Body issues

Kevin Lewis

August 23, 2018

Does When You Die Depend on Where You Live? Evidence from Hurricane Katrina
Tatyana Deryugina & David Molitor
NBER Working Paper, July 2018


We follow Medicare cohorts over time and space to estimate Hurricane Katrina's long-run mortality effects on elderly and disabled victims initially living in New Orleans. Inclusive of the initial shock, the hurricane improved survival eight years past the storm by 1.74 percentage points. Migration to lower-mortality regions explains most of this survival increase. Migrants to low- versus high-mortality regions look similar at baseline, but migrants’ subsequent mortality is 0.83-0.90 percentage points lower for each percentage-point reduction in local mortality, quantifying causal effects of place on mortality among this population. By contrast, migrants’ mortality is unrelated to local Medicare spending.

Dying to Win? Olympic Gold Medals and Longevity
Adam Leive
Journal of Health Economics, forthcoming


This paper compares mortality between Gold and Silver medalists in Olympic Track and Field to study how achievement influences health. Contrary to conventional wisdom, winners die over one year earlier than losers. I find strong evidence of differences in earnings and occupational choices as a mechanism. Losers pursued higher-paying occupations than winners according to individual Census records. I find no evidence consistent with selection or risk-taking. How people respond to success or failure in pivotal life events may produce long-lasting consequences for health.

Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors
Erin Cook et al.
Pediatrics, forthcoming

Methods: This is a difference-in-difference study in which we use data on adolescent sexual behaviors from the school-based state Youth Risk Behavior Surveillance System from 2001 to 2015. Sexual behaviors included ever having sexual intercourse in the last 3 months and condom use during last sexual intercourse. We compared changes in sexual behaviors among high school students before and after HPV legislation to changes among high school students in states without legislation.

Results: A total of 715 338 participants reported ever having sexual intercourse in the last 3 months, and 217 077 sexually active participants reported recent condom use. We found no substantive or statistically significant associations between HPV legislation and adolescent sexual behaviors. Recent sexual intercourse decreased by 0.90 percentage points (P = .21), and recent condom use increased by 0.96 percentage points (P = .32) among adolescents in states that enacted legislation compared with states that did not. Results were robust to a number of sensitivity analyses.

A bias for action in cancer screening?
Laura Scherer et al.
Journal of Experimental Psychology: Applied, forthcoming


Research that has explored public enthusiasm for cancer screening has suggested that the public may be overly enthusiastic about being screened with certain tests, and this has been attributed, in part, to lack of knowledge about the risks and benefits. In this article the authors considered the possibility that some people may be enthusiastic about screening even when they are informed and also accept that the test unquestionably does not save lives. Two studies were conducted, one that involved a nationally representative U.S. sample and another that involved an online convenience sample. All participants were asked whether they would want to receive a hypothetical screening test for breast (women) or prostate (men) cancer that does not reduce the chance of cancer death or extend the length of life. Over half of participants wanted to receive the described screening test. Many people did not believe that cancer screening might not save lives, yet screening preferences were not due to disbelief alone. Results further suggested that cancer worry, reassurance, and a desire for health information explained variance in preferences for unbeneficial screening, adjusting for beliefs about screening benefits, perceptions of screening risks, family history, perceptions of cancer risk, and demographics.

Fracking and Risky Behaviors: Evidence from Pennsylvania
Trinidad Beleche & Inna Cintina
Economics & Human Biology, forthcoming


In the past decade, the technological developments in the oil and natural gas extraction industry made the extraction of shale gas economically feasible and prompted local economic booms across the US. Anecdotal evidence suggests that areas with unconventional gas development experience a disproportionate increase in the young male population who are more likely to be involved in risk-taking behavior. Moreover, the sudden income gains or demographic shifts might increase the demand for various goods and services, including entertainment and illegal activities provided by the adult entertainment industry. We investigate the relationship between unconventional gas development and a variety of risk-taking outcomes such as sexually transmitted infections, and prostitution-related arrests. Our identification strategy exploits the variation in shale gas or unconventional well drilling across time and counties in conjecture with a number of datasets that allow us to investigate the potential mechanisms. Our findings indicate that Pennsylvania counties with fracking activities have higher rates of gonorrhea and chlamydia infections (7.8% and 2.6%, respectively), as well as higher prostitution related arrests (19.7%). We posit that changes in the labor market and associated impacts to income or composition of workers may play a role in the estimated effects, but we do not find evidence in support of these hypotheses.

When It Rains It Pours: The Long-run Economic Impacts of Salt Iodization in the United States
Achyuta Adhvaryu et al.
NBER Working Paper, July 2018


In 1924, The Morton Salt Company began nationwide distribution of iodine-fortified salt. Access to iodine, a key determinant of cognitive ability, rose sharply. We compare outcomes for cohorts exposed in utero with those of slightly older, unexposed cohorts, across states with high versus low baseline iodine deficiency. Income increased by 11%; labor force participation rose 0.68 percentage points; and full-time work went up 0.9 percentage points due to increased iodine availability. These impacts were largely driven by changes in the economic outcomes of young women. In later adulthood, both men and women had higher family incomes due to iodization.

Trends in the Prevalence of Diabetes Among U.S. Adults: 1999–2016
Michael Fang
American Journal of Preventive Medicine, forthcoming

Methods: This paper estimated trends in the prevalence of diagnosed, undiagnosed, and total diabetes among U.S. adults from 1999–2000 to 2015–2016 (analyzed in 2017). Data come from 42,554 respondents aged ≥20 years who participated in the National Health and Nutrition Examination Survey. Diagnosed diabetes was measured through self-report, undiagnosed diabetes was measured as never being diagnosed with diabetes but having glycated hemoglobin levels ≥6.5%, and total diabetes was measured as the sum of individuals with diagnosed and undiagnosed diabetes.

Results: In the overall U.S. adult population, the unadjusted prevalence of total diabetes increased from 7.7% in 1999–2000 to 13.3% in 2015–2016 (p<0.001 for trend). Growth was observed for all subgroups, though the rate of change was higher in older adults, racial minorities, and those who were obese compared with their peers. Increasing prevalence among Mexican-American adults was particularly pronounced, rising by 10.1 percentage points during the study period (8.3% to 18.4%, p < 0.001). Roughly 40% of the increase in total diabetes was accounted for by changes in the age and rates of obesity in the U.S. population.

Diabetes and Diet: Purchasing Behavior Change in Response to Health Information
Emily Oster
American Economic Journal: Applied Economics, forthcoming


Individuals with obesity and related conditions are often reluctant to change their diet. Evaluating the details of this reluctance is hampered by limited data. I use household scanner data to estimate food purchase response to a diagnosis of diabetes. I use a machine learning approach to infer diagnosis from purchases of diabetes-related products. On average, households show significant, but relatively small, calorie reductions. These reductions are concentrated in unhealthy foods, suggesting they reflect real efforts to improve diet. There is some heterogeneity in calorie changes across households, although this heterogeneity is not well predicted by demographics or baseline diet, despite large correlations between these factors and diagnosis. I suggest a theory of behavior change which may explain the limited overall change and the fact that heterogeneity is not predictable.

Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: Observational study
Elliot Tapper & Neehar Parikh
British Medical Journal, July 2018

Setting: Death certificate data from the Vital Statistics Cooperative, and population data from the US Census Bureau compiled by the Center for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (1999-2016).

Results: From 1999 to 2016 in the US annual deaths from cirrhosis increased by 65%, to 34 174, while annual deaths from hepatocellular carcinoma doubled to 11 073. Only one subgroup — Asians and Pacific Islanders — experienced an improvement in mortality from hepatocellular carcinoma: the death rate decreased by 2.7% (95% confidence interval 2.2% to 3.3%, P<0.001) per year. Annual increases in cirrhosis related mortality were most pronounced for Native Americans (designated as “American Indians” in the census database) (4.0%, 2.2% to 5.7%, P=0.002). The age adjusted death rate due to hepatocellular carcinoma increased annually by 2.1% (1.9% to 2.3%, P<0.001); deaths due to cirrhosis began increasing in 2009 through 2016 by 3.4% (3.1% to 3.8%, P<0.001). During 2009-16 people aged 25-34 years experienced the highest average annual increase in cirrhosis related mortality (10.5%, 8.9% to 12.2%, P<0.001), driven entirely by alcohol related liver disease. During this period, mortality due to peritonitis and sepsis in the setting of cirrhosis increased substantially, with respective annual increases of 6.1% (3.9% to 8.2%) and 7.1% (6.1% to 8.4%). Only one state, Maryland, showed improvements in mortality (−1.2%, −1.7% to −0.7% per year), while many, concentrated in the south and west, observed disproportionate annual increases: Kentucky 6.8% (5.1% to 8.5%), New Mexico 6.0% (4.1% to 7.9%), Arkansas 5.7% (3.9% to 7.6%), Indiana 5.0% (3.8% to 6.1%), and Alabama 5.0% (3.2% to 6.8%). No state showed improvements in hepatocellular carcinoma related mortality, while Arizona (5.1%, 3.7% to 6.5%) and Kansas (4.3%, 2.8% to 5.8%) experienced the most severe annual increases.

Conclusions: Mortality due to cirrhosis has been increasing in the US since 2009. Driven by deaths due to alcoholic cirrhosis, people aged 25-34 have experienced the greatest relative increase in mortality. White Americans, Native Americans, and Hispanic Americans experienced the greatest increase in deaths from cirrhosis. Mortality due to cirrhosis is improving in Maryland but worst in Kentucky, New Mexico, and Arkansas. The rapid increase in death rates among young people due to alcohol highlight new challenges for optimal care of patients with preventable liver disease.

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