Sick days
The Relationship Between Workplace Stressors and Mortality and Health Costs in the United States
Joel Goh, Jeffrey Pfeffer & Stefanos Zenios
Management Science, forthcoming
Abstract:
Even though epidemiological evidence links specific workplace stressors to health outcomes, the aggregate contribution of these factors to overall mortality and health spending in the United States is not known. In this paper, we build a model to estimate the excess mortality and incremental health expenditures associated with exposure to the following 10 workplace stressors: unemployment, lack of health insurance, exposure to shift work, long working hours, job insecurity, work–family conflict, low job control, high job demands, low social support at work, and low organizational justice. Our model uses input parameters obtained from publicly accessible data sources. We estimated health spending from the Medical Expenditure Panel Survey and joint probabilities of workplace exposures from the General Social Survey, and we conducted a meta-analysis of the epidemiological literature to estimate the relative risks of poor health outcomes associated with exposure to these stressors. The model was designed to overcome limitations with using inputs from multiple data sources. Specifically, the model separately derives optimistic and conservative estimates of the effect of multiple workplace exposures on health, and uses optimization to calculate upper and lower bounds around each estimate, which accounts for the correlation between exposures. We find that more than 120,000 deaths per year and approximately 5%–8% of annual healthcare costs are associated with and may be attributable to how U.S. companies manage their work forces. Our results suggest that more attention should be paid to management practices as important contributors to health outcomes and costs in the United States.
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The Content and Effect of Politicized Health Controversies
Erika Franklin Fowler & Sarah Gollust
ANNALS of the American Academy of Political and Social Science, March 2015, Pages 155-171
Abstract:
Health issues are increasingly becoming politicized, but little is known about how politicization takes shape in the news and its effect on the public. We analyze the evolution of politicization in news coverage of two health controversies: the uproar over the 2009 mammography screening guidelines and the 2006–2007 debate over mandating the HPV vaccine as a requirement for middle school–aged girls. We then examine the public response to politicization in the HPV case, using original data from a survey-embedded experiment that was linked with news coverage in all fifty states. We find that real-world politicization is associated with decreases in support for HPV vaccine requirements, state immunization programs, and confidence in doctors and in government. In addition, among those less likely to have encountered real-world politicization, we find marginal evidence that exposure to political conflict decreases support for state immunization programs and clear evidence that politicization reduces confidence in doctors. We discuss the implications of these findings and suggest future avenues of research.
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Success is Something to Sneeze at: Influenza Mortality in Regions that Send Teams to the Super Bowl
Charles Stoecker, Nicholas Sanders & Alan Barreca
Tulane University Working Paper, January 2015
Abstract:
Using county-level Vital Statistics of the United States data from 1974-2009, we employ a differences-in-differences framework comparing influenza mortality rates in Super Bowl-participating counties to non-participants. Having a local team in the Super Bowl causes an 18% increase in influenza deaths for the population over age 65, with evidence suggesting one mechanism is increased local socialization. Effects are most pronounced in years when the dominant influenza strain is more virulent, or when the Super Bowl occurs closer to the peak of influenza season. Mitigating influenza transmission at gatherings related to large spectator events could have substantial returns for public health.
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Disentangling Race and Social Context in Understanding Disparities in Chronic Conditions among Men
Roland Thorpe et al.
Journal of Urban Health, February 2015, Pages 83-92
Abstract:
Disparities in men’s health research may inaccurately attribute differences in chronic conditions to race rather than the different health risk exposures in which men live. This study sought to determine whether living in the same social environment attenuates race disparities in chronic conditions among men. This study compared survey data collected in 2003 from black and white men with similar incomes living in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. Multivariable logistic regression models estimated to determine whether race disparities in chronic conditions were attenuated among men living in the same social environment. In the national sample, black men exhibited greater odds of having hypertension (odds ratio [OR] = 1.58, 95 % confidence interval [CI] 1.34, 1.86) and diabetes (OR = 1.62, 95 % CI 1.27–2.08) than white men. In the sample of men living in the same social context, black and white respondents had similar odds of having hypertension (OR = 1.05, 95 % CI 0.70, 1.59) and diabetes (OR = 1.12, 95 % CI 0.57–2.22). There are no race disparities in chronic conditions among low-income, urban men living in the same social environment. Policies and interventions aiming to reduce disparities in chronic conditions should focus on modifying social aspects of the environment.
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Lauren Jones & Nicolas Ziebarth
Journal of Applied Econometrics, forthcoming
Abstract:
Using US fatality data from 1975 to 2003, Levitt (Evidence that seat belts are as effective as child safety seats in preventing death for children aged two and up, Review of Economics and Statistics 2008; 90(1): 158–163) shows that child safety seats do not significantly reduce fatalities for children aged 2–6 years as compared to standard seat belts. Although we were unable to gain access to the original programs and dataset used, we were able to replicate Levitt's (2008) findings almost exactly. We extend Levitt (2008) by showing that the findings also hold for the years 2004–2011 despite changing driver characteristics and restraint use patterns. We fail to find evidence that SUVs provide additional safety for children.
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Education and Health: The Role of Cognitive Ability
Govert Bijwaard, Hans van Kippersluis & Justus Veenman
Journal of Health Economics, forthcoming
Abstract:
We aim to disentangle the relative impact of (i) cognitive ability, and (ii) education on health and mortality using a structural equation model suggested by Conti et al. (2010). We extend their model by allowing for a duration dependent variable (mortality), and an ordinal educational variable. Data come from a Dutch cohort born between 1937 and 1941, including detailed measures of cognitive ability and family background in the final grade of primary school. The data are linked to the mortality register 1995-2011, such that we observe mortality between ages 55 and 75. The results suggest that at least half of the unconditional survival differences between educational groups are due to a ‘selection effect’, primarily on the basis of cognitive ability. Conditional survival differences across those having finished just primary school and those entering secondary education are still substantial, and amount to a 4 years gain in life expectancy, on average.
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Neighborhood Blight, Stress, and Health: A Walking Trial of Urban Greening and Ambulatory Heart Rate
Eugenia South et al.
American Journal of Public Health, forthcoming
Abstract:
We measured dynamic stress responses using ambulatory heart rate monitoring as participants in Philadelphia, Pennsylvania walked past vacant lots before and after a greening remediation treatment of randomly selected lots. Being in view of a greened vacant lot decreased heart rate significantly more than did being in view of a nongreened vacant lot or not in view of any vacant lot. Remediating neighborhood blight may reduce stress and improve health.
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Arjumand Siddiqi, Marcella Jones & Paul Campbell Erwin
Social Science & Medicine, April 2015, Pages 82–88
Abstract:
As the struggle continues to explain the relatively high rates of infant mortality (IMR) exhibited in the United States, a renewed emphasis is being placed on the role of possible 'contextual' determinants. Cross-sectional and short time-series studies have found that higher income inequality is associated with higher IMR at the state level. Yet, descriptively, the longer-term trends in income inequality and in IMR seem to call such results into question. To assess whether, over the period 1990–2007, state-level income inequality is associated with state-level IMR; to examine whether the overall effect of income inequality on IMR over this period varies by state; to test whether the association between income inequality and IMR varies across this time period. IMR data - number of deaths per 1000 live births in a given state and year - were obtained from the U.S. Centers for Disease Control Wonder database. Income inequality was measured using the Gini coefficient, which varies from zero (complete equality) to 100 (complete inequality). Covariates included state-level poverty rate, median income, and proportion of high school graduates. Fixed and random effects regressions were conducted to test hypotheses. Fixed effects models suggested that, overall, during the period 1990–2007, income inequality was inversely associated with IMR (β = −0.07, SE (0.01)). Random effects models suggested that when the relationship was allowed to vary at the state-level, it remained inverse (β = −0.05, SE (0.01)). However, an interaction between income inequality and time suggested that, as time increased, the effect of income inequality had an increasingly positive association with total IMR (β = 0.009, SE (0.002)). The influence of state income inequality on IMR is dependent on time, which may proxy for time-dependent aspects of societal context.
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The impact of low birth weight and maternal age on adulthood offending
Jamie Vaske et al.
Journal of Criminal Justice, January–February 2015, Pages 49–56
Purpose: The current study examines the relationship between low birth weight and adult offending, and whether maternal age at childbirth moderates this relationship.
Methods: Using longitudinal data from mothers and offspring from the Providence sample of the Collaborative Perinatal Project, multivariate logistic regression models were used to study the relationship between low birth weight and adulthood arrest by maternal age.
Results: Offspring born at low birth weight were at an increased risk of adult arrest, but only if they were born to adolescent (and not adult) mothers. These results remained while controlling for preterm delivery, number of cigarettes smoked during pregnancy, mothers’ marital status, socioeconomic status, African American race, gender, and court contact during adolescence.
Conclusions: Results highlight the importance of considering the moderating role of maternal age at childbirth, and underscore the notion that the adverse effect of a child born at low birth weight — with respect to crime — can be exacerbated if the child is born to a young mother but lessened or even ameliorated if born to an older mother. Theoretical and practical implications of these findings are discussed.
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Mark Gius
Social Science Journal, forthcoming
Abstract:
The aim of the present study is to quantify the association between child access prevention (CAP) and minimum age laws and state-level youth firearm-related suicide and unintentional death rates. This paper differs from prior research in several ways. First, this is one of the few studies to focus exclusively on youth death rates. Second, this study looks at those laws with the most impact on youth suicides and unintentional deaths. Finally, this study uses one of the largest and most recent data sets of any study on this topic. In order to estimate the determinants of youth firearm deaths, a fixed effects regression model, controlling for both state-level and year-specific effects, is used. Results indicate that state-level minimum age laws have no significant effects on either youth suicides or unintentional deaths and that state-level CAP laws have no significant effects on unintentional deaths. States with CAP laws, however, have lower rates of youth suicide, and, after the enactment of the Federal minimum age requirement, both youth suicide and unintentional death rates fell. Given the mixed results regarding state-level juvenile firearm laws, national restrictions on juvenile handgun possession may be more effective in reducing both youth suicides and unintentional deaths than state-level regulations.
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Web search activity data accurately predict population chronic disease risk in the USA
Thin Nguyen et al.
Journal of Epidemiology & Community Health, forthcoming
Background: The WHO framework for non-communicable disease (NCD) describes risks and outcomes comprising the majority of the global burden of disease. These factors are complex and interact at biological, behavioural, environmental and policy levels presenting challenges for population monitoring and intervention evaluation. This paper explores the utility of machine learning methods applied to population-level web search activity behaviour as a proxy for chronic disease risk factors.
Methods: Web activity output for each element of the WHO's Causes of NCD framework was used as a basis for identifying relevant web search activity from 2004 to 2013 for the USA. Multiple linear regression models with regularisation were used to generate predictive algorithms, mapping web search activity to Centers for Disease Control and Prevention (CDC) measured risk factor/disease prevalence. Predictions for subsequent target years not included in the model derivation were tested against CDC data from population surveys using Pearson correlation and Spearman's r.
Results: For 2011 and 2012, predicted prevalence was very strongly correlated with measured risk data ranging from fruits and vegetables consumed (r=0.81; 95% CI 0.68 to 0.89) to alcohol consumption (r=0.96; 95% CI 0.93 to 0.98). Mean difference between predicted and measured differences by State ranged from 0.03 to 2.16. Spearman's r for state-wise predicted versus measured prevalence varied from 0.82 to 0.93.
Conclusions: The high predictive validity of web search activity for NCD risk has potential to provide real-time information on population risk during policy implementation and other population-level NCD prevention efforts.
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Jesse Catlin, Cornelia (Connie) Pechmann & Eric Brass
Journal of Public Policy & Marketing, forthcoming
Abstract:
In a series of studies, consumers reviewed over-the-counter (OTC) drug packages and evaluated these OTC drugs for concurrent use to investigate whether they utilized the active ingredients and recognized the risks of double dosing when using two drugs contained the same active ingredient. Both novice and expert consumers used active ingredients to assess drug similarity, indicating the information was accessible. However, only medically trained experts used this information to assess the risks of taking two drugs concurrently, indicating they understood its diagnosticity or relevancy. Novices' failure to view double dosing as risky suggested they might hold a naive belief that OTC drugs are relatively risk-free, and so interventions to increase active ingredient diagnosticity versus accessibility were tested. One intervention considered by OTC drug manufacturers makes active ingredients more accessible on packages using icons. However, this approach alone was not found to be effective, while interventions enhancing the diagnosticity of ingredients through public service messages or package warnings yielded promising results. Thus, interventions may benefit from going beyond accessibility to also highlight active ingredient diagnosticity.
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Allergy in Children in Hand Versus Machine Dishwashing
Bill Hesselmar, Anna Hicke-Roberts & Göran Wennergren
Pediatrics, March 2015, Pages e590-e597
Backrgound and objective: The hygiene hypothesis stipulates that microbial exposure during early life induces immunologic tolerance via immune stimulation, and hence reduces the risk of allergy development. Several common lifestyle factors and household practices, such as dishwashing methods, may increase microbial exposure. The aim of this study was to investigate if such lifestyle factors are associated with allergy prevalence.
Methods: Questionnaire-based study of 1029 children aged 7 to 8 years from Kiruna, in the north of Sweden, and Mölndal, in the Gothenburg area on the southwest coast of Sweden. Questions on asthma, eczema, and rhinoconjunctivitis were taken from the International Study of Asthma and Allergies in Childhood questionnaire.
Results: Hand dishwashing was associated with a reduced risk of allergic disease development (multivariate analysis, odds ratio 0.57; 95% confidence interval: 0.37–0.85). The risk was further reduced in a dose-response pattern if the children were also served fermented food and if the family bought food directly from farms.
Conclusions: In families who use hand dishwashing, allergic diseases in children are less common than in children from families who use machine dishwashing. We speculate that a less-efficient dishwashing method may induce tolerance via increased microbial exposure.
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Susan Brown, Susan Shirachi & Danielle Zandbergen
Quarterly Review of Biology, March 2015, Pages 3-21
Abstract:
Paradoxically, men report better health and quality of life than women, but men experience higher mortality rates than women at most ages. One conclusion from these findings is that men have been selected to disregard signs of ill health, or even to deceive themselves about their health, to their detriment because presenting themselves as healthy has fitness benefits. We hypothesize that men have been sexually selected to present themselves to women as healthy but that the cost of not attending to their minor health problems results in earlier mortality than women. We present a review of the human and primate literature that supports health selection theory, the hypothesis that females have preferentially selected males who present themselves as healthy.
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Accelerometer-Monitored Sedentary Behavior and Observed Physical Function Loss
Pamela Semanik et al.
American Journal of Public Health, March 2015, Pages 560-566
Objectives: We examined whether objectively measured sedentary behavior is related to subsequent functional loss among community-dwelling adults with or at high risk for knee osteoarthritis.
Methods: We analyzed longitudinal data (2008–2012) from 1659 Osteoarthritis Initiative participants aged 49 to 83 years in 4 cities. Baseline sedentary time was assessed by accelerometer monitoring. Functional loss (gait speed and chair stand testing) was regressed on baseline sedentary time and covariates (baseline function; socioeconomics [age, gender, race/ethnicity, income, education], health factors [obesity, depression, comorbidities, knee symptoms, knee osteoarthritis severity, prior knee injury, other lower extremity pain, smoking], and moderate-to-vigorous activity).
Results: This cohort spent almost two thirds of their waking hours (average = 9.8 h) in sedentary behaviors. Sedentary time was significantly positively associated with subsequent functional loss in both gait speed (−1.66 ft/min decrease per 10% increment sedentary percentage waking hours) and chair stand rate (−0.75 repetitions/min decrease), controlling for covariates.
Conclusions: Being less sedentary was related to less future decline in function, independent of time spent in moderate-to-vigorous activity. Both limiting sedentary activities and promoting physical activity in adults with knee osteoarthritis may be important in maintaining function.
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Peter Collignon et al.
PLoS ONE, March 2015
Objectives: To determine how important governmental, social, and economic factors are in driving antibiotic resistance compared to the factors usually considered the main driving factors—antibiotic usage and levels of economic development.
Design: A retrospective multivariate analysis of the variation of antibiotic resistance in Europe in terms of human antibiotic usage, private health care expenditure, tertiary education, the level of economic advancement (per capita GDP), and quality of governance (corruption). The model was estimated using a panel data set involving 7 common human bloodstream isolates and covering 28 European countries for the period 1998–2010.
Results: Only 28% of the total variation in antibiotic resistance among countries is attributable to variation in antibiotic usage. If time effects are included the explanatory power increases to 33%. However when the control of corruption indicator is included as an additional variable, 63% of the total variation in antibiotic resistance is now explained by the regression. The complete multivariate regression only accomplishes an additional 7% in terms of goodness of fit, indicating that corruption is the main socioeconomic factor that explains antibiotic resistance. The income level of a country appeared to have no effect on resistance rates in the multivariate analysis. The estimated impact of corruption was statistically significant (p< 0.01). The coefficient indicates that an improvement of one unit in the corruption indicator is associated with a reduction in antibiotic resistance by approximately 0.7 units. The estimated coefficient of private health expenditure showed that one unit reduction is associated with a 0.2 unit decrease in antibiotic resistance.
Conclusions: These findings support the hypothesis that poor governance and corruption contributes to levels of antibiotic resistance and correlate better than antibiotic usage volumes with resistance rates. We conclude that addressing corruption and improving governance will lead to a reduction in antibiotic resistance.
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Geospatial Resolution of Human and Bacterial Diversity with City-Scale Metagenomics
Ebrahim Afshinnekoo et al.
Cell Systems, forthcoming
Abstract:
The panoply of microorganisms and other species present in our environment influence human health and disease, especially in cities, but have not been profiled with metagenomics at a city-wide scale. We sequenced DNA from surfaces across the entire New York City (NYC) subway system, the Gowanus Canal, and public parks. Nearly half of the DNA (48%) does not match any known organism; identified organisms spanned 1,688 bacterial, viral, archaeal, and eukaryotic taxa, which were enriched for harmless genera associated with skin (e.g.,Acinetobacter). Predicted ancestry of human DNA left on subway surfaces can recapitulate U.S. Census demographic data, and bacterial signatures can reveal a station’s history, such as marine-associated bacteria in a hurricane-flooded station. Some evidence of pathogens was found (Bacillus anthracis), but a lack of reported cases in NYC suggests that the pathogens represent a normal, urban microbiome. This baseline metagenomic map of NYC could help long-term disease surveillance, bioterrorism threat mitigation, and health management in the built environment of cities.
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Hua-Wei Huang et al.
Critical Care, March 2015
Introduction: Sleep deprivation is common in critically ill patients in the intensive care unit (ICU). Noise and light in the ICU and the reduction in plasma melatonin play the essential roles. The aim of this study was to determine the effect of simulated ICU noise and light on nocturnal sleep quality, and compare the effectiveness of melatonin and earplugs and eye masks on sleep quality in these conditions in healthy subjects.
Methods: This study was conducted in two parts. In part one, 40 healthy subjects slept under baseline night and simulated ICU noise and light (NL) by a cross-over design. In part two, 40 subjects were randomly assigned to four groups: NL, NL plus placebo (NLP), NL plus use of earplugs and eye masks (NLEE) and NL plus melatonin (NLM). 1 mg of oral melatonin or placebo was administered at 21:00 on four consecutive days in NLM and NLP. Earplugs and eye masks were made available in NLEE. The objective sleep quality was measured by polysomnography. Serum was analyzed for melatonin levels. Subjects rated their perceived sleep quality and anxiety levels.
Results: Subjects had shorter total sleep time (TST) and rapid eye movement (REM) sleep, longer sleep onset latency, more light sleep and awakening, poorer subjective sleep quality, higher anxiety level and lower serum melatonin level in NL night (P <0.05). NLEE had less awakenings and shorter sleep onset latency (P <0.05). NLM had longer TST and REM and shorter sleep onset latency (P <0.05). Compared with NLEE, NLM had fewer awakenings (P = 0.004). Both NLM and NLEE improved perceived sleep quality and anxiety level (P = 0.000), and NLM showed better than NLEE in perceived sleep quality (P = 0.01). Compared to baseline night, the serum melatonin levels were lower in NL night at every time point, and the average maximal serum melatonin concentration in NLM group was significantly greater than other groups (P <0.001).
Conclusions: Compared with earplugs and eye masks, melatonin improves sleep quality and serum melatonin levels better in healthy subjects exposed to simulated ICU noise and light.