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State and Local Government Expenditures and Infant Mortality in the United States
Journal article   Open access

State and Local Government Expenditures and Infant Mortality in the United States

Neal D Goldstein, Aimee J Palumbo, Scarlett L Bellamy, Jonathan Purtle and Robert Locke
Pediatrics (Evanston), v 146(5), pe20201134
Nov 2020
PMID: 33077541
url
https://doi.org/10.1542/peds.2020-1134View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze) Open

Abstract

Humans Infant Infant Mortality Investments - economics Local Government Longitudinal Studies Public Expenditures - statistics & numerical data State Government United States
Evidence suggests that government expenditures on non-health care services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Thus, we sought to quantify how US state government spending on various services impacted infant mortality rates (IMRs) over time and whether spending differentially reduced mortality in some subpopulations. A longitudinal, repeated-measures study of US state-level infant mortality and state and local government spending for the years 2000-2016, the most recent data available. Expenditures included spending on education, social services, and environment and housing. Using generalized linear regression models, we assessed how changes in spending impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group. State and local governments spend, on average, $9 per person. A $0.30 per-person increase in environmental spending was associated with a decrease of 0.03 deaths per 1000 live births, and a $0.73 per-person increase in social services spending was associated with a decrease of 0.02 deaths per 1000 live births. Infants born to mothers aged <20 years had the single greatest benefit from an increase in expenditures compared with all other groups. Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall IMR. Investment in non-health care services was associated with lower IMRs among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing IMR disparities.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#10 Reduced Inequalities
#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Pediatrics
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