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. 2014 Jan;23(1):69-92.
doi: 10.1002/hec.2901. Epub 2013 Jan 22.

Fetal health shocks and early inequalities in health capital accumulation

George L Wehby  1 , Kwame A Nyarko, Jorge S Lopez-Camelo
Affiliations

Fetal health shocks and early inequalities in health capital accumulation

George L Wehby et al. Health Econ. 2014 Jan.

Abstract

Several studies report socioeconomic inequalities in child health and consequences of early disease. However, not much is known about inequalities in health capital accumulation in the womb in response to fetal health shocks, which is essential for finding the earliest sensitive periods for interventions to reduce inequalities. We identify inequalities in birth weight accumulation as a result of fetal health shocks from the occurrence of one of the most common birth defects, oral clefts, within the first 9 weeks of pregnancy, using quantile regression and two datasets from South America and the USA. Infants born at lower birth weight quantiles are significantly more adversely affected by the health shock compared with those born at higher birth weight quantiles, with overall comparable results between the South American and US samples. These results suggest that fetal health shocks increase child health disparities by widening the spread of the birth weight distribution and that health inequalities begin in the womb, requiring interventions before pregnancy.

Keywords: child health; disparities; health production; inequalities; pregnancy; quantile regression.

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Figures

Figure 1
Figure 1. Effects of non-isolated oral clefts on birth weight quantiles and mean using the ECLAMC data – Basic specification
The figure reports the effects of non-isolated oral clefts (both overall and by type) on birth weight quantiles (solid line) and mean (dashed line). The effects are estimated from the basic specification that only controls for country and year of birth fixed effects (equation 4). 95% CI intervals for the quantile effects estimated using 500 bootstrap applications are in the shaded area.
Figure 2
Figure 2. Effects of isolated oral clefts on birth weight quantiles and mean using the ECLAMC data – Basic specification
The figure reports the effects of isolated oral clefts (both overall and by type) on birth weight quantiles (solid line) and mean (dashed line). The effects are estimated from the basic specification that only controls for country and year of birth fixed effects (equation 4). 95% CI intervals for the quantile effects estimated using 500 bootstrap applications are in the shaded area.
Figure 3
Figure 3. Effects of oral clefts on birth weight quantiles and mean using the natality data – Basic specification
The figure reports the effects of non-isolated and isolated oral clefts on birth weight quantiles (solid line) and mean (dashed line). The effects are estimated from the basic specification that only controls for state fixed effects (equation 4). 95% CI intervals for the quantile effects estimated using 500 bootstrap applications are in the shaded area.
Figure 4
Figure 4. Effects of non-isolated oral clefts on birth weight quantiles and mean using the ECLAMC data – Expanded specification
The figure reports the effects of non-isolated oral clefts (both overall and by type) on birth weight quantiles (solid line) and mean (dashed line). The effects are estimated from the expanded model that includes all control variables (equation 5). 95% CI intervals for the quantile effects estimated using 500 bootstrap applications are in the shaded area.
Figure 5
Figure 5. Effects of isolated oral clefts on birth weight quantiles and mean using the ECLAMC data – Expanded specification
The figure reports the effects of isolated oral clefts (both overall and by type) on birth weight quantiles (solid line) and mean (dashed line). The effects are estimated from the model that includes all control variables (equation 5). 95% CI intervals for the quantile effects estimated using 500 bootstrap applications are in the shaded area.
Figure 6
Figure 6. Effects of oral clefts on birth weight quantiles and mean using the natality data – Expanded specification
The figure reports the effects of non-isolated and isolated oral clefts on birth weight quantiles (solid line) and mean (dashed line). The effects are estimated from the model that includes all control variables (equation 5). 95% CI intervals for the quantile effects estimated using 500 bootstrap applications are in the shaded area.
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References

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