ImportanceAcute respiratory tract infections are the leading cause of emergency department visits and hospitalizations in US children, with highest risks in the first 2 months after birth. Out-of-home childcare settings increase the spread of respiratory tract infections. The study team hypothesized that access to state-paid family leave could reduce acute care encounters (hospital admissions or emergency department visits) for respiratory tract infections in young infants by reducing out-of-home childcare transmissions.ObjectiveTo determine if the 2018 introduction of paid family leave in New York state reduced acute care encounters for respiratory tract infections in infants 8 weeks or younger.Design, Setting, and ParticipantsThis population-based study of acute care encounters took place in New York state and New England control states (Maine, Massachusetts, New Hampshire, Vermont) from October 2015 through February 2020. Participants included infants aged 8 weeks or younger. Controlled time series analysis using Poisson regression was used to estimate the impact of paid family leave on acute care encounters for respiratory tract infections, comparing observed counts during respiratory virus season (October through March) with those predicted in the absence of the policy. Acute care encounters for respiratory tract infections in 1-year-olds (who would not be expected to benefit as directly from the policy) were modeled as a placebo test.InterventionNew York State Paid Family Leave policy, introduced on January 1, 2018, providing 8 weeks of paid leave for eligible parents.Main Outcomes and MeasuresEmergency department visits or hospitalizations with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) codes for upper or lower respiratory tract infections or associated symptoms (ie, fever, cough), excluding newborn hospitalizations. The secondary outcome was acute care encounters for respiratory syncytial virus (RSV) bronchiolitis.ResultsThere were 52 943 acute care encounters for respiratory infection among infants 8 weeks or younger. There were 15 932 encounters that were hospitalizations (30%) and 33 304 of the encounters were paid for by Medicaid (63%). Encounters were 18% lower than predicted (relative percentage change = −17.9; 95% CI, −20.3 to −15.7) after the introduction of paid family leave. RSV encounters were 27.0% lower (95% CI, −30.9 to −23.5) than predicted. Similar reductions were not observed in 1-year-olds (relative percentage change = −1.5; 95% CI, −2.5 to −0.6).ConclusionsNew York state’s paid family leave policy was associated with reduced acute care encounters for respiratory tract infections in young infants. These findings may be useful for informing implementation of paid family leave federally and in the states that have not enacted paid family leave policies.

中文翻译：

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带薪家事假与幼儿急性呼吸道感染的预防


重要性急性呼吸道感染是美国儿童急诊和住院的主要原因，出生后前 2 个月的风险最高。户外托儿所会增加呼吸道感染的传播。研究小组假设，享受国家带薪探亲假可以通过减少外出托儿传播来减少幼儿呼吸道感染的紧急护理（入院或急诊科就诊）。目的确定 2018 年引入带薪探亲假是否可以纽约州的探亲假减少了 8 周或更小的婴儿因呼吸道感染而发生的紧急护理事件。设计、设置和参与者这项基于人群的紧急护理事件研究在纽约州和新英格兰对照州（缅因州、马萨诸塞州）进行，新罕布什尔州，佛蒙特州）从 2015 年 10 月到 2020 年 2 月。参与者包括 8 周或更小的婴儿。使用泊松回归进行受控时间序列分析，将呼吸道病毒季节（10 月至 3 月）观察到的计数与没有该政策时的预测计数进行比较，估计带薪探亲假对呼吸道感染急性护理的影响。将 1 岁儿童（预计不会直接从该政策中受益）的呼吸道感染急性护理经历建模为安慰剂测试。干预纽约州带薪家事假政策，于 2018 年 1 月 1 日推出，规定符合条件的父母可享受 8 周带薪休假。主要成果和措施 符合国际疾病和相关健康问题统计分类、上呼吸道或下呼吸道感染或相关症状（即发烧、咳嗽）第十修订版（ICD）代码的急诊科就诊或住院治疗，不包括新生儿住院治疗。次要结局是呼吸道合胞病毒 (RSV) 细支气管炎的紧急护理事件。结果 8 周或更小的婴儿中有 52 943 例呼吸道感染的紧急护理事件。有 15 932 例住院治疗 (30%)，其中 33 304 例由医疗补助 (Medicaid) 支付费用 (63%)。引入带薪家庭假后，遭遇次数比预期低 18%（相对百分比变化 = -17.9；95% CI，-20.3 至 -15.7）。 RSV 遭遇比预测低 27.0%（95% CI，-30.9 至 -23.5）。在 1 岁儿童中没有观察到类似的减少（相对百分比变化 = -1.5；95% CI，-2.5 至 -0.6）。 结论 纽约州的带薪家事假政策与青少年呼吸道感染急性护理事件的减少有关婴儿。这些发现可能有助于告知联邦和尚未颁布带薪家庭假政策的州实施带薪家庭假。