Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data

Abstract

We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary non-monotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. Adjusting for basic demographic factors reveals that the disproportionately adverse birth outcomes at the top of the income distribution are largely explained by higher average parental age and a greater share of non-singleton births among those families. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---are nevertheless more than twice more likely to survive than infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. Additionally, we find that racial disparities in infant and maternal health are significantly wider than those by income, such that infant and maternal health in Black families at the top of the income distribution are worse than that of white families at the bottom of the income distribution even after conditioning on observable characteristics. Lastly, we benchmark the infant and maternal health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden at all income levels and for all outcomes, and that the outcomes for Black Americans are disproportionately low, even compared to the lowest-income mothers in Sweden and their infants.

About the Presenter's meeting

Maya Rossin-Slater is an Associate Professor in the Department of Health Policity, and Department of Economics at Stanford University. She is available for meetings from 8am - 9am on Thursday 1^st April 2022. If you would like to meet with Maya Rossin-Slater, please contact Dr Andrea La Nauze a.lanauze@uq.edu.au who will be her host at The University of Queensland.