Health Booms and Busts
The Broad Decline in Health and Human Capital of Americans Born after 1947
Nicholas Reynolds
American Economic Review: Insights, forthcoming
Abstract:
I present evidence of a cross-cohort decline in the health and human capital of Americans, beginning with those born after 1947 and continuing until those born in the mid-1960s. Education, men’s wages, women’s maternal health (proxied by their infants’ birthweight), and mortality all exhibit trend breaks near the 1947 cohort, such that each outcome worsens for subsequent cohorts relative to prior trend. The decline is large enough to drive: i) educational declines in the 1960s, ii) increases in low birthweight in the 1980s, iii) mortality increases since 1999, and to contribute substantially to iv) wage stagnation since the 1970s.
Health Inequality and Health Types
Margherita Borella et al.
NBER Working Paper, August 2024
Abstract:
While health affects many economic outcomes, its dynamics are still poorly understood. We use k means clustering, a machine learning technique, and data from the Health and Retirement Study to identify health types during middle and old age. We identify five health types: the vigorous resilient, the fair-health resilient, the fair-health vulnerable, the frail resilient, and the frail vulnerable. They are characterized by different starting health and health and mortality trajectories. Our five health types account for 84% of the variation in health trajectories and are not explained by observable characteristics, such as age, marital status, education, gender, race, health-related behaviors, and health insurance status, but rather, by one’s past health dynamics. We also show that health types are important drivers of health and mortality heterogeneity and dynamics. Our results underscore the importance of better understanding health type formation and of modeling it appropriately to properly evaluate the effects of health on people’s decisions and the implications of policy reforms.
The Effect of Semaglutide on Mortality and COVID-19–Related Deaths: An Analysis From the SELECT Trial
Benjamin Scirica et al.
Journal of the American College of Cardiology, forthcoming
Methods: The SELECT (Semaglutide Effects on Cardiovascular Outcomes in Patients With Overweight or Obesity) trial randomized 17,604 participants ≥45 years of age with a body mass index ≥27 kg/m2 with established CV [cardiovascular] disease but without diabetes to once-weekly subcutaneous semaglutide 2.4 mg or placebo; the mean trial duration was 3.3 years. Adjudicated causes of all deaths, COVID-19 cases, and associated deaths were captured prospectively.
Results: Of 833 deaths, 485 (58%) were CV deaths, and 348 (42%) were non-CV deaths. Participants assigned to semaglutide vs placebo had lower rates of all-cause death (HR: 0.81; 95% CI: 0.71-0.93), CV death (HR: 0.85; 95% CI: 0.71-1.01), and non-CV death (HR: 0.77; 95% CI: 0.62-0.95). The most common causes of CV death with semaglutide vs placebo were sudden cardiac death (98 vs 109; HR: 0.89; 95% CI: 0.68-1.17) and undetermined death (77 vs 90; HR: 0.85; 95% CI: 0.63-1.15). Infection was the most common cause of non-CV death and occurred at a lower rate in the semaglutide vs the placebo group (62 vs 87; HR: 0.71; 95% CI: 0.51-0.98). Semaglutide did not reduce incident COVID-19; however, among participants who developed COVID-19, fewer participants treated with semaglutide had COVID-19–related serious adverse events (232 vs 277; P = 0.04) or died of COVID-19 (43 vs 65; HR: 0.66; 95% CI: 0.44-0.96). High rates of infectious deaths occurred during the COVID-19 pandemic, with less infectious death in the semaglutide arm, and resulted in fewer participants in the placebo group being at risk for CV death.
Evidence of association between higher cardiorespiratory fitness and higher cerebral myelination in aging
Mary Faulkner et al.
Proceedings of the National Academy of Sciences, 27 August 2024
Abstract:
Emerging evidence suggests that altered myelination is an important pathophysiologic correlate of several neurodegenerative diseases, including Alzheimer and Parkinson’s diseases. Thus, improving myelin integrity may be an effective intervention to prevent and treat age-associated neurodegenerative pathologies. It has been suggested that cardiorespiratory fitness (CRF) may preserve and enhance cerebral myelination throughout the adult lifespan, but this hypothesis has not been fully tested. Among cognitively normal participants from two well-characterized studies spanning a wide age range, we assessed CRF operationalized as the maximum rate of oxygen consumption (VO2max) and myelin content defined by myelin water fraction (MWF) estimated through our advanced multicomponent relaxometry MRI method. We found significant positive correlations between VO2max and MWF across several white matter regions. Interestingly, the effect size of this association was higher in brain regions susceptible to early degeneration, including the frontal lobes and major white matter fiber tracts. Further, the interaction between age and VO2max exhibited i) a steeper positive slope in the older age group, suggesting that the association of VO2max with MWF is stronger at middle and older ages and ii) a steeper negative slope in the lower VO2max group, indicating that lower VO2max levels are associated with lower myelination with increasing age. Finally, the nonlinear pattern of myelin maturation and decline is VO2max-dependent with the higher VO2max group reaching the MWF peak at later ages. This study provides evidence of an interconnection between CRF and cerebral myelination and suggests therapeutic strategies for promoting brain health and attenuating white matter degeneration.
The effect of vertical identification card laws on teenage tobacco and alcohol use
Erica Louis Mtenga & Michael Pesko
Health Economics, forthcoming
Abstract:
We study the impact of vertical identification card laws, which changed the orientation of driver's licenses and state identification cards from horizontal to vertical for those under 21 years, on teenage tobacco and alcohol use. We study this question using four national datasets (pooled national and state Youth Risk Behavior Surveillance System, National Youth Tobacco Survey, Current Population Survey to Tobacco Use Supplements, and Behavioral Risk Factor Surveillance System). We improve previous databases of vertical ID law implementation by using original archival research to identify the exact date of the law change. We estimate models using standard two-way fixed effects and stacked difference-in-differences that avoid bias from dynamic and heterogeneous treatment effects. Using data through 2021, we do not find evidence of reductions in teenage tobacco and alcohol use. While these laws reduce retail-based purchasing, they also increase social sourcing, thus leading to no net impact on use.
Elite Cues and Noncompliance
Zachary Dickson & Sara Hobolt
American Political Science Review, forthcoming
Abstract:
Political leaders increasingly use social media to speak directly to voters, but the extent to which elite cues shape offline political behavior remains unclear. In this article, we study the effects of elite cues on noncompliant behavior, focusing on a series of controversial tweets sent by US President Donald Trump calling for the “liberation” of Minnesota, Virginia, and Michigan from state and local government COVID-19 restrictions. Leveraging the fact that Trump’s messages exclusively referred to three specific US states, we adopt a generalized difference-in-differences design relying on spatial variation to identify the causal effects of the targeted cues. Our analysis shows that the President’s messages led to an increase in movement, a decrease in adherence to stay-at-home restrictions, and an increase in arrests of white Americans for crimes related to civil disobedience and rebellion. These findings demonstrate the consequences of elite cues in polarized environments.
Prices and Policies in Opioid Markets
Casey Mulligan
Journal of Political Economy, forthcoming
Abstract:
Opioid mortality increases have been linked to both lax and restrictive opioid prescription regulations. Modeling choice between prescription and illicitly manufactured opioid sources helps reconcile the apparently contradictory empirical findings. It also identifies groups responding opposite of the average and applies previous studies to new supply conditions. Organized around the two supply channels, a policy database is assembled that reveals distinct pricing phases during 1999–2021. Consistent with the model, during the later phases the relationship between the opioid fatality rate (measured from death certificates) and its composition changes sign, minors’ fatality rates trend opposite of adults’, and the black-white gap changes sign.
Opioids Prescribing Restrictions and Homelessness: Evidence from Hydrocodone Rescheduling
Johabed Olvera et al.
Journal of Housing Economics, December 2024
Abstract:
This paper examines the effect of restricting opioid prescription on homelessness. We assess this relationship by exploiting plausible exogenous variation in prescribed opioid supply derived from an opioid restriction policy: the hydrocodone (i.e., Vicodin, not oxycodone products like Oxycontin) rescheduling. We identified the causal effect of this decrease in the supply of hydrocodone, the most prescribed opioid in the U.S. and comprising 55% of overall use opioid prescription dispensing, by comparing the number of homeless individuals in geographies with higher exposure to Hydrocodone against those in areas with lower exposure, before and after the enactment of the policy. We find that in the quarter following hydrocodone upscheduling, the rate of people experiencing homelessness decreased by almost 56 per 100,000 inhabitants (a 25.4% reduction relative to the pre-policy mean). In addition, results show that hydrocodone prescriptions, drug related deaths, unemployment, and divorce rates decrease following the upscheduling. Taken together, our results suggest that during our study period (2007-2017) the hydrocodone rescheduling reduced homelessness by preventing some household crises.
Consumption Responses to an Unpopular Policy: Evidence from a Short-Lived Soda Tax
Andrew Ching & Daniel Goetz
Marketing Science, forthcoming
Abstract:
Public policies that restrict or intervene in consumer choices are often controversial. We investigate whether consumers’ disagreement with a policy affects how they respond to that policy using a natural experiment in Washington state, where a consumption tax on soda was repealed by popular ballot. We use data on precinct-level voting and shoppers’ home locations to create a novel measure of grocery store–level tax opposition. We then combine this measure with price and quantity data from grocery stores statewide. Leveraging a difference-in-differences research design in which we instrument for tax opposition, we show that, in response to the short-lived Washington state soda tax, stores frequented by tax opponents experience a 53% greater reduction in quantity sold of taxed beverages compared with stores frequented by tax supporters even though the tax pass-through is generally uniform across all stores. Our mechanism analysis is consistent with an oppositional behavioral response, in which upset consumers decrease consumption more strongly to avoid the tax burden. If this behavioral response is not taken into account, the optimal tax rate may be set too high, resulting in lower tax revenue.
Unhealthy food, regulations, and consumer welfare: The US microwaveable popcorn market
Christoph Bauner et al.
Economic Inquiry, forthcoming
Abstract:
Due to significant health concerns, governments across the world have taken measures to regulate dietary trans fat, for example, through bans and ad-valorem taxes. We assess the effectiveness of these two strategies and measure their ensuing welfare implications. We estimate a structural demand and supply model for the microwavable popcorn market using NielsenIQ Homescan data. Applying the recovered consumer preferences and marginal costs, we find a ban and a 35% tax result in similar levels of welfare loss and trans fat reduction. A 10% tax can still significantly reduce trans fat consumption (around 48%), while the associated consumer welfare loss is substantially smaller.
Maternal Obesity and Risk of Sudden Unexpected Infant Death
Darren Tanner et al.
JAMA Pediatrics, September 2024, Pages 906-913
Importance: Rates of maternal obesity are increasing in the US. Although obesity is a well-documented risk factor for numerous poor pregnancy outcomes, it is not currently a recognized risk factor for sudden unexpected infant death (SUID).
Design, Setting, and Participants: This was a US nationwide cohort study using Centers for Disease Control and Prevention National Center for Health Statistics linked birth–infant death records for birth cohorts in 2015 through 2019. All US live births for the study years occurring at 28 weeks’ gestation or later from complete reporting areas were eligible; SUID cases were deaths occurring at 7 to 364 days after birth with International Statistical Classification of Diseases, Tenth Revision cause of death code R95 (sudden infant death syndrome), R99 (ill-defined and unknown causes), or W75 (accidental suffocation and strangulation in bed). Data were analyzed from October 1 through November 15, 2023.
Exposure: Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared).
Results: Of 18 857 694 live births eligible for analysis (median [IQR] age: maternal, 29 [9] years; paternal, 31 [9] years; gestational, 39 [2] weeks), 16 545 died of SUID (SUID rate, 0.88/1000 live births). After confounder adjustment, compared with mothers with normal BMI (BMI 18.5-24.9), infants born to mothers with obesity had a higher SUID risk that increased with increasing obesity severity. Infants of mothers with class I obesity (BMI 30.0-34.9) were at increased SUID risk (adjusted odds ratio [aOR], 1.10; 95% CI, 1.05-1.16); with class II obesity (BMI 35.0-39.9), a higher risk (aOR, 1.20; 95% CI, 1.13-1.27); and class III obesity (BMI ≥40.0), an even higher risk (aOR, 1.39; 95% CI, 1.31-1.47). A generalized additive model showed that increased BMI was monotonically associated with increased SUID risk, with an acceleration of risk for BMIs greater than approximately 25 to 30. Approximately 5.4% of SUID cases were attributable to maternal obesity.
Financial Incentives and Treatment Outcomes in Adolescents With Severe Obesity: A Randomized Clinical Trial
Amy Gross et al.
JAMA Pediatrics, August 2024, Pages 753-762
Importance: Adolescent severe obesity is usually not effectively treated with traditional lifestyle modification therapy. Meal replacement therapy (MRT) shows short-term efficacy for body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) reduction in adolescents, and financial incentives (FIs) may be an appropriate adjunct intervention to enhance long-term efficacy.
Design, Setting, and Participants: This was a randomized clinical trial of MRT plus FIs vs MRT alone at a large academic health center in the Midwest conducted from 2018 to 2022. Participants were adolescents (ages 13-17 y) with severe obesity (≥120% of the 95th BMI percentile based on sex and age or ≥35 BMI, whichever was lower) who were unaware of the FI component of the trial until they were randomized to MRT plus FIs or until the end of the trial. Study staff members collecting clinical measures were blinded to treatment condition. Data were analyzed from March 2022 to February 2024.
Interventions: MRT included provision of preportioned, calorie-controlled meals (~1200 kcals/d). In the MRT plus FI group, incentives were provided based on reduction in body weight from baseline.
Results: Among 126 adolescents with severe obesity (73 female [57.9%]; mean [SD] age, 15.3 [1.2] years), 63 participants received MRT plus FIs and 63 participants received only MRT. At 52 weeks, the mean BMI reduction was greater by −5.9 percentage points (95% CI, −9.9 to −1.9 percentage points; P = .004) in the MRT plus FI compared with the MRT group. The MRT plus FI group had a greater reduction in mean total body fat mass by −4.8 kg (95% CI, −9.1 to −0.6 kg; P = .03) and was cost-effective (incremental cost-effectiveness ratio, $39 178 per quality-adjusted life year) compared with MRT alone. There were no significant differences in cardiometabolic risk factors or unhealthy weight-control behaviors between groups.