Socioeconomic Gradients and Low Birth-Weight: Empirical and Policy Considerations

• Published in: Health services research 2003-12, Vol.38 (6p2), p.1819-1842
• Main Author: Finch, Brian Karl
• Format: Article
• Language: English
• Subjects: Analysis; Birth weight; Birth weight, Low; Demographic aspects; Educational Status; Empirical Analyses; Empirical Research; Family Characteristics; Family income; Female; Health aspects; Health Behavior; Health Policy; Health Surveys; Humans; Income; Income inequality; Infant, Low Birth Weight; Infant, Newborn; Infants; Logistic Models; Low birth weight; Maternal Behavior; Policy Making; Pregnancy; Pregnancy Outcome - economics; Pregnancy Outcome - epidemiology; Prenatal Care - utilization; Regression analysis; Social Class; Social classes; Socioeconomic factors; Socioeconomic status gradients; Studies; United States - epidemiology
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/j.1475-6773.2003.00204.x

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; 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‐à‐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.