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Mortality and Morbidity in the 21st Century
Anne Case & Angus Deaton
Brookings Papers on Economic Activity, Spring 2017, Pages 397-476
Building on our earlier research (Case and Deaton 2015), we find that mortality and morbidity among white non-Hispanic Americans in midlife since the turn of the century continued to climb through 2015. Additional increases in drug overdoses, suicides, and alcohol-related liver mortality — particularly among those with a high school degree or less — are responsible for an overall increase in all-cause mortality among whites. We find marked differences in mortality by race and education, with mortality among white non-Hispanics (males and females) rising for those without a college degree, and falling for those with a college degree. In contrast, mortality rates among blacks and Hispanics have continued to fall, irrespective of educational attainment. Mortality rates in comparably rich countries have continued their premillennial fall at the rates that used to characterize the United States. Contemporaneous levels of resources — particularly slowly growing, stagnant, and even declining incomes — cannot provide a comprehensive explanation for poor mortality outcomes. We propose a preliminary but plausible story in which cumulative disadvantage from one birth cohort to the next — in the labor market, in marriage and child outcomes, and in health — is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies — even ones that successfully improve earnings and jobs, or redistribute income — will take many years to reverse the increase in mortality and morbidity, and that those in midlife now are likely to do worse in old age than the current elderly. This is in contrast to accounts in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this, however, implies that there are no policy levers to be pulled. For instance, reducing the overprescription of opioids should be an obvious target for policymakers.
Cancer incidence increasing globally: The role of relaxed natural selection
Wenpeng You & Maciej Henneberg
Evolutionary Applications, forthcoming
Cancer incidence increase has multiple aetiologies. Mutant alleles accumulation in populations may be one of them due to strong heritability of many cancers. The opportunity for the operation of natural selection has decreased in the past ~150 years because of reduction in mortality and fertility. Mutation-selection balance may have been disturbed in this process and genes providing background for some cancers may have been accumulating in human gene pools. Worldwide, based on the WHO statistics for 173 countries the index of the opportunity for selection is strongly inversely correlated with cancer incidence in peoples aged 0–49 years and in people of all ages. This relationship remains significant when gross domestic product per capita (GDP), life expectancy of older people (e50), obesity, physical inactivity, smoking and urbanization are kept statistically constant for fifteen (15) of twenty-seven (27) individual cancers incidence rates. Twelve (12) cancers which are not correlated with relaxed natural selection after considering the six potential confounders are largely attributable to external causes like viruses and toxins. Ratios of the average cancer incidence rates of the 10 countries with lowest opportunities for selection to the average cancer incidence rates of the 10 countries with highest opportunities for selection are 2.3 (all cancers at all ages), 2.4 (all cancers in 0–49 years age group), 5.7 (average ratios of strongly genetically based cancers) and 2.1 (average ratios of cancers with less genetic background).
Geotagged US Tweets as Predictors of County-Level Health Outcomes, 2015–2016
Quynh Nguyen et al.
American Journal of Public Health, November 2017, Pages 1776-1782
Objectives: To leverage geotagged Twitter data to create national indicators of the social environment, with small-area indicators of prevalent sentiment and social modeling of health behaviors, and to test associations with county-level health outcomes, while controlling for demographic characteristics.
Methods: We used Twitter’s streaming application programming interface to continuously collect a random 1% subset of publicly available geo-located tweets in the contiguous United States. We collected approximately 80 million geotagged tweets from 603 363 unique Twitter users in a 12-month period (April 2015–March 2016).
Results: Across 3135 US counties, Twitter indicators of happiness, food, and physical activity were associated with lower premature mortality, obesity, and physical inactivity. Alcohol-use tweets predicted higher alcohol-use–related mortality.
Strategic Interaction among Governments in the Provision of a Global Public Good
Margaret Kyle, David Ridley & Su Zhang
Journal of Public Economics, forthcoming
How do governments respond to other governments when providing a global public good? Using data from 2007-2014 on medical research funding for infectious and parasitic diseases, we examine how governments and foundations in 41 countries respond to funding changes by the US government (which accounts for half of funding for these diseases). Because funding across governments might be positively correlated due to unobserved drivers they have in common, we use variation in the representation of research-intensive universities on US Congressional appropriations committees as an instrument for US funding. We find that a 10 percent increase in US government funding for a disease is associated with a 2 to 3 percent reduction in funding for that disease by another government in the following year.
Life expectancy and education: Evidence from the cardiovascular revolution
Casper Worm Hansen & Holger Strulik
Journal of Economic Growth, December 2017, Pages 421–450
This paper exploits the unexpected decline in the death rate from cardiovascular diseases since the 1970s as a large positive health shock that affected predominantly old-age mortality; i.e. the fourth stage of the epidemiological transition. Using a difference-in-differences estimation strategy, we find that US states with higher mortality rates from cardiovascular disease prior to the 1970s experienced greater increases in adult life expectancy and higher education enrollment. Our estimates suggest that a one-standard deviation higher treatment intensity is associated with an increase in adult life expectancy of 0.37 years and 0.07–0.15 more years of higher education.
Allocating Scarce Organs: How a Change in Supply Affects Transplant Waiting Lists
Stacy Dickert-Conlin, Todd Elder & Keith Teltser
Michigan State University Working Paper, August 2017
Vast organ shortages have motivated recent efforts to increase the supply of transplantable organs, but little is known about the demand side of the market. We develop a model of organ demand and test its implications using the universe of U.S. transplant data from 1988 to 2013. Exploiting variation in supply induced by state-level motorcycle helmet laws, we demonstrate that each organ that becomes available from a deceased donor induces seven transplant candidates to join transplant waitlists, while living-donor transplants are entirely crowded out. Positive supply shocks also increase post-transplant survival rates due to improvements in expected donor-recipient match quality.
Therapeutic Translation in the Wake of the Genome
Manuel Hermosilla & Jorge Lemus
NBER Working Paper, November 2017
The completion of the Human Genome Project (“HGP”) led many scientists to predict a swift revolution in human therapeutics. Despite large advances, however, this revolution has been slow to materialize. We investigate the hypothesis that this slow progress may stem from the large amounts of biological complexity unveiled by the Genome. Our test relies on a disease-specific measure of biological complexity, constructed by drawing on insights from Network Medicine (Barabasi et al., 2011). According to this measure, more complex diseases are those associated with a larger number of genetic associations, or with higher centrality in the Human Disease Network (Goh et al., 2007). With this measure in hand, we estimate the rate of translation of new science into early stage drug innovation by focusing on a leading type of genetic epidemiological knowledge (Genome-Wide Association Studies), and employing standard methods for the measurement of R&D productivity. For less complex diseases, we find a strong and positive association between cumulative knowledge and the amount of innovation. This association weakens as complexity increases, becoming statistically insignificant at the extreme. Our results therefore suggest that biological complexity is in part responsible for the slower-than-expected unfolding of the therapeutical revolution set in motion by the HGP.
Who Can Predict Their Own Demise? Heterogeneity in the Accuracy and Value of Longevity Expectations
Teresa Bago d'Uva, Owen O'Donnell & Eddy van Doorslaer
Journal of the Economics of Ageing, forthcoming
Inaccurate longevity expectations can result in suboptimal lifecycle planning with negative consequences for wellbeing in old age. We evaluate the accuracy of expectations by comparing the subjective probability of living to 75 reported in the Health and Retirement Study with survival to that age. Outcomes are positively correlated with the subjective predictions. But the prediction errors are large. Even larger than if every respondent had reported a 50-50 chance of survival. The subjective predictions are less accurate than life table probabilities based on age and sex only. On average, the respondents underestimate their chances of survival by almost 9 percentage points, with women displaying greater downward bias. Predictions are least accurate, most poorly calibrated and most noisy among the least educated and least cognitively able. By and large, using the subjective predictions to take decisions would generate less value than if everyone were to decide on the basis of the mean survival rate, or even the life table probability. Despite the predictions of the least educated being the least accurate, they are not unambiguously the least valuable, although they are most prone to generating large losses from excessive pessimism and optimism.
Safer driver responses at intersections with green signal countdown timers
Mohammad Islam, Amy Wyman & David Hurwitz
Transportation Research Part F: Traffic Psychology and Behaviour, November 2017, Pages 1-13
Traffic signal countdown timers (TSCTs) are innovative, practical, and cost effective technologies with the potential to improve safety at signalized intersections. The purpose of these devices is to assist motorists in decision-making at signalized intersections by providing them with real-time signal duration information. This study examines US driver responses in the presence of a green signal countdown timer (GSCT) and the implications those responses have on intersection safety. A driving simulator study was conducted to record driver responses to virtual GSCTs. Fifty-five participants (32 male and 23 female) responded to 1100 simulated traffic signals, half of which had GSCTs. A predictive model was developed and validated to estimate the change in driver’s probability to stop at different distances from the stop line in the presence of a GSCT. The presence of a GSCT increased average driver stopping probability in the dilemma zone by 13.10%, while decreasing average driver deceleration rates by 1.50 ft/s2. These results suggest that GSCTs may contribute to improved intersection safety in the US.
Risk of Developing Dementia at Older Ages in the United States
Demography, October 2017, Pages 1897–1919
Dementia is increasingly recognized as a major source of disease burden in the United States, yet little research has evaluated the lifecycle implications of dementia. To address this research gap, this article uses the Aging, Demographics, and Memory Study (ADAMS) to provide the first nationally representative, longitudinal estimates of the probability that a dementia-free person will develop dementia later in life. For the 1920 birth cohort, the average dementia-free 70-year-old male had an estimated 26.9 % (SE = 3.2 %) probability of developing dementia, and the average dementia-free 70-year-old female had an estimated 34.7 % (SE = 3.7 %) probability. These estimates of risk of dementia are higher for younger, lower-mortality cohorts and are substantially higher than those found in local epidemiological studies in the United States, suggesting a widespread need to prepare for a life stage with dementia.
Will a Shrink Make you Richer? Gender Differences in the Effects of Psychotherapy on Labour Efficiency
Guido Cozzi, Silvia Galli & Noemi Mantovan
European Economic Review, forthcoming
This paper provides a first theoretical and empirical analysis of the effects of psychotherapy on individual productivity. We build a simple model in which a deterioration of mental health endogenously causes a decrease in productivity, which is counterbalanced by psychotherapy. We test our hypotheses on the British Household Panel Survey data. We find that individuals suffering from mental health problems benefit economically from consulting a psychotherapist. Moreover, we find that the returns are higher for men than for women, even though women are more likely to seek help.
A pilot treatment study for mild traumatic brain injury: Neuroimaging changes detected by MEG after low-intensity pulse-based transcranial electrical stimulation
Ming-Xiong Huang et al.
Brain Injury, forthcoming
Methods: We used magnetoencephalography (MEG) to investigate neuronal changes in individuals with mTBI following a passive neurofeedback-based treatment programme called IASIS. This programme involved applying low-intensity pulses using transcranial electrical stimulation (LIP-tES) with electroencephalography monitoring. Study participants included six individuals with mTBI and persistent post-concussive symptoms (PCS). MEG exams were performed at baseline and follow-up to evaluate the effect of IASIS on brain functioning.
Results: At the baseline MEG exam, all participants had abnormal slow-waves. In the follow-up MEG exam, the participants showed significantly reduced abnormal slow-waves with an average reduction of 53.6 ± 24.6% in slow-wave total score. The participants also showed significant reduction of PCS scores after IASIS treatment, with an average reduction of 52.76 ± 26.4% in PCS total score.