General Health
Childhood exposure to birth registration laws and old-age mortality
Hamid Noghanibehambari & Jason Fletcher
Health Economics, forthcoming
Abstract:
This paper studies the effects of the enactment of birth registration laws, as the official universal and uniform method of recording births, across US states in the first decades of the 20th century on old-age longevity for children affected by these laws. We show that establishing birth registration laws has long-term benefits for old-age health. The benefits are primarily driven by states with an effective child labor policy, suggesting that registering births helps the enforcement of child labor laws which in turn operate as the mechanism channel to improve old-age longevity. A treatment-on-treated calculation suggests an increase of 0.6 years of longevity from not working during childhood due to the birth registration law.
The Effects of Recreational Marijuana Legalization on Employment and Earnings
Dhaval Dave et al.
NBER Working Paper, December 2022
Abstract:
Despite nearly 70 percent of the American public supporting legalization of recreational marijuana, opponents argue that increased marijuana use may diminish motivation, impede cognitive function, and harm health, each of which could adversely affect adults’ economic wellbeing. This study is the first to explore the impacts of recreational marijuana laws (RMLs) on employment and wages. Difference-in-differences estimates show little evidence that RMLs adversely affect labor market outcomes among most working-age individuals. Rather, our estimates show that RML adoption is associated with an increase in agricultural employment, consistent with the opening of a new licit market. A causal interpretation of our findings is supported by (1) event-study analyses using dynamic difference-in-differences estimates designed to expunge bias due to heterogeneous and dynamic treatment effects, and (2) alternative policy estimates generated using a synthetic control design.
Associations Between State and Local Government Spending and Pregnancy-Related Mortality in the U.S.
Dovile Vilda et al.
American Journal of Preventive Medicine, forthcoming
Methods: State-specific total population and race/ethnicity-specific 5-year (2015–2019) pregnancy-related mortality ratios were estimated from annual natality and mortality files provided by the National Center for Health Statistics. Data on state and local government spending and population-level characteristics were obtained from U.S. Census Bureau surveys. Generalized linear Poisson regression models with robust SEs were fitted to estimate adjusted rate ratios and 95% CIs associated with proportions of total spending allocated to social services and healthcare domains, adjusting for state-level covariates. All analyses were completed in 2021–2022.
Results: State and local government spending on transportation was associated with 11% lower overall pregnancy-related mortality (adjusted rate ratio=0.89, 95% CI=0.83, 0.96) and 9%–12% lower pregnancy-related mortality among the racial/ethnic groups. Among spending subdomains, expenditures on higher education, highways and roads, and parks and recreation were associated with lower pregnancy-related mortality rates in the total population (adjusted rate ratio=0.90, 95% CI=0.86, 0.94; adjusted rate ratio=0.87, 95% CI=0.81, 0.94; and adjusted rate ratio=0.68, 95% CI=0.49, 0.95, respectively). These results were consistent among the racial/ethnic groups, but patterns of associations with pregnancy-related mortality and other spending subdomains differed notably between racial/ethnic groups.
The Long-term Impact of In-Utero Cigarette Taxes on Adult Prenatal Smoking
Lauren Hoehn-Velasco, Michael Pesko & Serena Phillips
American Journal of Health Economics, forthcoming
Abstract:
This study examines the long-term link between in-utero cigarette taxes and adult prenatal smoking. We use U.S. birth certificate records to demonstrate that exposure to higher in-utero cigarette taxes (over 1965-2001) reduces later-life adult pre-pregnancy and prenatal smoking. We also show that higher in-utero cigarette taxes have long-lasting effects on adult health, and intergenerational consequences for infant health. Finally, we demonstrate that larger in-utero tax responsiveness correlates with smaller contemporary cigarette tax responsiveness, suggesting that higher in-utero taxes may alter the composition of remaining smokers and contribute to reductions in contemporary cigarette tax responsiveness.
Neuroticism, urbanization, and the state prevalence of Parkinson’s disease in the USA
Stewart McCann
Journal of Research in Personality, forthcoming
Abstract:
This study was conducted primarily to determine whether state prevalence rates of Parkinson’s disease (PD) among Medicare beneficiaries 65 and over are associated with U.S. state resident standing on the Big Five personality dimensions. Key variables for the 50 states were PD prevalence rates in 2014, Big Five scores based on 619,397 survey respondents, socioeconomic status (SES), White population percent, urban population percent, health environment, and overall health outcomes. A sequential multiple regression equation with the SES, White, and urbanization variables selected stepwise and followed by the Big Five selected stepwise showed state PD prevalence rate variance was significantly accounted for by urbanization (16.9 %, β = 0.53) and neuroticism (32.8 %, β = 0.59). This prediction pattern persisted in another equation when state health environment and health outcomes served as additional controls, with neuroticism accounting for an additional 17.4 % of the variance. The only independent predictors in that equation also were urbanization (β = 0.57) and neuroticism (β = 0.48). Essentially similar results were found using simultaneous entry equations. Spatial analysis using Moran’s I test for residual spatial autocorrelation also showed that spatial autocorrelation was not an issue. The present results based on the geographical psychology perspective underline the importance of corroborating correlative patterns found in personality studies with individuals as the analytic units with research using aggregates of individuals as the units of analysis. It also is speculated that health policy and promotion managers eventually might profit from tailoring PD initiatives according to resident neuroticism levels and degree of urbanization.
Marijuana Legalization and Opioid Deaths
Neil Mathur & Christopher Ruhm
Journal of Health Economics, forthcoming
Abstract:
Many states have legalized marijuana over the last two decades, initially for medical purposes and more recently for recreational consumption. Despite prior research, it remains unclear how these policies are related to rates of opioid-involved overdose deaths, which have trended rapidly upwards over time. We examine this question in two ways. First, we replicate and extend previous investigations to show that the prior empirical results are frequently fragile to the choice of specifications and time periods, and probably provide an overly optimistic assessment of the effects of marijuana legalization on opioid deaths. Second, we present new estimates suggesting that legal medical marijuana, particularly when available through retail dispensaries, is associated with higher opioid mortality. The results for recreational marijuana, while less reliable, also indicate that retail sales may be correlated with greater death rates relative to the counterfactual of no legal cannabis. A likely mechanism for these effects is the emergence of illicit fentanyl, which has increased the riskiness of even small positive effects of cannabis legalization on the consumption of opioids.
Recreational marijuana laws and the misuse of prescription opioids: Evidence from National Survey on Drug Use and Health microdata
Mir Ali et al.
Health Economics, February 2023, Pages 277-301
Abstract:
Several studies have concluded that legalizing medical marijuana can reduce deaths from opioid overdoses. Drawing on micro data from the National Survey on Drug Use and Health, a survey uniquely suited to assessing patterns of substance use, we examine the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. Using a standard difference-in-differences (DD) regression model, we find that RML adoption reduces the likelihood of frequently misusing prescription opioids such as OxyContin, Percocet, and Vicodin. However, using a two-stage procedure designed to account for staggered treatment and dynamic effects, the DD estimate of relationship between RML adoption and the likelihood of frequently misusing prescription opioids becomes positive. Although event study estimates suggest that RML adoption leads to a decrease in the frequency of prescription opioid abuse, this effect appears to dissipate after only 2 or 3 years.
The impact of recreational cannabis markets on motor vehicle accident, suicide, and opioid overdose fatalities
Samantha Marinello & Lisa Powell
Social Science & Medicine, forthcoming
Abstract:
In the U.S., an increasing number of states are legalizing regulated commercial markets for recreational cannabis, which allows private industry to produce, distribute, and sell marijuana to those 21 and older. The health impacts of these markets are not fully understood. Preliminary evidence suggests recreational markets may be associated with increased use among adults, which indicates there may be downstream health impacts on outcomes related to cannabis use. Three causes of death that are linked to cannabis use are motor vehicle accidents, suicide, and opioid overdose. Drawing on data from U.S. death certificates from 2009 to 2019, we conducted a difference-in-differences analysis to estimate the impact of recreational markets on fatalities from motor vehicle accidents, suicide, and opioid overdose in seven states: Colorado, Washington, Oregon, Alaska, Nevada, California, and Massachusetts. States with comprehensive medical cannabis programs with similar pre-trends in deaths were used as comparisons. For each outcome, a pooled estimate was generated with a meta-analysis using random effects models. The results revealed substantial increases in crash fatalities in Colorado, Oregon, Alaska, and California of 16%, 22%, 20%, and 14%, respectively. Based on estimates from all seven states, recreational markets were associated with a 10% increase in motor vehicle accident deaths, on average. This study found no evidence that recreational markets impacted suicides. Most states saw a relative reduction in opioid overdose death that ranged between 3 and 28%. On average, recreational markets were associated with an 11% reduction in opioid overdose fatalities.
Spillover Effects of the Opioid Epidemic on Consumer Finance
Mark Jansen
Journal of Financial and Quantitative Analysis, forthcoming
Abstract:
I examine the impact of the opioid epidemic on subprime auto lending. Using a difference-in-differences framework, I find that county-level increases in opioid abuse cause an increase in loan defaults. Moreover, I find that traditional credit scoring attributes (e.g., FICO score) fail to predict loan performance deterioration associated with opioid addiction. The weak predictive performance of traditional credit measures and the resulting higher default rates generate a negative externality for borrowers in opioid-afflicted areas, as evidenced by 5.7% higher loan costs for subprime borrowers.
Opioid Use Among Social Security Disability Insurance Applicants, 2013–2018
Nicole Maestas, Tisamarie Sherry & Alexander Strand
Journal of Disability Policy Studies, forthcoming
Abstract:
Opioid use is common among Social Security Disability Insurance (SSDI) beneficiaries who account for a disproportionate share of opioid-related hospitalizations and mortality. However, little is known about the prevalence of opioid use prior to SSDI enrollment. Understanding when opioid use is established and how it correlates with individual characteristics and community prescribing practices would inform policy approaches to reducing opioid-related harms among SSDI beneficiaries. We estimated the prevalence of opioid use among SSDI applicants by applying a natural language processing algorithm to SSDI application data. We find the prevalence of opioid use among SSDI applicants declined from 33% in 2013 to 24% in 2018. In contrast, the share of applicants with musculoskeletal impairments, which are commonly associated with pain, was unchanged. The share of applications reporting opioid use declined across both sexes, all age groups and education levels, and all regions. There was substantial variation, however, in the magnitude of decline by geography, with the smallest declines in parts of the Midwest and Southeastern United States. SSDI application rates and applications reporting opioid use were more likely to come from communities with higher opioid prescribing rates. Our estimates suggest most SSDI beneficiaries began opioid use prior to entering the SSDI program.
Effect of phosphodiesterase type 5 inhibitors on major adverse cardiovascular events and overall mortality in a large nationwide cohort of men with erectile dysfunction and cardiovascular risk factors: A retrospective, observational study based on healthcare claims and national death index data
Robert Kloner et al.
Journal of Sexual Medicine, January 2023, Pages 38–48
Aim: The objective of this study was to determine the effect of PDE-5is on the incidence of major adverse cardiovascular (CV) events (MACE; composite outcome of CV death, hospitalization for myocardial infarction, coronary revascularization, stroke, heart failure, and unstable angina pectoris) and overall mortality.
Methods: A retrospective observational cohort study was conducted in a large US claims database in men with ≥1 diagnosis of ED without prior MACE within 1 year, from January 1, 2006, to October 31, 2020. The exposed group had ≥1 claim for PDE-5i and the unexposed group had no claims for PDE-5i, and the groups were matched up to 1:4 on baseline risk variables.
Results: Matched plus multivariable analyses showed that MACE was lower by 13% in men exposed (n = 23 816) to PDE-5is (hazard ratio [HR] 0.87; 95% CI 0.79-0.95; P = .001) vs nonexposure (n = 48 682) over mean follow-up periods of 37 and 29 months, respectively, with lower incidence of coronary revascularization (HR 0.85; 95% CI 0.73-0.98; P = .029), heart failure (HR 0.83; 95% CI 0.72-0.97; P = .016), unstable angina (HR 0.78; 95% CI 0.64-0.96; P = .021), and CV death (HR 0.61; 95% CI 0.41-0.90; P = .014) with PDE-5i exposure. Phosphodiesterase type 5 inhibitor–exposed men had a 25% lower incidence of overall mortality (HR 0.75; 95% CI 0.65-0.87; P < .001). Men without coronary artery disease (CAD) but with CV risk factors at baseline showed a similar pattern. In the main study cohort, men in the highest quartile of PDE-5i exposure had the lowest incidence of MACE (HR 0.45; 95% CI 0.37-0.54; P < .001) and overall mortality (HR 0.51; 95% CI 0.37-0.71; P < .001) vs the lowest exposure quartile. In a subgroup with baseline type 2 diabetes (n = 6503), PDE-5i exposure was associated with a lower MACE risk (HR 0.79; 95% CI 0.64-0.97; P = .022).