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Online Program

335215
$81 A Month: A PATHS Equity study evaluating the impact of an unconditional income supplement on child health


Sunday, November 1, 2015

Marni Brownell, PhD, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Nathan Nickel, MPH, PhD, Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Dan Chateau, PhD, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Elaine Burland, PhD, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Carole Taylor, MSc, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Joykrishna Sarkar, MSc, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Alan Katz, MBChB, MSc, CCFP, Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Chun Yan Goh, MSc, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Mariette Chartier, RN, PhD, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Background

Infant/child health follows a socioeconomic gradient- infants/children from disadvantaged populations have worse outcomes. Manitoba implemented an unconditional prenatal income supplement – Healthy Baby Prenatal Benefit (HBPB) – where low-income women receive a monthly check (<$100) during pregnancy. The objective of this study was to evaluate the impact of this supplement on birth outcomes.

Methods

Data came from the PATHS Resource comprising de-identified linkable data on health and social services for 99% of children living in Manitoba. We linked data from HPBP, risk screen, hospital abstracts, physician visits, income assistance, and prescription drugs. Our sample included all mother-newborn pairs where the mother received income assistance, from 2003-2010 (n=14,591). Our exposed group included women on income assistance who received HBPB (n=10,738); the control group comprised women on income assistance who did not (n=3,853). Outcomes included: low birth weight (LBW), preterm birth, small-for-gestational age (SGA), 5-minute Apgar scores (5-Apgar), breastfeeding initiation (BF), neonatal readmission, and newborn hospital length of stay (LOS). We adjusted for over 25 variables from the risk screen and administrative data using inverse probability of treatment weights.

Results

HBPB was associated with reductions in LBW (aRR=0.71 95% CI=0.63, 0.81), preterm (aRR=0.76 (0.69, 0.84)) and SGA (aRR=0.90 (0.81, 0.99)) births. It was also associated with increases in BF initiation (aRR=1.06 (1.03, 1.09)) and with shortened LOS (X=2.86, p<0.0001). Sensitivity tests for unmeasured confounding suggested BF, LBW, LOS, and preterm results were robust to unmeasured confounding.

Conclusion

Providing an unconditional monthly income supplement to low-income women may improve birth outcomes.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Implementation of health education strategies, interventions and programs
Public health or related nursing
Public health or related public policy
Public health or related research

Learning Objectives:
Explain methods for adjusting for measured confounding. Describe approaches to assess sensitivity to unmeasured confounding. Identify the benefits of an unconditional income supplement on child health outcomes.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been PI on several studies using administrative data to evaluate policies' impact on child health. I teach a graduate level course in methods for causal inference and another graduate level course on evaluation methods for health services research. I have several peer-reviewed articles on child health and child health equity.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2039.0: Infant & Child Health Poster Session