Household income supplements in early childhood to reduce inequities in children's development

Sharon Goldfeld; Marnie Downes; Sarah Gray; Cindy Pham; Shuaijun Guo; Elodie O'Connor; Gerry Redmond; Francisco Azpitarte; Hannah Badland; Sue Woolfenden; Katrina Williams; Naomi Priest; Meredith O'Connor; Margarita Moreno-Betancur

doi:10.1016/j.socscimed.2023.116430

Household income supplements in early childhood to reduce inequities in children's development

Soc Sci Med. 2024 Jan:340:116430. doi: 10.1016/j.socscimed.2023.116430. Epub 2023 Nov 18.

Authors

Affiliations

¹ Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia. Electronic address: Sharon.Goldfeld@rch.org.au.
² Department of Pediatrics, University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
³ Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
⁴ College of Business, Government and Law, Flinders University, Adelaide, Australia.
⁵ School of Social Sciences, Loughborough University, Loughborough, United Kingdom.
⁶ Social and Global Studies Centre, RMIT University, Melbourne, Australia.
⁷ Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Australia; Discipline of Pediatrics, University of New South Wales, Sydney, Australia.
⁸ Department of Pediatrics, University of Melbourne, Melbourne, Australia; Department of Pediatrics, Monash University, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
⁹ Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Social Research & Methods, The Australian National University, Canberra, Australia.
¹⁰ Department of Pediatrics, University of Melbourne, Melbourne, Australia; Melbourne Children's LifeCourse Initiative, Murdoch Children's Research Institute, Melbourne, Australia; Faculty of Education, University of Melbourne, Melbourne, Australia.
¹¹ Department of Pediatrics, University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.

PMID: 38048739
DOI: 10.1016/j.socscimed.2023.116430

Abstract

Background: Early childhood interventions have the potential to reduce children's developmental inequities. We aimed to estimate the extent to which household income supplements for lower-income families in early childhood could close the gap in children's developmental outcomes and parental mental health.

Methods: Data were drawn from a nationally representative birth cohort, the Longitudinal Study of Australian Children (N = 5107), which commenced in 2004 and conducted follow-ups every two years. Exposure was annual household income (0-1 year). Outcomes were children's developmental outcomes, specifically social-emotional, physical functioning, and learning (bottom 15% versus top 85%) at 4-5 years, and an intermediate outcome, parental mental health (poor versus good) at 2-3 years. We modelled hypothetical interventions that provided a fixed-income supplement to lower-income families with a child aged 0-1 year. Considering varying eligibility scenarios and amounts motivated by actual policies in the Australian context, we estimated the risk of poor outcomes for eligible families under no intervention and the hypothetical intervention using marginal structural models. The reduction in risk under intervention relative to no intervention was estimated.

Results: A single hypothetical supplement of AU$26,000 (equivalent to ∼USD$17,350) provided to lower-income families (below AU$56,137 (∼USD$37,915) per annum) in a child's first year of life demonstrated an absolute reduction of 2.7%, 1.9% and 2.6% in the risk of poor social-emotional, physical functioning and learning outcomes in children, respectively (equivalent to relative reductions of 12%, 10% and 11%, respectively). The absolute reduction in risk of poor mental health in eligible parents was 1.0%, equivalent to a relative reduction of 7%. Benefits were similar across other income thresholds used to assess eligibility (range, AU$73,329-$99,864).

Conclusions: Household income supplements provided to lower-income families may benefit children's development and parental mental health. This intervention should be considered within a social-ecological approach by stacking complementary interventions to eliminate developmental inequities.

Keywords: Causal inference; Child development; Disadvantage; Health inequity; Income supplement; Target trial.

MeSH terms

Australia
Child
Child, Preschool
Humans
Income*
Longitudinal Studies
Parents*
Social Adjustment