Association between preterm birth and economic and educational outcomes in adulthood: A population-based matched cohort study

by Asma M. Ahmed, Eleanor Pullenayegum, Sarah D. McDonald, Marc Beltempo, Shahirose S. Premji, Jason D. Pole, Fabiana Bacchini, Prakesh S. Shah, Petros Pechlivanoglou

Preterm birth (PTB) affects ~10% of births worldwide; however, most literature focused on short-term clinical outcomes, with much less focus on long-term socioeconomic outcomes after PTB. We examined associations between PTB and individuals’ income, employment, and educational outcomes during early adulthood.

We conducted a population-level matched cohort study including all live births in Canada between 1990 and 1996, followed until 2018. Outcomes included Employment income per year in 2018 CAD and employment between ages 18 and 28 years, postsecondary education enrollment (18–22 years), and maximum educational attainment at age 22–27 years. Mean differences and risk ratios (RR) and differences (RD) were estimated using generalized estimating equation regression models for economic outcomes and multinomial logistic regression models for educational outcomes.

Of 2.4 million births, 7% were born preterm (0.3%, 0.6%, 0.8%, and 5.4% born extremely preterm (24–27 weeks), very preterm (28–31 weeks), moderately preterm (32–33 weeks), and late preterm (34–36 weeks) respectively). After matching on baseline characteristics (e.g., sex, province of birth, and parental demographics) and adjusting for age and period effects, preterm-born individuals, on average, had $958 CAD less employment income per year (95% CI: $854-$1062), 6% lower income per year, than term-born individuals, and were 2.13% less likely to be employed (1.98–2.29%). PTB was also negatively associated with university enrollment (RR 0.93 (0.91–0.94) and graduation with a university degree (RR 0.95 (0.94–0.97)). Mean income differences for those born 24–27 weeks were -$5,463 CAD per year (17% lower), and adjusted RR were 0.55 for university enrollment and graduation.

In this population-based study, preterm birth was associated with lower economic and educational achievements at least until the late twenties. The associations were stronger with decreasing GA at birth. Policymakers, clinicians, and parents should be aware that the socioeconomic impact of PTB is not limited to the early neonatal period but extends into adulthood.