Effects of State-Level Earned Income Tax Credit Laws on Birth Outcomes by Race and Ethnicity.

Kelli A Komro,Sara Markowitz,Alexander C Wagenaar,Melvin D Livingston

doi:10.1089/heq.2018.0061

Abstract

Purpose: Health disparities persist in birth outcomes by mother's income, education, and race in the United States. Disadvantaged mothers may experience benefit from supplements to family income, such as the earned income tax credit (EITC). We examined the effects of state-level EITCs on birth outcomes among women with a high school education or less, stratified by race and ethnicity.Methods: A quasi-experimental multistate and multiyear difference-in-differences design is used to assess effects of the presence and generosity of 23 state-level EITC laws on birth outcomes from 1994 to 2013. The methods utilized the U.S. National Vital Statistics System birth data for the outcomes: birth weight, probability of low birth weight (LBW; <2500 g), and gestation weeks.Results: Across all subgroups, any level of state EITC is associated with better birth outcomes with the largest effects seen among states with more generous EITCs. Black mothers experience larger percentage point reductions in the probability of LBW and increases in gestation duration. Among mothers with a high school education or less, results translate into 3760 fewer LBW babies with black mothers and 8364 fewer LBW babies with white mothers per year at the most generous state EITC level (i.e., 10% or more of federal and refundable). Hispanic and non-Hispanic mothers display relatively similar effects.Conclusions: The EITC at the federal and state level is an effective policy tool to reduce poverty and improve birth outcomes across racial and ethnic subgroups. Given the historically higher risk among black mothers, state-level EITC expansions offer one policy option to address this persistent health disparity.

Highlights

There are striking and persistent health inequities in birth outcomes by mother’s income, education level, and race in the United States
The current study examines whether a key policy strategy to improve family income among low- to middleincome working families—the earned income tax credit (EITC)—improves birth outcomes or differentially across race and ethnic subgroups
The study results indicated that the federal EITC expansions reduced the likelihood of having a low birth weight (LBW) baby (

Summary

Introduction

There are striking and persistent health inequities in birth outcomes by mother’s income, education level, and race in the United States. Compared with the majority white population, blacks are more than twice as likely to be poor (22% vs 9%) and are less likely to have a college degree (23% vs 36%).[1,2] Such socioeconomic characteristics contribute to higher risks for negative birth outcomes among black women. Across racial/ethnic groups, a clear graded association exists between income quintile and low birth weight (LBW).[3]. In 2016, LBW levels ranged from 7% for births to nonHispanic white women to nearly 14% among those to Departments of 1Behavioral Sciences and Health Education and 2Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. In 2016, LBW levels ranged from 7% for births to nonHispanic white women to nearly 14% among those to Departments of 1Behavioral Sciences and Health Education and 2Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 3Department of Economics, Emory University, Atlanta, Georgia

Methods

Results

Discussion

Conclusion