There's some risk
Uber and Metropolitan Traffic Fatalities in the United States
Noli Brazil & David Kirk
American Journal of Epidemiology, 1 August 2016, Pages 192-198
Abstract:
Uber and similar rideshare services are rapidly dispersing in cities across the United States and beyond. Given the convenience and low cost, Uber has been characterized as a potential countermeasure for reducing the estimated 121 million episodes of drunk driving and the 10,000 resulting traffic fatalities that occur annually in the United States. We exploited differences in the timing of the deployment of Uber in US metropolitan counties from 2005 to 2014 to test the association between the availability of Uber's rideshare services and total, drunk driving-related, and weekend- and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States using negative binomial and Poisson regression models. We found that the deployment of Uber services in a given metropolitan county had no association with the number of subsequent traffic fatalities, whether measured in aggregate or specific to drunk-driving fatalities or fatalities during weekends and holidays.
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Economic Conditions and Children's Mental Health
Ezra Golberstein, Gilbert Gonzales & Ellen Meara
NBER Working Paper, July 2016
Abstract:
Research linking economic conditions and health largely ignores children’s mental health problems, which are the most common and consequential health issues for children and adolescents. We examine the effects of unemployment rates and housing prices on child and adolescent mental health and use of special education services for emotional problems in the 2001-2013 National Health Interview Survey. Mental health status declines as economic conditions deteriorate, and this result is pervasive across nearly every subgroup we examine, including families least likely to experience job loss. The use of special education services for emotional problems also rises when economic conditions worsen.
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Changing Polygenic Penetrance on Phenotypes in the 20th Century Among Adults in the US Population
Dalton Conley et al.
Scientific Reports, July 2016
Abstract:
This study evaluates changes in genetic penetrance — defined as the association between an additive polygenic score and its associated phenotype — across birth cohorts. Situating our analysis within recent historical trends in the U.S., we show that, while height and BMI show increasing genotypic penetrance over the course of 20th Century, education and heart disease show declining genotypic effects. Meanwhile, we find genotypic penetrance to be historically stable with respect to depression. Our findings help inform our understanding of how the genetic and environmental landscape of American society has changed over the past century, and have implications for research which models gene-environment (GxE) interactions, as well as polygenic score calculations in consortia studies that include multiple birth cohorts.
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Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion
Charles Roehrig
Health Affairs, June 2016, Pages 1130-1135
Abstract:
Estimates of annual health spending for a comprehensive set of medical conditions are presented for the entire US population and with totals benchmarked to the National Health Expenditure Accounts. In 2013 mental disorders topped the list of most costly conditions, with spending at $201 billion.
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“Sorry, I’m Not Accepting New Patients”: An Audit Study of Access to Mental Health Care
Heather Kugelmass
Journal of Health and Social Behavior, June 2016, Pages 168-183
Abstract:
Through a phone-based field experiment, I investigated the effect of mental help seekers’ race, class, and gender on the accessibility of psychotherapists. Three hundred and twenty psychotherapists each received voicemail messages from one black middle-class and one white middle-class help seeker, or from one black working-class and one white working-class help seeker, requesting an appointment. The results revealed an otherwise invisible form of discrimination. Middle-class help seekers had appointment offer rates almost three times higher than their working-class counterparts. Race differences emerged only among middle-class help-seekers, with blacks considerably less likely than whites to be offered an appointment. Average appointment offer rates were equivalent across gender, but women were favored over men for appointment offers in their preferred time range.
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Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues
Marian MacDorman et al.
Obstetrics & Gynecology, forthcoming
Objective: To develop methods for trend analysis of vital statistics maternal mortality data, taking into account changes in pregnancy question formats over time and between states, and to provide an overview of U.S. maternal mortality trends from 2000 to 2014.
Methods: This observational study analyzed vital statistics maternal mortality data from all U.S. states in relation to the format and year of adoption of the pregnancy question. Correction factors were developed to adjust data from before the standard pregnancy question was adopted to promote accurate trend analysis. Joinpoint regression was used to analyze trends for groups of states with similar pregnancy questions.
Results: The estimated maternal mortality rate (per 100,000 live births) for 48 states and Washington, DC (excluding California and Texas, analyzed separately) increased by 26.6%, from 18.8 in 2000 to 23.8 in 2014. California showed a declining trend, whereas Texas had a sudden increase in 2011-2012. Analysis of the measurement change suggests that U.S. rates in the early 2000s were higher than previously reported.
Conclusions: Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality by 2015, the estimated maternal mortality rate for 48 states and Washington, DC, increased from 2000 to 2014; the international trend was in the opposite direction. There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year.
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Are handheld cell phone and texting bans really effective in reducing fatalities?
Leandro Rocco & Breno Sampaio
Empirical Economics, September 2016, Pages 853-876
Abstract:
This paper aims at evaluating if texting and handheld cell phone bans are effective in reducing the number of fatalities occurring in motor vehicle crashes using US county-level data. In the past two decades, many debates have been going on among policy makers regarding the impact of using mobile phone devices while driving. This political debate is partially motivated by the lack of clear empirical evidence on the relationship between cell phone use, bans and driving performance. Our results show that states that enacted primary cell phone bans experienced a significant reduction in the number of fatalities. Primary texting bans also affected fatalities, but this effect was significantly smaller than that estimated for handheld cell phone bans. This is an important and contradicting result, given most of the legislative activity in 2012 focused on text messaging behind the wheel, considered the most dangerous of the distracted driving activities. Additionally, we looked at how heterogeneous were these effects among states that enacted such bans. We observed that all states benefited from the ban in terms of fatality reduction; however, some were highly affected (such as CA and DC) and some affected in small scale (such as UT and WA).
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Tami Mark et al.
Health Affairs, June 2016, Pages 958-965
Abstract:
This study updates previous estimates of US spending on mental health and substance use disorders through 2014. The results reveal that the long-term trend of greater insurance financing of mental health care continued in recent years. The share of total mental health treatment expenditures financed by private insurance, Medicare, and Medicaid increased from 44 percent in 1986 to 68 percent in 2014. In contrast, the share of spending for substance use disorder treatment financed by private insurance, Medicare, and Medicaid was 45 percent in 1986 and 46 percent in 2014. From 2004 to 2013, a growing percentage of adults received mental health treatment (12.6 percent and 14.6 percent, respectively), albeit only because of the increased use of psychiatric medications. In the same period, only 1.2–1.3 percent of adults received substance use disorder treatment in inpatient, outpatient, or residential settings, although the use of medications to treat substance use disorders increased rapidly.
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Eat (and Drink) Better Tonight: Food Stamp Benefit Timing and Drunk Driving Fatalities
Chad Cotti, John Gordanier & Orgul Ozturk
American Journal of Health Economics, forthcoming
Abstract:
This paper examines the relationship between the timing of food stamp benefits and daily alcohol related fatal accidents. We exploit substantial exogenous variation in state food stamp distribution dates and enrollment numbers to estimate the relationship using binary outcome and count data frameworks. Our main result is that, in contrast to previous work on income receipt and mortality, alcohol related accidents with fatalities are substantially lower on the date of food stamp receipt and that the result is largely driven by a same-day effect. Further this effect is only present on weekdays. We find no effect of receipt on non-alcohol related accidents. We hypothesize that this is possibly driven by families being more likely to eat at home on distribution days.
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Cost and benefit estimates of partially-automated vehicle collision avoidance technologies
Corey Harper, Chris Hendrickson & Constantine Samaras
Accident Analysis & Prevention, October 2016, Pages 104–115
Abstract:
Many light-duty vehicle crashes occur due to human error and distracted driving. Partially-automated crash avoidance features offer the potential to reduce the frequency and severity of vehicle crashes that occur due to distracted driving and/or human error by assisting in maintaining control of the vehicle or issuing alerts if a potentially dangerous situation is detected. This paper evaluates the benefits and costs of fleet-wide deployment of blind spot monitoring, lane departure warning, and forward collision warning crash avoidance systems within the US light-duty vehicle fleet. The three crash avoidance technologies could collectively prevent or reduce the severity of as many as 1.3 million U.S. crashes a year including 133,000 injury crashes and 10,100 fatal crashes. For this paper we made two estimates of potential benefits in the United States: (1) the upper bound fleet-wide technology diffusion benefits by assuming all relevant crashes are avoided and (2) the lower bound fleet-wide benefits of the three technologies based on observed insurance data. The latter represents a lower bound as technology is improved over time and cost reduced with scale economies and technology improvement. All three technologies could collectively provide a lower bound annual benefit of about $18 billion if equipped on all light-duty vehicles. With 2015 pricing of safety options, the total annual costs to equip all light-duty vehicles with the three technologies would be about $13 billion, resulting in an annual net benefit of about $4 billion or a $20 per vehicle net benefit. By assuming all relevant crashes are avoided, the total upper bound annual net benefit from all three technologies combined is about $202 billion or an $861 per vehicle net benefit, at current technology costs. The technologies we are exploring in this paper represent an early form of vehicle automation and a positive net benefit suggests the fleet-wide adoption of these technologies would be beneficial from an economic and social perspective.
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Increasing incidence of metastatic prostate cancer in the United States (2004–2013)
Adam Weiner et al.
Prostate Cancer and Prostatic Diseases, forthcoming
Background: Changes in prostate cancer screening practices in the United States have led to recent declines in overall incidence, but it is unknown whether relaxed screening has led to changes in the incidence of advanced and metastatic prostate cancer at diagnosis.
Methods: We identified all men diagnosed with prostate cancer in the National Cancer Data Base (2004–2013) at 1089 different health-care facilities in the United States. Joinpoint regressions were used to model annual percentage changes (APCs) in the incidence of prostate cancer based on stage relative to that of 2004.
Results: The annual incidence of metastatic prostate cancer increased from 2007 to 2013 (Joinpoint regression: APC: 7.1%, P<0.05) and in 2013 was 72% more than that of 2004. The incidence of low-risk prostate cancer decreased from years 2007 to 2013 (APC: −9.3%, P<0.05) to 37% less than that of 2004. The greatest increase in metastatic prostate cancer was seen in men aged 55–69 years (92% increase from 2004 to 2013).
Conclusions: Beginning in 2007, the incidence of metastatic prostate cancer has increased especially among men in the age group thought most likely to benefit from definitive treatment for prostate cancer. These data highlight the continued need for nationwide refinements in prostate cancer screening and treatment.
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Adam Hayward, Francesca Rigby & Virpi Lummaa
Proceedings of the National Academy of Sciences, 9 August 2016, Pages 8951–8956
Abstract:
A leading hypothesis proposes that increased human life span since 1850 has resulted from decreased exposure to childhood infections, which has reduced chronic inflammation and later-life mortality rates, particularly from cardiovascular disease, stroke, and cancer. Early-life cohort mortality rate often predicts later-life survival in humans, but such associations could arise from factors other than disease exposure. Additionally, the impact of early-life disease exposure on reproduction remains unknown, and thus previous work ignores a major component of fitness through which selection acts upon life-history strategy. We collected data from seven 18th- and 19th-century Finnish populations experiencing naturally varying mortality and fertility levels. We quantified early-life disease exposure as the detrended child mortality rate from infectious diseases during an individual’s first 5 y, controlling for important social factors. We found no support for an association between early-life disease exposure and all-cause mortality risk after age 15 or 50. We also found no link between early-life disease exposure and probability of death specifically from cardiovascular disease, stroke, or cancer. Independent of survival, there was no evidence to support associations between early-life disease exposure and any of several aspects of reproductive performance, including lifetime reproductive success and age at first birth, in either males or females. Our results do not support the prevailing assertion that exposure to infectious diseases in early life has long-lasting associations with later-life all-cause mortality risk or mortality putatively linked to chronic inflammation. Variation in adulthood conditions could therefore be the most likely source of recent increases in adult life span.
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Returns on Investment in California County Departments of Public Health
Timothy Brown
American Journal of Public Health, August 2016, Pages 1477-1482
Objectives: To estimate the average return on investment for the overall activities of county departments of public health in California.
Methods: I gathered the elements necessary to estimate the average return on investment for county departments of public health in California during the period 2001 to 2008–2009. These came from peer-reviewed journal articles published as part of a larger project to develop a method for determining return on investment for public health by using a health economics framework. I combined these elements by using the standard formula for computing return on investment, and performed a sensitivity analysis. Then I compared the return on investment for county departments of public health with the returns on investment generated for various aspects of medical care.
Results: The estimated return on investment from $1 invested in county departments of public health in California ranges from $67.07 to $88.21.
Conclusions: The very large estimated return on investment for California county departments of public health relative to the return on investment for selected aspects of medical care suggests that public health is a wise investment.
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Equity and length of lifespan are not the same
Benjamin Seligman, Gabi Greenberg & Shripad Tuljapurkar
Proceedings of the National Academy of Sciences, 26 July 2016, Pages 8420–8423
Abstract:
Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.
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Elliot Coups, Jerod Stapleton & Cristine Delnevo
Journal of the American Academy of Dermatology, August 2016, Pages 440–442
"We examined indoor tanning rates among New Jersey youth before and after a ban on indoor tanning for those younger than 17 years was enacted on October 1, 2013... Among girls, boys, and for both sexes combined, indoor tanning rates in 2014 did not differ significantly from those in 2012 for those younger than 17 years (to whom the ban applied) or for students aged 17 years and older. Among students of all ages, the indoor tanning rate did not differ significantly from 2012 to 2014 for female students but among male students the rate increased from 2012 to 2014."
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A ubiquitous but ineffective intervention: Signs do not increase hand hygiene compliance
David Birnbach et al.
Journal of Infection and Public Health, forthcoming
Abstract:
Proper hand hygiene is critical for preventing healthcare-associated infection, but provider compliance remains suboptimal. While signs are commonly used to remind physicians and nurses to perform hand hygiene, the content of these signs is rarely based on specific, validated health behavior theories. This observational study assessed the efficacy of a hand hygiene sign disseminated by the Centers for Disease Control and Prevention in an intensive care unit compared to an optimized evidence-based sign designed by a team of patient safety experts. The optimized sign was developed by four patient safety experts to include known evidence-based components and was subsequently validated by surveying ten physicians and ten nurses using a 10 point Likert scale. Eighty-two physicians and 98 nurses (102 females; 78 males) were observed for hand hygiene (HH) compliance, and the total HH compliance rate was 16%. HH compliance was not significantly different among the signs (Baseline 10% vs. CDC 18% vs. OIS 20%; p = 0.280). The findings of this study suggest that even when the content and design of a hand hygiene reminder sign incorporates evidence-based constructs, healthcare providers comply only a fraction of the time.