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Health Equity. 2019 Mar 12;3(1):61-67. doi: 10.1089/heq.2018.0061. eCollection 2019.

Effects of State-Level Earned Income Tax Credit Laws on Birth Outcomes by Race and Ethnicity.

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Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Department of Economics, Emory University, Atlanta, Georgia.


Purpose: Health disparities persist in birth outcomes by mother's income, education, and race in the United States. Disadvantaged mothers may experience benefit from supplements to family income, such as the earned income tax credit (EITC). We examined the effects of state-level EITCs on birth outcomes among women with a high school education or less, stratified by race and ethnicity. Methods: A quasi-experimental multistate and multiyear difference-in-differences design is used to assess effects of the presence and generosity of 23 state-level EITC laws on birth outcomes from 1994 to 2013. The methods utilized the U.S. National Vital Statistics System birth data for the outcomes: birth weight, probability of low birth weight (LBW; <2500 g), and gestation weeks. Results: Across all subgroups, any level of state EITC is associated with better birth outcomes with the largest effects seen among states with more generous EITCs. Black mothers experience larger percentage point reductions in the probability of LBW and increases in gestation duration. Among mothers with a high school education or less, results translate into 3760 fewer LBW babies with black mothers and 8364 fewer LBW babies with white mothers per year at the most generous state EITC level (i.e., 10% or more of federal and refundable). Hispanic and non-Hispanic mothers display relatively similar effects. Conclusions: The EITC at the federal and state level is an effective policy tool to reduce poverty and improve birth outcomes across racial and ethnic subgroups. Given the historically higher risk among black mothers, state-level EITC expansions offer one policy option to address this persistent health disparity.


birth outcomes; earned income tax credit; health disparities; health policy; infant health; socioeconomic factors

Conflict of interest statement

The National Institute on Minority Health and Health Disparities, National Institutes of Health supported this work (award R01MD010241). The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health. Human Participant Protection: This research made use of publicly available data sets and was determined to be exempt by the Emory University Institutional Review Board.

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