage points. During the period encompassing the Great Recession, the magnitude of these associations doubled in size. We found substantial variation in the impact of economic conditions across different groups, with highly educated white women least affected and less-educated black women most affected. The results highlight the increased relevance of economic conditions for birth outcomes and population health as well as continuing, large inequities in the exposure and impact of macroeconomic fluctuations on birth outcomes.