Departments of Epidemiology and Biostatistics and
Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania.
Pediatrics. 2020 Nov;146(5). doi: 10.1542/peds.2020-1134. Epub 2020 Oct 19.
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.
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.
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.
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.
有证据表明，政府对非医疗保健服务的支出可以降低婴儿死亡率，但目前尚不清楚在高风险人群中，哪种类型的支出影响最大。因此，我们试图量化美国州政府在各种服务上的支出如何随时间推移影响婴儿死亡率（IMR），以及支出是否在某些亚人群中对死亡率有不同程度的降低。
这是一项针对美国州级婴儿死亡率和州及地方政府 2000-2016 年支出的纵向、重复测量研究，这是可获得的最新数据。支出包括教育、社会服务以及环境和住房支出。我们使用广义线性回归模型，评估了支出变化如何随时间推移对婴儿死亡率产生影响，总体上以及按种族和民族以及产妇年龄组进行分层评估。
州和地方政府平均每人支出 9 美元。环境支出每人增加 0.30 美元，每 1000 例活产死亡人数减少 0.03 人，社会服务支出每人增加 0.73 美元，每 1000 例活产死亡人数减少 0.02 人。与所有其他群体相比，20 岁以下产妇所生婴儿从支出增加中获益最大。公共卫生、住房、公园和娱乐以及固体废物管理方面支出的增加与整体 IMR 降幅最大相关。
对非医疗保健服务的投资与某些高风险人群的较低 IMR 相关。对改善社会和环境服务的持续投资有望进一步降低 IMR 差异。
