TY - JOUR
T1 - State and Local Government Expenditures and Infant Mortality in the United States
AU - Goldstein, Neal D.
AU - Palumbo, Aimee J.
AU - Bellamy, Scarlett L.
AU - Purtle, Jonathan
AU - Locke, Robert
N1 - Publisher Copyright:
Copyright © 2020 by the American Academy of Pediatrics
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
KW - Humans
KW - Infant
KW - Infant Mortality
KW - Investments/economics
KW - Local Government
KW - Longitudinal Studies
KW - Public Expenditures/statistics & numerical data
KW - State Government
KW - United States
UR - http://www.scopus.com/inward/record.url?scp=85095461830&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85095461830&partnerID=8YFLogxK
U2 - 10.1542/peds.2020-1134
DO - 10.1542/peds.2020-1134
M3 - Article
C2 - 33077541
AN - SCOPUS:85095461830
SN - 0031-4005
VL - 146
JO - Pediatrics
JF - Pediatrics
IS - 5
M1 - e20201134
ER -