Socioeconomic Gradients and Low Birth-Weight
Empirical and Policy Considerations
Published in: Health Services Research, v. 38, no. 6, pt. 2, suppl., Dec. 2003, p. 1819-1841
Posted on rand.org 2003
OBJECTIVE: To examine whether socioeconomic status (SES) gradients emerge in health outcomes as early as birth and to examine the magnitude, potential sources, and explanations of any observed SES gradients. DATA SOURCES: The National Maternal and Infant Health Survey conducted in 1988. STUDY DESIGN: A multinomial logistic regression of trichotomized birth-weight categories was conducted for normal birth-weight (2,500-5,500 grams), low birth-weight (LBWT; < 2,500 grams), and heavy birth-weight (> 5,500 grams). Key variables included income, education, occupational grade, state-level income inequality, and length of participation in Women-Infants-Children (WIC) for pregnant mothers. PRINCIPAL FINDINGS: A socioeconomic gradient for low birth-weight was discovered for an adjusted household income measure, net of all covariates in the unrestricted models. A gross effect of maternal education was explained by maternal smoking behaviors, while no effect of occupational grade was observed, net of household income. There were no significant state-level income inequality effects (Gini coefficient) for any of the models. In addition, participation in WIC was discovered to substantially flatten income gradients for short-term participants and virtually eliminate an income gradient among long-term participants. CONCLUSIONS: Although a materialist explanation for early-life SES gradients seems the most plausible (vis-a-vis psychosocial and occupational explanations), more research is needed to discover potential interventions. In addition, the notion of a monotonic gradient in which income is salutary across the full range of the distribution is challenged by these data such that income may cease to be beneficial after a given threshold. Finally, the success of WIC participation in flattening SES gradients argues for either: (a) the experimental efficacy of WIC, or (b) the biasing selection characteristics of WIC participants; either conclusion suggests that interventions or characteristics of participants deserves further study as a potential remedy for socioeconomic disparities in early-life health outcomes such as LBWT.