Neal D Goldstein1, Aimee J Palumbo2, Scarlett L Bellamy3, Jonathan Purtle4, Robert Locke5,6. 1. Departments of Epidemiology and Biostatistics and ng338@drexel.edu. 2. Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania. 3. Departments of Epidemiology and Biostatistics and. 4. Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania. 5. Department of Pediatrics, ChristianaCare, Newark, Delaware; and. 6. Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University and Department of Neonatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
Abstract
BACKGROUND AND OBJECTIVES: Evidence suggests that government expenditures on non-health care services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Thus, we sought to quantify how US state government spending on various services impacted infant mortality rates (IMRs) over time and whether spending differentially reduced mortality in some subpopulations. METHODS: A longitudinal, repeated-measures study of US state-level infant mortality and state and local government spending for the years 2000-2016, the most recent data available. Expenditures included spending on education, social services, and environment and housing. Using generalized linear regression models, we assessed how changes in spending impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group. RESULTS: State and local governments spend, on average, $9 per person. A $0.30 per-person increase in environmental spending was associated with a decrease of 0.03 deaths per 1000 live births, and a $0.73 per-person increase in social services spending was associated with a decrease of 0.02 deaths per 1000 live births. Infants born to mothers aged <20 years had the single greatest benefit from an increase in expenditures compared with all other groups. Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall IMR. CONCLUSIONS: Investment in non-health care services was associated with lower IMRs among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing IMR disparities.
BACKGROUND AND OBJECTIVES: Evidence suggests that government expenditures on non-health care services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Thus, we sought to quantify how US state government spending on various services impacted infant mortality rates (IMRs) over time and whether spending differentially reduced mortality in some subpopulations. METHODS: A longitudinal, repeated-measures study of US state-level infant mortality and state and local government spending for the years 2000-2016, the most recent data available. Expenditures included spending on education, social services, and environment and housing. Using generalized linear regression models, we assessed how changes in spending impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group. RESULTS: State and local governments spend, on average, $9 per person. A $0.30 per-person increase in environmental spending was associated with a decrease of 0.03 deaths per 1000 live births, and a $0.73 per-person increase in social services spending was associated with a decrease of 0.02 deaths per 1000 live births. Infants born to mothers aged <20 years had the single greatest benefit from an increase in expenditures compared with all other groups. Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall IMR. CONCLUSIONS: Investment in non-health care services was associated with lower IMRs among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing IMR disparities.
Authors: Alina S Schnake-Mahl; Pricila H Mullachery; Jonathan Purtle; Ran Li; Ana V Diez Roux; Usama Bilal Journal: Epidemiology Date: 2022-10-05 Impact factor: 4.860
Authors: Xi Wang; Jennifer Whittaker; Katherine Kellom; Stephanie Garcia; Deanna Marshall; Tara Dechert; Meredith Matone Journal: Int J Environ Res Public Health Date: 2020-12-10 Impact factor: 3.390
Authors: Shervin Assari; Shanika Boyce; Mohsen Bazargan; Alvin Thomas; Ryon J Cobb; Darrell Hudson; Tommy J Curry; Harvey L Nicholson; Adolfo G Cuevas; Ritesh Mistry; Tabbye M Chavous; Cleopatra H Caldwell; Marc A Zimmerman Journal: Children (Basel) Date: 2021-05-18
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