PC1073: Are Caregivers of Low and Very Low Birthweight Infants at Higher Risk for Experiencing Changes in Employment Status?

Background: Infants born with low or very low birthweight (LBW or VLBW) are at increased risk for early morbidity and mortality as well as long term adverse health outcomes. These infants often require additional medical follow-up and caregiver involvement in their care as compared to their non-growth restricted counterparts. Various studies have demonstrated disparities in rates of LBW/VLBW births between different racial, ethnic and socio-economic groups; however, few studies have assessed the impact of LBW/VLBW infants on caregiver employment status or job change.

Objective: To investigate the association between infant birthweight and caregiver job change in the first year of life, by comparing the frequency of job change amongst caregivers of LBW and VLBW infants as compared to controls.

Methods: We merged five years of cross-sectional data (2016-2020) from the National Survey of Children’s Health (NSCH). We estimated the odds of a caregiver job change and food or housing instability relative to infant birthweight and multiple covariates of interest. Birthweight was categorized as either VLBW ( < 1500g), LBW ( < 2500g) or controls (≥2500g). Bivariate and multivariate logistic regression were performed with applied survey weights to draw national inferences. Multivariate logistic regression models were adjusted to only include the variables that had significance in bivariate analysis. Selected covariates are listed in Table 1.

Results: In this nationally representative sample, 23% of primary caregivers with VLBW infants reported a job change (Table 1). Caregiver job change was significantly more common with VLBW infants compared to controls (OR 2.82, 1.72-4.64) (Table 2). Food and housing insecurity was significantly more likely to occur in families with LBW infants (OR 1.13, 1.01-1.25) (Table 2). Amongst the co-variates, the most significant odds of caregiver job change were found for non-white families and those reporting a single parent or unmarried dual parent household (Table 2). Caregivers with private insurance had a lower likelihood of job changes compared to those with public insurance. The likelihood of food or housing insecurity was also significantly higher in families with single or unmarried parents and those with public insurance (Table 2). Caregiver level of education did not have any significant associations with employment changes, but was protective against food/housing insecurity (Table 2).

Conclusion: Nationally caregivers of VLBW infants have a significantly higher rate of job change compared to controls. Caregivers of LBW infants also report a significantly higher rate of food/housing insecurity. Families with unmarried or single parents or those with public insurance also demonstrated higher rates of job changes as well as food and housing insecurity. These findings merit further research into the impacts of VLBW infant births on caregiver job status as well as investigation into targets for nationwide resource allocation to support families with VLBW infants.