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Does Social Health Insurance Close the Gap: The Case of Socioeconomic Status and Preterm Low-Birth-Weight Survival

Vivian Chia-Rong Hsieh1, Shwn-Huey Shieh2, Chiu-Ying Chen3

  • 1China Medical University, Taichung, Taiwan National Health Research Institutes, Zhunan, Taiwan.

Asia-Pacific Journal of Public Health
|April 30, 2015
PubMed

Insights

Higher parental income and adequate antenatal care significantly reduce mortality in preterm or low-birth-weight (PLBW) babies. Promoting primary care access is crucial for preventing premature PLBW deaths.

Area of Science:

  • Public Health
  • Neonatal Medicine
  • Health Economics

Background:

  • Preterm or low-birth-weight (PLBW) babies face increased mortality risks.
  • Understanding the impact of socioeconomic factors and healthcare access on PLBW infant survival is critical within universal healthcare systems.

Purpose of the Study:

  • To investigate the effects of parental socioeconomic status, primary care, and healthcare expenditure on PLBW infant mortality.
  • To analyze neonatal, postneonatal, and under-5 mortality rates in PLBW infants under Taiwan's universal healthcare system.

Main Methods:

  • Retrospective cohort study utilizing a population-based medical claims database.
  • Analysis of 4668 singleton PLBW babies born in Taiwan in 2001, with up to 5 years of follow-up.
  • Multivariate survival models to assess the impact of income, antenatal care, and healthcare expenditure on mortality outcomes.

Main Results:

  • Higher parental income showed a significant positive effect on survival during the neonatal period, diminishing in later stages.
  • Adequate antenatal care demonstrated a consistent inverse relationship with mortality: neonatal HR=0.494 (95% CI=0.312-0.783), postneonatal HR=0.282 (95% CI=0.102-0.774), and under-5 HR=0.575 (95% CI=0.386-0.857).
  • Healthcare expenditure did not show a significant independent effect on mortality in this cohort.

Conclusions:

  • Parental income and access to quality antenatal care are significant determinants of survival for PLBW infants.
  • Active promotion of primary care services, especially for lower-income families, is recommended to reduce premature PLBW mortality.
  • Universal healthcare systems can mitigate some risks, but targeted interventions remain essential for vulnerable infant populations.

Keywords:
health care disparitieslow birth weightpremature mortalitypreterm birthsocioeconomic status

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