Estimating the effect of timing of earned income tax credit refunds on perinatal outcomes: a quasi-experimental study of California births

Deborah Karasek; Akansha Batra; Rebecca J Baer; Brittany D Chambers Butcher; Sky Feuer; Jonathan D Fuchs; Miriam Kuppermann; Anu Manchikanti Gomez; Aric A Prather; Matt Pantell; Elizabeth Rogers; Jonathan M Snowden; Jacqueline Torres; Larry Rand; Laura Jelliffe-Pawlowski; Rita Hamad

doi:10.1186/s12889-023-16920-0

Estimating the effect of timing of earned income tax credit refunds on perinatal outcomes: a quasi-experimental study of California births

BMC Public Health. 2023 Nov 7;23(1):2180. doi: 10.1186/s12889-023-16920-0.

Authors

Deborah Karasek^{1

2

3}, Akansha Batra⁴, Rebecca J Baer^{5

6}, Brittany D Chambers Butcher⁷, Sky Feuer^{8

5}, Jonathan D Fuchs⁹, Miriam Kuppermann^{8

5}, Anu Manchikanti Gomez¹⁰, Aric A Prather¹¹, Matt Pantell¹², Elizabeth Rogers¹², Jonathan M Snowden¹³, Jacqueline Torres⁴, Larry Rand^{8

5}, Laura Jelliffe-Pawlowski^{5

4}, Rita Hamad^{14

15}

Affiliations

¹ School of Public Health, Oregon Health & Science University - Portland State University, Portland, USA. karasekd@ohsu.edu.
² Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA. karasekd@ohsu.edu.
³ California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA. karasekd@ohsu.edu.
⁴ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA.
⁵ California Preterm Birth Initiative, University of California, San Francisco, San Francisco, USA.
⁶ Department of Pediatrics, University of California, San Diego, San Diego, USA.
⁷ Department of Human Ecology, University of California, Davis, Davis, USA.
⁸ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, USA.
⁹ Department of Public Health, Population Health Division, San Francisco, USA.
¹⁰ Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, USA.
¹¹ Department of Psychiatry, University of California, San Francisco, San Francisco, USA.
¹² Department of Pediatrics, University of California, San Francisco, San Francisco, USA.
¹³ School of Public Health, Oregon Health & Science University - Portland State University, Portland, USA.
¹⁴ Department of Family and Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
¹⁵ Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Cambridge, USA.

Abstract

Background: The largest poverty alleviation program in the US is the earned income tax credit (EITC), providing $60 billion to over 25 million families annually. While research has shown positive impacts of EITC receipt in pregnancy, there is little evidence on whether the timing of receipt may lead to differences in pregnancy outcomes. We used a quasi-experimental difference-in-differences design, taking advantage of EITC tax disbursement each spring to examine whether trimester of receipt was associated with perinatal outcomes.

Methods: We conducted a difference-in-differences analysis of California linked birth certificate and hospital discharge records. The sample was drawn from the linked CA birth certificate and discharge records from 2007-2012 (N = 2,740,707). To predict eligibility, we created a probabilistic algorithm in the Panel Study of Income Dynamics and applied it to the CA data. Primary outcome measures included preterm birth, small-for-gestational age (SGA), gestational diabetes, and gestational hypertension/preeclampsia.

Results: Eligibility for EITC receipt during the third trimester was associated with a lower risk of preterm birth compared with preconception. Eligibility for receipt in the preconception period resulted in improved gestational hypertension and SGA.

Conclusion: This analysis offers a novel method to impute EITC eligibility using a probabilistic algorithm in a data set with richer sociodemographic information relative to the clinical and administrative data sets from which outcomes are drawn. These results could be used to determine the optimal intervention time point for future income supplementation policies. Future work should examine frequent income supplementation such as the minimum wage or basic income programs.

Keywords: Gestational diabetes; Gestational hypertension; Income effects; Maternal health; Policy evaluation; Pregnancy outcomes; Preterm birth.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

California / epidemiology
Female
Fetal Growth Retardation
Humans
Hypertension, Pregnancy-Induced*
Income
Income Tax
Infant, Newborn
Pregnancy
Premature Birth*

Abstract

Publication types

MeSH terms

Grants and funding