Primary Submission Category: Policy
Estimating the Effect of Timing of Earned Income Tax Credit Refunds on Perinatal health
Authors: Deborah Karasek Daniel Collin Caitlin Turner Akansha Batra Rita Hamad
Presenting Author: Deborah Karasek*
Background: A strong evidence base exists linking poverty with adverse perinatal outcomes, including preterm birth, with persistent stark racial/ethnic disparities. Policy interventions, including the earned income tax credit (EITC), the largest US poverty alleviation program, provide tax refunds to low-income working families and have been shown to increase gestational age and birthweight. Using a quasi-experimental design, we examined whether the trimester of income receipt affects likelihood of and racial/ethnic disparities in perinatal outcomes, and if these relationships differed by state EITC generosity. Methods: The sample was drawn from National Center for Health Statistics (NCHS) birth certificate data from 2010-2019 (N= 36,946,027). To predict eligibility, we created a probabilistic algorithm in the Panel Study of Income Dynamics and apply it to the NCHS data. We used difference-in-difference models, comparing perinatal outcomes among EITC-eligible births exposed to the EITC in different trimesters, while controlling for seasonal trends and state differences in outcomes among non-eligible births. Results: EITC receipt during any trimester compared to preconception was associated with increased birthweight, with the strongest association during the third trimester (17.81 grams, 95%CI: 16.78, 18.88). EITC receipt during any trimester was also associated with lower likelihood of preterm birth with the strongest association in the third trimester (-2.16 percentage points, 95%CI: -2.21, -2.10). Preconception receipt of EITC appeared to be protective towards SGA, gestational diabetes, and gestational hypertension compared to receipt in pregnancy. Stratified analyses revealed stronger results among states with more generous EITC programs, as well as US-born compared to foreign-born birthing people, although with some exceptions. Conclusion: As interest in income policies as a poverty alleviation strategy is increasing, these results could be used to determine optimal timing of interventions.