Muskie School of Public Service, University of Southern Maine, Portland, Maine.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
JAMA Pediatr. 2024 Oct 1;178(10):1057-1065. doi: 10.1001/jamapediatrics.2024.3184.
Acute respiratory tract infections are the leading cause of emergency department visits and hospitalizations in US children, with highest risks in the first 2 months after birth. Out-of-home childcare settings increase the spread of respiratory tract infections. The study team hypothesized that access to state-paid family leave could reduce acute care encounters (hospital admissions or emergency department visits) for respiratory tract infections in young infants by reducing out-of-home childcare transmissions.
To determine if the 2018 introduction of paid family leave in New York state reduced acute care encounters for respiratory tract infections in infants 8 weeks or younger.
DESIGN, SETTING, AND PARTICIPANTS: This population-based study of acute care encounters took place in New York state and New England control states (Maine, Massachusetts, New Hampshire, Vermont) from October 2015 through February 2020. Participants included infants aged 8 weeks or younger. Controlled time series analysis using Poisson regression was used to estimate the impact of paid family leave on acute care encounters for respiratory tract infections, comparing observed counts during respiratory virus season (October through March) with those predicted in the absence of the policy. Acute care encounters for respiratory tract infections in 1-year-olds (who would not be expected to benefit as directly from the policy) were modeled as a placebo test.
New York State Paid Family Leave policy, introduced on January 1, 2018, providing 8 weeks of paid leave for eligible parents.
Emergency department visits or hospitalizations with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) codes for upper or lower respiratory tract infections or associated symptoms (ie, fever, cough), excluding newborn hospitalizations. The secondary outcome was acute care encounters for respiratory syncytial virus (RSV) bronchiolitis.
There were 52 943 acute care encounters for respiratory infection among infants 8 weeks or younger. There were 15 932 encounters that were hospitalizations (30%) and 33 304 of the encounters were paid for by Medicaid (63%). Encounters were 18% lower than predicted (relative percentage change = -17.9; 95% CI, -20.3 to -15.7) after the introduction of paid family leave. RSV encounters were 27.0% lower (95% CI, -30.9 to -23.5) than predicted. Similar reductions were not observed in 1-year-olds (relative percentage change = -1.5; 95% CI, -2.5 to -0.6).
New York state's paid family leave policy was associated with reduced acute care encounters for respiratory tract infections in young infants. These findings may be useful for informing implementation of paid family leave federally and in the states that have not enacted paid family leave policies.
在美国儿童中，急性呼吸道感染是导致急诊就诊和住院的主要原因，出生后前 2 个月的风险最高。日托机构增加了呼吸道感染的传播。研究小组假设，获得国家支付的家庭假可以通过减少儿童在家庭以外的托管场所的传播，从而降低婴儿急性呼吸道感染的发生。
确定 2018 年纽约州引入带薪家庭假是否降低了 8 周或更小的婴儿的急性呼吸道感染的医疗保健次数。
设计、地点和参与者：这项基于人群的急性护理就诊研究在纽约州和新英格兰对照州（缅因州、马萨诸塞州、新罕布什尔州、佛蒙特州）进行，时间为 2015 年 10 月至 2020 年 2 月。参与者包括 8 周或更小的婴儿。采用泊松回归的对照时间序列分析，以估计带薪家庭休假对急性呼吸道感染的医疗保健次数的影响，将呼吸道病毒季节（10 月至 3 月）期间的观察到的数量与无政策情况下的预测数量进行比较。对 1 岁儿童（不太可能直接从政策中受益）的急性呼吸道感染进行了模型测试。
纽约州带薪家庭休假政策于 2018 年 1 月 1 日实施，为符合条件的父母提供 8 周的带薪休假。
因上呼吸道或下呼吸道感染或相关症状（即发热、咳嗽）而就诊急诊或住院的国际疾病分类第十版（ICD）编码，不包括新生儿住院。次要结果是因呼吸道合胞病毒（RSV）细支气管炎而进行的急性护理。
在 8 周或更小的婴儿中，有 52943 例急性呼吸道感染的医疗保健。有 15932 例是住院治疗（30%），33304 例是由医疗补助支付（63%）。在引入带薪家庭休假后，就诊次数比预测的低 18%（相对百分比变化= -17.9；95%置信区间，-20.3 至-15.7）。RSV 就诊次数比预测的低 27.0%（95%置信区间，-30.9 至-23.5）。1 岁儿童没有观察到类似的减少（相对百分比变化= -1.5；95%置信区间，-2.5 至-0.6）。
纽约州的带薪家庭休假政策与婴儿急性呼吸道感染的医疗保健次数减少有关。这些发现可能有助于为联邦和尚未制定带薪家庭休假政策的州实施带薪家庭休假提供信息。
