Using Multistate Model to Evaluate Socioeconomic Impact of Preterm Birth on Mothers

Background & Objectives: One in every 12 infants in Canada is born preterm, significantly impacting children’s health and socioeconomic outcomes. However, little is known about how preterm birth affects maternal labour market participation and socioeconomic stability. This study aims to evaluate the impact of preterm birth on mothers by estimating transition intensities between states of parental leave, employment, unemployment, second birth, and death. Methods: Using linked Canadian administrative, survey, and tax data from the Vital Statistics–Birth (VSB), Vital Statistics–Death (VSD), T1 Family File (T1FF), and the Employment Insurance Status Vector (EISV), we established a matched cohort of nulliparous women who gave birth to either preterm or term singleton infants between 2006 and 2015, totaling approximately 199,000 subjects. Exact matching was performed at a 1:1 ratio on baseline characteristics, including maternal and paternal age, place of birth, birth year, marital status, and maternal income quintiles at birth. We applied a multistate model to analyze the matched data, estimating the impact of preterm birth categories on transition rates. Results: Multistate modeling demonstrated certain trends across preterm birth categories: mothers with higher levels of preterm birth were more likely to transition from employment to unemployment and less likely to transition from parental leave to employment. Conversely, transitions from employment to second birth were higher among mothers with lower levels of preterm birth. Conclusions: This study suggests that preterm birth levels are associated with specific socioeconomic trajectories for mothers, highlighting the need for targeted policies and interventions to address the socioeconomic challenges faced by mothers and families experiencing preterm births.