Quantifying the Clinical and Socioeconomic Burden of Prematurity in Singapore
Main Applicant – Prof Eric Finkelstein, Executive Director, Lien Centre for Palliative Care, Duke-NUS Medical School

Prematurity is a leading cause of infant morbidity and mortality, yet evidence on its long-term clinical, economic, and social consequences remains limited, particularly in Singapore. Survival among very preterm infants has improved substantially, but less is known about downstream outcomes across the life course and the broader impacts on families.

This study will provide a population-level assessment of the long-term consequences and costs of prematurity in Singapore using administrative data from the TRUST platform, spanning health, education, and socioeconomic domains. The study addresses two primary questions: 1) what are the long-term health, healthcare utilisation, costs, and educational outcomes associated with preterm birth; and 2) what spillover effects does prematurity have on siblings’ educational outcomes and parents’ economic and marital stability.

We hypothesise that prematurity is associated with higher healthcare utilisation, poorer academic performance, and adverse family economic outcomes, with effects that intensify at lower gestational ages and among socioeconomically disadvantaged households. National birth cohorts of preterm and full-term infants will be constructed and analysed using sibling fixed-effects and propensity score-based methods to address observed and unobserved confounding. Sensitivity analyses will assess robustness to residual bias.

The study will generate policy-relevant evidence on the long-term and family-level burden of prematurity to inform healthcare planning and future research.