Analyzing all live births in Canada over a six-year period and following the children for more than two decades, researchers found that premature births and the related cognitive, developmental and physical health effects of prematurity were associated with lower income, employment and university enrollment.

Individuals born before 37 weeks of gestation who are considered preterm infants have, on average, lower employment income, college enrollment and educational attainment by age 28, according to a new study published Nov. 6, 2024, in the open-access journal. PLOS ONE Petros Pechlivanoglou, Hospital for Sick Children, Toronto, Canada.

Premature birth affects approximately 10% of all births worldwide and is responsible for 1 in 5 deaths in children. Economic and lifestyle factors can affect a family’s access to therapies and supports, financial stability, and quality of life.

Many studies have looked at the short-term clinical consequences of preterm birth, but few have followed these children over long periods and also examined the socioeconomic effects of preterm birth.

In the new study, Pechlivanoglou and colleagues used data on 2.4 million people born in Canada between 1990 and 1996. Information was available about individuals’ birth, employment, and education until 2018.

After controlling for key characteristics such as parental demographics, the study found that the average income of individuals born prematurely, ages 18 to 28, was C$958 (6%) per year lower than those born full-term. Those born prematurely were also 2.13% less likely to be employed, 17% less likely to enroll in college, and 16% less likely to graduate with a college degree. These associations were even stronger for individuals born at the earliest gestational age (24–27 weeks); $5,463 CAD (17%) lower annual income and a 45% drop in college enrollment and graduation rates.

Although clinical care during the neonatal period is critical, our findings suggest that developing long-term supports (including psychological, educational, and professional resources) that go beyond clinical care may help alleviate the long-term effects of preterm birth. “Policymakers and society as a whole must recognize that the socioeconomic impact of preterm birth can extend into early adulthood and that considerations for ongoing support may be vital to ensure this population has an equal opportunity to develop.”

Petros Pechlivanoglou, Hospital for Sick Children, Toronto, ON, Canada