Side effects
Effects of a Presidential Candidate's Comments on HPV Vaccine
Rachel Zucker et al.
Journal of Health Communication, July 2015, Pages 783-789
Abstract:
During and after the 2011 Republican presidential debate, a candidate questioned the safety of HPV vaccine. The authors aimed to determine the effect of these comments on parents. A national sample of 327 parents with adolescent sons ages 11–17 years completed online surveys in fall 2010 (baseline, about 1 year before the debate) and 2011 (follow-up, about 1 month after the debate). The authors used regression models to examine the association of parents’ awareness of the candidate's comments with HPV vaccine initiation among their sons, their willingness to get sons free HPV vaccine, and their beliefs about potential harms of HPV vaccine. Overall, 17% of parents reported hearing about the Republican presidential candidate's comments about HPV vaccine. Parents aware of the comments had a larger increase between baseline and follow-up in the belief that HPV vaccine might cause short-term health problems compared with parents who were not aware. Although the candidate's comments may have increased some parents’ beliefs about the short-term harms of HPV vaccine, the comments had no effect on other beliefs, willingness to vaccinate, or behavior. Having accurate information about HPV vaccine that is readily available to the public during such controversies may diminish their effect.
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Spring Forward at Your Own Risk: Daylight Saving Time and Fatal Vehicle Crashes
Austin Smith
American Economic Journal: Applied Economics, forthcoming
Abstract:
Daylight Saving Time (DST) impacts over 1.5 billion people, yet many of its impacts on practicing populations remain uncertain. Exploiting the discrete nature of DST transitions and a 2007 policy change, I estimate the impact of DST on fatal automobile crashes. My results imply that from 2002-2011 the transition into DST caused over 30 deaths at a social cost of $275 million annually. Employing four tests to decompose the aggregate effect into an ambient light or sleep mechanism, I find that shifting ambient light only reallocates fatalities within a day, while sleep deprivation caused by the spring transition increases risk.
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Brad Greenwood & Ritu Agarwal
Management Science, forthcoming
Abstract:
Although recent work has examined the adverse implications of Internet-enabled matching platforms, limited attention has been paid to whom the negative externalities accrue. We examine how the entry of platforms for the solicitation of casual sex influences the incidence rate of HIV by race, gender, and socio-economic status. Using a census of 12 million patients subjected to a natural experiment in Florida, we find a significant increase in HIV incidence after platform implementation, with the largest effect accruing to historically at risk populations (i.e. African-Americans) despite documented lower rates of Internet utilization. Strikingly, our analysis reveals that HIV incidence increases in historically low risk populations as well (e.g. individuals of higher socio-economic status), and that men and women experience similar penalties. Identifying granular effects across subpopulations allows us to offer additional insight into the mechanisms by which matching platforms increase HIV incidence. We estimate the cumulative effect of platform entry over the five year period of the study as 1,149 additional Floridians contracting HIV at a cost of $710 million.
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Prenatal Stress and Low Birth Weight: Evidence from the Super Bowl
Brian Duncan, Hani Mansour & Daniel Rees
University of Colorado Working Paper, May 2015
Abstract:
Studies have estimated the relationship between psychological stress and birth weight by exploiting natural disasters and terrorist attacks, both of which could affect fetal health through other channels. Using data from the National Vital Statistics System for the period 1969-2004, we estimate the effect of prenatal exposure to the Super Bowl on low birth weight. Although major sporting events elicit intense emotions, they do not threaten viewers with direct physical harm or limit access to prenatal care. We find that Super Bowl exposure is associated with a small, but precisely estimated, increase in the probability of low birth weight.
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Money Transfer and Birth Weight: Evidence from the Alaska Permanent Fund Dividend
Wankyo Chung, Hyungserk Ha & Beomsoo Kim
Economic Inquiry, forthcoming
Abstract:
The positive relationship between income and health is well established. However, the direction of causality remains unclear: do economic resources influence health, or vice versa? Exploiting a new source of exogenous income variation, this study examines the impact of the Alaska Permanent Fund Dividend (APFD) on newborns' health outcomes. The results show that income has a significantly positive, but modest effect on birth weight. We find that an additional $1,000 ($2,331 in 2011 dollars) increases birth weight by 17.7 g and substantially decreases the likelihood of a low birth weight (a decrease of around 14% of the sample mean). Furthermore, the income effect is higher for less-educated mothers. Based on a gestation-weight profile in the sample, increased gestation owing to the APFD could explain a maximum of 34%–57% of the measured weight increase, although we are unable to examine all the potential mechanisms.
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Financial Incentives for Kidney Donation: A Comparative Case Study using Synthetic Controls
Firat Bilgel & Brian Galle
Journal of Health Economics, September 2015, Pages 103–117
Abstract:
Although many commentators called for increased efforts to incentivize organ donations, theorists and some evidence suggest these efforts will be ineffective. Studies examining the impact of tax incentives generally report zero/negative coefficients, but these studies incorrectly define their tax variables and rely on difference-in-differences despite likely failures of the parallel trends assumption. We identify the causal effect of tax legislation to serve as an organ donor on living kidney donation rates in the U.S states using more precise tax data and allowing for heterogeneous time-variant causal effects. Employing a synthetic control method, we find that the passage of tax incentive legislation increased living unrelated kidney donation rates by 52 percent in New York relative to a comparable synthetic New York in the absence of legislation. It is possible that New York is unique, but our methodology does not allow us to measure accurately effects in other states.
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Does Retirement Improve Health and Life Satisfaction?
Aspen Gorry, Devon Gorry & Sita Slavov
NBER Working Paper, July 2015
Abstract:
We utilize panel data from the Health and Retirement Study to investigate the impact of retirement on physical and mental health, life satisfaction, and health care utilization. Because poor health can induce retirement, we instrument for retirement using eligibility for Social Security and employer sponsored pensions and coverage by the Social Security earnings test. We find strong evidence that retirement improves both health and life satisfaction. While the impact on life satisfaction occurs within the first 4 years of retirement, many of the improvements in health show up 4 or more years later, consistent with the view that health is a stock that evolves slowly. We find little evidence that retirement influences health care utilization.
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David Rehkopf et al.
American Journal of Public Health, August 2015, Pages 1689-1695
Objectives: We examined how state characteristics in early life are associated with individual chronic disease later in life.
Methods: We assessed early-life state of residence using the first 3 digits of social security numbers from blue- and white-collar workers from a US manufacturing company. Longitudinal data were available from 1997 to 2012, with 305 936 person-years of observation. Disease was assessed using medical claims. We modeled associations using pooled logistic regression with inverse probability of censoring weights.
Results: We found small but statistically significant associations between early-state-of-residence characteristics and later life hypertension, diabetes, and ischemic heart disease. The most consistent associations were with income inequality, percentage non-White, and education. These associations were similar after statistically controlling for individual socioeconomic and demographic characteristics and current state characteristics.
Conclusions: Characteristics of the state in which an individual lives early in life are associated with prevalence of chronic disease later in life, with a strength of association equivalent to genetic associations found for these same health outcomes.
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The Effect of EITC Expansion on Health: A Different Approach to Income Gradient in Health
Otto Lenhart
Emory University Working Paper, July 2015
Abstract:
This study investigates the validity of previous findings of a positive relationship between income and health. This paper differs from previous studies in three ways. First, it directly accounts for potential income endogeneity by exploiting expansions of the Earned Income Tax Credit (EITC) as exogenous income variations. Second, this study offers a more accurate identification of affected individuals by obtaining simulated EITC benefits. I find that the expansion positively impacts health, especially when allowing it to adjust for some time. Third, this study provides evidence that insurance coverage and food expenditures are potential mechanisms underlying the income gradient in health.
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Short-run Effects of Job Loss on Health Conditions, Health Insurance, and Health Care Utilization
Jessamyn Schaller & Ann Huff Stevens
Journal of Health Economics, forthcoming
Abstract:
Job loss in the United States is associated with reductions in income and long-term increases in mortality rates. This paper examines the short-run changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 10,000 individual job losses and longitudinal data on a wide variety of health-related outcomes, we show that job loss results in worse self-reported health, activity limitations, and worse mental health, but is not associated with statistically significant increases in a variety of specific chronic conditions. Among the full sample of workers, we see reductions in insurance coverage, but little evidence of reductions in health care utilization after job loss. Among the subset of displaced workers with chronic conditions and those for whom the lost job was their primary source of insurance we do see reductions in doctor's visits and prescription drug usage.
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Income Effects on Health: Evidence from Union Army Pensions
Shari Eli
Journal of Economic History, June 2015, Pages 448-478
Abstract:
To what extent do rising income levels explain the decline in adult mortality rates experienced in the United States a century ago? I explore this question by investigating the income effect of the country's first wide-scale entitlement program: the Union Army pensions. Documenting that Republican Congressional candidates boosted pensions to secure votes, I exploit exogenous increases in income stemming from patronage politics to estimate the semi-elasticity of disease onset with respect to pensions. Income effects are large for cardiovascular, gastrointestinal, and respiratory illnesses.
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Twentieth century surge of excess adult male mortality
Hiram Beltrán-Sánchez, Caleb Finch & Eileen Crimmins
Proceedings of the National Academy of Sciences, 21 July 2015, Pages 8993–8998
Abstract
Using historical data from 1,763 birth cohorts from 1800 to 1935 in 13 developed countries, we show that what is now seen as normal — a large excess of female life expectancy in adulthood — is a demographic phenomenon that emerged among people born in the late 1800s. We show that excess adult male mortality is clearly rooted in specific age groups, 50–70, and that the sex asymmetry emerged in cohorts born after 1880 when male:female mortality ratios increased by as much as 50% from a baseline of about 1.1. Heart disease is the main condition associated with increased excess male mortality for those born after 1900. We further show that smoking-attributable deaths account for about 30% of excess male mortality at ages 50–70 for cohorts born in 1900–1935. However, after accounting for smoking, substantial excess male mortality at ages 50–70 remained, particularly from cardiovascular disease. The greater male vulnerability to cardiovascular conditions emerged with the reduction in infectious mortality and changes in health-related behaviors.
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Richard Steckel & Garrett Senney
Ohio State University Working Paper, May 2015
Abstract:
Many studies by social scientists view heart disease as the outcome of current or recent conditions such as poverty, smoking and obesity. An alternative approach gaining recognition is developmental origins of health and disease, which we apply to understand high death rates of whites in the South from cardiovascular disease (CVD). In this interpretation CVD vulnerability follows from unbalanced physical development created by poor conditions in utero that underbuilds major organs such as the kidneys and the cardiovascular system relative to those needed to process lush nutrition later in life. The South underwent an economic transformation from generations of poverty to rapid economic growth in the post-WWII era, exposing many children born in the 1950s through the 1980s to unbalanced physical development. Here we use state-level data for whites on income growth, smoking, obesity and education to explain variation in CVD death rates in 2010-2011. Our proxy for unbalanced physical growth, the ratio of average household income in 1980 to that in 1950, has a large systematic influence on CVD mortality, an impact that increases dramatically with age. The income ratio combined with smoking, obesity, and education explains two thirds of the variance in CVD mortality across states. Metaphorically, persistent intergenerational poverty loads the gun and rapid income growth pulls the trigger.
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Andrew Polyak, Richard Kubina & Santhosh Girirajan
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, forthcoming
Abstract:
While recent studies suggest a converging role for genetic factors towards risk for nosologically distinct disorders including autism, intellectual disability (ID), and epilepsy, current estimates of autism prevalence fail to take into account the impact of comorbidity of these disorders on autism diagnosis. We aimed to assess the effect of comorbidity on the diagnosis and prevalence of autism by analyzing 11 years (2000–2010) of special education enrollment data on approximately 6.2 million children per year. We found a 331% increase in the prevalence of autism from 2000 to 2010 within special education, potentially due to a diagnostic recategorization from frequently comorbid features such as ID. The decrease in ID prevalence equaled an average of 64.2% of the increase of autism prevalence for children aged 3–18 years. The proportion of ID cases potentially undergoing recategorization to autism was higher (P = 0.007) among older children (75%) than younger children (48%). Some US states showed significant negative correlations between the prevalence of autism compared to that of ID while others did not, suggesting state-specific health policy to be a major factor in categorizing autism. Further, a high frequency of autistic features was observed when individuals with classically defined genetic syndromes were evaluated for autism using standardized instruments. Our results suggest that current ascertainment practices are based on a single facet of autism-specific clinical features and do not consider associated comorbidities that may confound diagnosis. Longitudinal studies with detailed phenotyping and deep molecular genetic analyses are necessary to completely understand the cause of this complex disorder.
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Natalya Kogan et al.
Journal of Bone and Mineral Research, forthcoming
Abstract:
Cannabinoid ligands regulate bone mass, but skeletal effects of cannabis (marijuana and hashish) have not been reported. Bone fractures are highly prevalent, involving prolonged immobilization and discomfort. Here we report that the major non-psychoactive cannabis constituent, cannabidiol (CBD), enhances the biomechanical properties of healing rat mid-femoral fractures. The maximal load and work-to-failure, but not the stiffness, of femurs from rats given a mixture of CBD and Δ9-tetrahydrocannabinol (THC) for 8 weeks were markedly increased by CBD. This effect is not shared by THC (the psychoactive component of cannabis), but THC potentiates the CBD stimulated work-to-failure at 6 weeks postfracture followed by attenuation of the CBD effect at 8 weeks. Using micro–computed tomography (μCT), the fracture callus size was transiently reduced by either CBD or THC 4 weeks after fracture but reached control level after 6 and 8 weeks. The callus material density was unaffected by CBD and/or THC. By contrast, CBD stimulated mRNA expression of Plod1 in primary osteoblast cultures, encoding an enzyme that catalyzes lysine hydroxylation, which is in turn involved in collagen crosslinking and stabilization. Using Fourier transform infrared (FTIR) spectroscopy we confirmed the increase in collagen crosslink ratio by CBD, which is likely to contribute to the improved biomechanical properties of the fracture callus. Taken together, these data show that CBD leads to improvement in fracture healing and demonstrate the critical mechanical role of collagen crosslinking enzymes.
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Louis Garrison et al.
Value in Health, June 2015, Pages 541–546
Background: Patients with breast cancer whose tumors test positive for human epidermal growth factor receptor 2 (HER2) are treated with HER2-targeted therapies such as trastuzumab, but limitations with HER2 testing may lead to false-positive (FP) or false-negative (FN) results.
Objectives: To develop a US-level model to estimate the effect of tumor misclassification on health care costs and patient quality-adjusted life-years (QALYs).
Methods: Decision analysis was used to estimate the number of patients with early-stage breast cancer (EBC) whose HER2 status was misclassified in 2012. FP results were assumed to generate unnecessary trastuzumab costs and unnecessary cases of trastuzumab-related cardiotoxicity. FN results were assumed to save money on trastuzumab, but with a loss of QALYs and greater risk of disease recurrence and its associated costs. QALYs were valued at $100,000 under a net monetary benefit approach.
Results: Among 226,870 women diagnosed with EBC in 2012, 3.12% (n = 7,070) and 2.18% (n = 4,955) were estimated to have had FP and FN test results, respectively. Approximately 8400 QALYs (discounted, lifetime) were lost among women not receiving trastuzumab because of FN results. The estimated incremental per-patient lifetime burden of FP or FN results was $58,900 and $116,000, respectively. The implied incremental losses to society were $417 million and $575 million, respectively.
Conclusions: HER2 tests result in misclassification and nonoptimal treatment of approximately 12,025 US patients with EBC annually. The total economic societal loss of nearly $1 billion suggests that improvements in HER2 testing accuracy are needed and that further clinical and economic studies are warranted.