abstract: 'Policy Points Policies that increase county income levels, particularly

  for middle-income households, may reduce low birth weight rates and

  shrink disparities between Black and White infants. Given the role of

  aggregate maternal characteristics in predicting low birth weight rates,

  policies that increase human capital investments (e.g., funding for

  higher education, job training) could lead to higher income levels while

  improving population birth outcomes. The association between county

  income levels and racial disparities in low birth weight is independent

  of disparities in maternal risks, and thus a broad set of policies aimed

  at increasing income levels (e.g., income supplements, labor

  protections) may be warranted. Context Low birth weight (LBW; <2,500

  grams) and infant mortality rates vary among place and racial group in

  the United States, with economic resources being a likely fundamental

  contributor to these disparities. The goals of this study were to

  examine time-varying county median income as a predictor of LBW rates

  and Black-White LBW disparities and to test county prevalence and racial

  disparities in maternal sociodemographic and health risk factors as

  mediators. Methods Using national birth records for 1992-2014 from the

  National Center for Health Statistics, a total of approximately 27.4

  million singleton births to non-Hispanic Black and White mothers were

  included. Data were aggregated in three-year county-period observations

  for 868 US counties meeting eligibility requirements (n = 3,723

  observations). Sociodemographic factors included rates of low maternal

  education, nonmarital childbearing, teenage pregnancy, and advanced-age

  pregnancy; and health factors included rates of smoking during pregnancy

  and inadequate prenatal care. Among other covariates, linear models

  included county and period fixed effects and unemployment, poverty, and

  income inequality. Findings An increase of \$10,000 in county median

  income was associated with 0.34 fewer LBW cases per 100 live births and

  smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying

  county rates of maternal sociodemographic and health risks mediated the

  association between median income and LBW, accounting for 65\% and 25\%

  of this estimate, respectively, but racial disparities in risk factors

  did not mediate the income association with Black-White LBW disparities.

  Similarly, county median income was associated with very low birth

  weight rates and related Black-White disparities. Conclusions Efforts to

  increase income levels-for example, through investing in human capital,

  enacting labor union protections, or attracting well-paying

  employment-have broad potential to influence population reproductive

  health. Higher income levels may reduce LBW rates and lead to more

  equitable outcomes between Black and White mothers.'
affiliation: 'Curtis, DS (Corresponding Author), Univ Utah, Dept Family \& Consumer
  Studies, Alfred Emory Bldg 228, Salt Lake City, UT 84112 USA.

  Curtis, David S.; Carlson, Daniel L.; Wen, Ming, Univ Utah, Salt Lake City, UT USA.

  Fuller-rowell, Thomas E., Auburn Univ, Auburn, AL 36849 USA.

  Kramer, Michael R., Emory Univ, Atlanta, GA 30322 USA.'
author: Curtis, David S. and Fuller-rowell, Thomas E. and Carlson, Daniel L. and Wen,
  Ming and Kramer, Michael R.
author-email: david.curtis@fcs.utah.edu
author_list:
- family: Curtis
  given: David S.
- family: Fuller-rowell
  given: Thomas E.
- family: Carlson
  given: Daniel L.
- family: Wen
  given: Ming
- family: Kramer
  given: Michael R.
da: '2023-09-28'
doi: 10.1111/1468-0009.12532
earlyaccessdate: OCT 2021
eissn: 1468-0009
files: []
issn: 0887-378X
journal: MILBANK QUARTERLY
keywords: 'low birth weight; health disparities; health equity; median income;

  fundamental cause theory; US counties'
keywords-plus: 'RACIAL RESIDENTIAL SEGREGATION; PRENATAL-CARE UTILIZATION;

  UNITED-STATES; INFANT-MORTALITY; PRETERM BIRTH; SOCIOECONOMIC

  DISPARITIES; HEALTH DISPARITIES; RACIAL/ETHNIC DISPARITIES; FUNDAMENTAL

  CAUSES; STRUCTURAL RACISM'
language: English
month: MAR
number: '1'
number-of-cited-references: '109'
pages: 38-77
papis_id: 0e2e4de09e8cadf796f87daee4b57e96
ref: Curtis2022doesrising
researcherid-numbers: Carlson, Daniel/GWU-9165-2022
times-cited: '2'
title: Does a Rising Median Income Lift All Birth Weights? County Median Income Changes
  and Low Birth Weight Rates Among Births to Black and White Mothers
type: Article
unique-id: WOS:000713640700001
usage-count-last-180-days: '0'
usage-count-since-2013: '4'
volume: '100'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2022'