All well and good

Kevin Lewis

July 25, 2017

Solving the Kidney Shortage via the Creation of Kidney Donation Co-operatives
K.C. Eames, Patrick Holder & Eduardo Zambrano
Journal of Health Economics, July 2017, Pages 91-97

Many people object to the creation of a market for kidneys on the grounds that such reform would hurt those patients unable to afford the market price of a kidney and that donors do not understand the risks they're taking when donating. In this paper, we propose a mechanism, the kidney co-operative, designed to provide sufficient incentives to alleviate the kidney shortage while at the same time addressing the concerns regarding the potential losers from reform. We show that it is reasonable to expect that the number of transplants will be larger under the kidney co-operative mechanism than under either the status quo or a conventional market mechanism.

New Kidney Allocation System Associated With Increased Rates Of Transplants Among Black And Hispanic Patients
Taylor Melanson et al.
Health Affairs, June 2017, Pages 1078-1085

Before the 2014 implementation of a new kidney allocation system by the United Network for Organ Sharing, white patients were more likely than black or Hispanic patients to receive a kidney transplant. To determine the effect of the new allocation system on these disparities, we examined data for 179,071 transplant waiting list events in the period June 2013-September 2016, and we calculated monthly transplantation rates (34,133 patients actually received transplants). Implementation of the new system was associated with a narrowing of the disparities in the average monthly transplantation rates by 0.29 percentage point for blacks compared to whites and by 0.24 percentage point for Hispanics compared to whites, which resulted in both disparities becoming nonsignificant after implementation of the new system.

Are fire safe cigarettes actually fire safe? Evidence from changes in US state laws
Carl Bonander, Niklas Jakobsson & Finn Nilson
Injury Prevention, forthcoming

Objective: To estimate the effects of fire safe cigarette laws on fire mortality and cigarette-related fires in the USA.

Methods: We examined the gradual implementation of the laws to identify their average effects, using difference-in-differences analysis to account for common year effects, time-invariant state effects, state-specific trends and observable time-varying state-level covariates.

Results: We found no statistically significant effects on all-cause fire mortality, residential fire mortality or cigarette-caused fire rates. The estimates for cigarette-caused fire deaths were significant under some specifications, but were not robust to the inclusion of state-specific trends or comparisons to effects on other cause-determined fires.

Why Do College Graduates Behave More Healthfully Than Those Who Are Less Educated?
Elizabeth Lawrence
Journal of Health and Social Behavior, forthcoming

College graduates live much healthier lives than those with less education, but research has yet to document with certainty the sources of this disparity. This study examines why U.S. young adults who earn college degrees exhibit healthier behaviors than those with less education. I use data from the National Longitudinal Study of Adolescent to Adult Health, which offers information on education and health behaviors across adolescence and young adulthood (N = 14,265). Accounting for selection into college, degree attainment substantially reduces the associations between college degree attainment and health behaviors, but college degree attainment demonstrates a strong causal effect on young adult health. Financial, occupational, social, cognitive, and psychological resources explain less than half of the association between college degree attainment and health behaviors. The healthier behaviors of college graduates are the result of sorting into educational attainment, embedding of human capital, and mechanisms other than socioeconomic and psychosocial resources.

An Olympic Legacy? Does the urban regeneration associated with the London 2012 Olympic Games impact on adolescent mental health?
Charlotte Clark et al.
American Journal of Epidemiology, forthcoming

Public expenditure on mega-events such as the London 2012 Olympic Games is often justified by the potential legacy of urban regeneration and its associated health and wellbeing benefits for local communities. The ORiEL (Olympic Regeneration in East London) study examined whether urban regeneration associated with the 2012 Games was associated with improved mental health. Adolescents aged 11-12 years attending schools in the Olympic host London Borough of Newham or in three adjacent comparison London Boroughs, completed a survey prior to the Olympic Games (2012) and six-months and 18-months after the Games (2013 and 2014, respectively). Change in depressive symptoms and wellbeing between baseline and each follow-up were examined. 2254 adolescents from 25 randomly selected schools participated. Adolescents from the Olympic host borough were more likely to have 'remained depressed' between baseline and the six-month and 18-month follow-ups (Relative Risk = 1.78, 95%CI 1.12-2.83; Relative Risk = 1.93, 95%CI 1.01-3.70), compared with adolescents from the comparison boroughs. No differences in wellbeing were observed. There was very little evidence that urban regeneration had any positive influence on adolescent mental health and some suggestion regeneration may have been associated with maintenance of depressive symptoms. Such programmes may have limited short-term impact on the mental health of adolescents.

Declining Risk of Sudden Death in Heart Failure
Li Shen et al.
New England Journal of Medicine, 6 July 2017, Pages 41-51

Methods: We analyzed data from 40,195 patients who had heart failure with reduced ejection fraction and were enrolled in any of 12 clinical trials spanning the period from 1995 through 2014. Patients who had an implantable cardioverter-defibrillator at the time of trial enrollment were excluded. Weighted multivariable regression was used to examine trends in rates of sudden death over time. Adjusted hazard ratios for sudden death in each trial group were calculated with the use of Cox regression models. The cumulative incidence rates of sudden death were assessed at different time points after randomization and according to the length of time between the diagnosis of heart failure and randomization.

Results: Sudden death was reported in 3583 patients. Such patients were older and were more often male, with an ischemic cause of heart failure and worse cardiac function, than those in whom sudden death did not occur. There was a 44% decline in the rate of sudden death across the trials (P=0.03). The cumulative incidence of sudden death at 90 days after randomization was 2.4% in the earliest trial and 1.0% in the most recent trial. The rate of sudden death was not higher among patients with a recent diagnosis of heart failure than among those with a longer-standing diagnosis.

Conclusions: Rates of sudden death declined substantially over time among ambulatory patients with heart failure with reduced ejection fraction who were enrolled in clinical trials, a finding that is consistent with a cumulative benefit of evidence-based medications on this cause of death.

The Methuselah Effect: The Pernicious Impact of Unreported Deaths on Old Age Mortality Estimates
Dan Black et al.
NBER Working Paper, July 2017

We examine inferences about old age mortality that arise when researchers use survey data matched to death records. We show that even small rates of failure to match respondents can lead to substantial bias in the measurement of mortality rates at older ages. This type of measurement error is consequential for three strands in the demographic literature: (1) the deceleration in mortality rates at old ages, (2) the black-white mortality crossover, and (3) the relatively low rate of old age mortality among Hispanics - often called the "Hispanic paradox." Using the National Longitudinal Survey of Older Men (NLS-OM) matched to death records in both the U.S. Vital Statistics system and the Social Security Death Index, we demonstrate that even small rates of missing mortality matching plausibly lead to an appearance of mortality deceleration when none exists, and can generate a spurious black-white mortality crossover. We confirm these findings using data from the National Health Interview Survey (NHIS) matched to the U.S. Vital Statistics system, a dataset known as the "gold standard" (Cowper et al., 2002) for estimating age-specific mortality. Moreover, with these data we show that the Hispanic paradox is also plausibly explained by a similar undercount.

The Impact of Public Health Spending on California STD Rates
Craig Arthur Gallet
International Advances in Economic Research, May 2017, Pages 149-159

This study assesses the impact of county-level public health spending on rates of sexually transmitted disease (STD) in California. Across a variety of empirical specifications, increases in own-county public health spending reduce rates of gonorrhea and syphilis. Indeed, a $1 increase in per capita public health spending reduces the gonorrhea (syphilis) rate by approximately 0.30 (0.60) percent. Spillover effects are also associated with public health spending, as increases in border-county spending reduce STD rates. To varying degrees of significance, county STD rates are also sensitive to lagged STD rates, county racial composition, whether or not a public university is located within the county, and a yearly time trend.

Associations Between County Wealth, Health and Social Services Spending, and Health Outcomes
Mac McCullough & Jonathon Leider
American Journal of Preventive Medicine, forthcoming

Introduction: Each year, the County Health Rankings rate the health outcomes of each county in the U.S. A common refrain is that poor counties perform worse than wealthier ones. This article examines that assumption and specifically analyzes characteristics of counties that have performed better in terms of health outcomes than their wealth alone would suggest.

Methods: Data from the 2013 County Health Rankings were used, as were 2012 financial and demographic information collected by the U.S. Census Bureau. A logistic model was constructed to examine the odds of a county "overperforming" in the rankings relative to community wealth. Analyses were performed in 2016.

Results: Communities that were wealthier performed better on the rankings. However, more than 800 of 3,141 counties overperformed by ranking in a better health outcomes quartile than their county's wealth alone would suggest. Regression analyses found that for each additional percentage point of total public spending that was allocated toward community health care and public health, the odds of being an overperformer increased by 3.7%.

Seeing and Hearing: The Impacts of New York City's Universal Prekindergarten Program on the Health of Low-Income Children
Kai Hong, Kacie Dragan & Sherry Glied
NBER Working Paper, March 2017

Prior research suggests that high quality universal pre-kindergarten (UPK) programs can generate lifetime benefits, but the mechanisms generating these effects are not well-understood. In 2014, New York City made all 4-year-old children eligible for high-quality UPK programs that emphasized developmental screening. We examine the effect of this program on the health and healthcare utilization of children enrolled in Medicaid using a difference-in-regression discontinuity design that exploits both the introduction of UPK and the fixed age cut-off for enrollment. The introduction of UPK increased the probability that a child was diagnosed with asthma or with vision problems, received treatment for hearing or vision problems, or received a screening during the prekindergarten year. UPK accelerated the timing of diagnoses of vision problems. We do not find any increases in injuries, infectious diseases, or overall utilization. These effects are not offset by lower screening rates in the kindergarten year, suggesting that one mechanism through which UPK might generate benefits is that it accelerates the rate at which children are identified with conditions that could potentially delay learning and cause behavioral problems. We do not find significant effects of having a child who was eligible for UPK on mothers' health, fertility, or healthcare utilization.

The Effects of Vocational Rehabilitation Services for People with Mental Illness
David Dean et al.
Journal of Human Resources, Summer 2017, Pages 826-858

We construct a structural model of participation in vocational rehabilitation for people with mental illness. There are multiple services to choose among, and each has different effects on employment, earnings, and receipt of DI/SSI. This is the first paper to jointly estimate VR service receipt, employment outcomes, and DI/SSI receipt. We estimate large effects for most of the services implying large rates of return to vocational rehabilitation.

Genetic loci associated with coronary artery disease harbor evidence of selection and antagonistic pleiotropy
Sean Byars et al.
PLoS Genetics, June 2017

How genetic variation contributes to disease is complex, especially for those such as coronary artery disease (CAD) that develop over the lifetime of individuals. One of the fundamental questions about CAD - whose progression begins in young adults with arterial plaque accumulation leading to life-threatening outcomes later in life - is why natural selection has not removed or reduced this costly disease. It is the leading cause of death worldwide and has been present in human populations for thousands of years, implying considerable pressures that natural selection should have operated on. Our study provides new evidence that genes underlying CAD have recently been modified by natural selection and that these same genes uniquely and extensively contribute to human reproduction, which suggests that natural selection may have maintained genetic variation contributing to CAD because of its beneficial effects on fitness. This study provides novel evidence that CAD has been maintained in modern humans as a by-product of the fitness advantages those genes provide early in human lifecycles.

The Shock of Falling Among Older Americans
Inas Rashad Kelly
NBER Working Paper, June 2017

Direct medical costs associated with falls have been shown to be $34 billion in 2013, an underestimate since full costs are not factored in. Using the 1998-2012 waves of the Health and Retirement Study and several econometric methods to address the endogeneity of falls, this study seeks to answer the question of how much worse physical and mental health outcomes are for individuals who fall compared to their steadier counterparts. Results across various specifications suggest that falling leads to lower activities of daily living, more depression, and more psychological problems. It leads to greater probabilities of being in poor health, having heart problems, and having a stroke. These results survive several robustness checks.

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