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- Title
Preterm Birth, Family Income, and Intergenerational Income Mobility.
- Authors
Ahmed, Asma M.; Pullenayegum, Eleanor; McDonald, Sarah D.; Beltempo, Marc; Premji, Shahirose S.; Shoukry, Roaa; Pole, Jason D.; Bacchini, Fabiana; Shah, Prakesh S.; Pechlivanoglou, Petros
- Abstract
Key Points: Question: Is preterm birth (PTB) associated with adulthood income and intergenerational income mobility? Findings: In this population-based matched cohort study of 1.6 million births, PTB was associated with lower yearly income, decreased upward mobility, and increased downward mobility during adulthood, with more pronounced differences in families with low socioeconomic status. These differences varied by gestational age at birth, with increasing differences as gestational age decreased. Meaning: This study suggests that PTB was associated with lower income during adulthood and less potential for social mobility, particularly for individuals from families with low socioeconomic status. Importance: Preterm birth (PTB) has been associated with lower income in adulthood, but associations with intergenerational income mobility and the role of family socioeconomic status (SES) as modifying factor are unclear. Objectives: To assess whether the association between PTB and income differs according to family SES at birth and to assess the association between PTB and intergenerational income mobility. Design, Setting, and Participants: This study comprised a matched cohort of live births in Canada between January 1, 1990, and December 31, 1996, with follow-up until December 31, 2018. Statistical analysis was performed between May 2023 and March 2024. Exposure: Preterm birth, defined as birth between 24 and 37 weeks' gestational age (with gestational age subcategories of 34-36, 32-33, 28-31, and 24-27 weeks) vs early and full term births (gestational age, 37-41 weeks). Main Outcomes and Measures: Associations between PTB and annual adulthood income in 2018 Canadian dollars were assessed overall (current exhange rate: $1 = CAD $1.37) and stratified by family income quintiles, using generalized estimating equation regression models. Associations between PTB and percentile rank change (ie, difference between the rank of individuals and their parents in the income distribution within their respective generations) and upward or downward mobility (based on income quintile) were assessed using linear and multinomial logistic regressions, respectively. Results: Of 1.6 million included births (51.1% boys and 48.9% girls), 6.9% infants were born preterm (5.4% born at 34-36 weeks, 0.7% born at 32-33 weeks, 0.5% born at 28-31 weeks, and 0.2% born at 24-27 weeks). After matching on baseline characteristics (eg, sex, province of birth, and parental demographics) and adjusting for age and period effects, PTB was associated with lower annual income (mean difference, CAD −$687 [95% CI, −$788 to −$586]; 3% lower per year), and the differences were greater among those belonging to families in the lowest family SES quintile (mean difference, CAD −$807 [95% CI, −$998 to −$617]; 5% lower per year). Preterm birth was also associated with lower upward mobility and higher downward mobility, particularly for those born earlier than 31 weeks' gestational age (24-27 weeks: mean difference in percentile rank change, −8.7 percentile points [95% CI, −10.5 to −6.8 percentile points]). Conclusions and Relevance: In this population-based matched cohort study, PTB was associated with lower adulthood income, lower upward social mobility, and higher downward mobility, with greater differences among those belonging to economically disadvantaged families. Interventions to optimize socioeconomic outcomes of preterm-born individuals would need to define target population considering SES. This cohort study assesses whether the association between preterm birth and adulthood income differs according to family socioeconomic status at birth and assesses the association between preterm birth and intergenerational income mobility.
- Subjects
FAMILIES &; economics; INCOME; RESEARCH funding; PREMATURE infants; LOGISTIC regression analysis; SOCIAL mobility; FAMILY roles; DESCRIPTIVE statistics; GESTATIONAL age; MARITAL status; CONFIDENCE intervals; INTERGENERATIONAL relations; SOCIAL classes
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2415921
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.15921