Healthy Time
Privacy Regulation and Barriers to Public Health
Joseph Buckman, Idris Adjerid & Catherine Tucker
Management Science, forthcoming
Abstract:
The COVID-19 pandemic has killed millions and gravely disrupted the world’s economy. A safe and effective vaccine was developed remarkably swiftly, but as of yet, uptake of the vaccine has been slow. This paper explores one potential explanation of delayed adoption of the vaccine, which is data privacy concerns. We explore two contrasting regulations that vary across U.S. states that have the potential to affect the perceived privacy risk associated with receiving a COVID-19 vaccine. The first regulation -- an “identification requirement” -- increases privacy concerns by requiring individuals to verify residency with government approved documentation. The second regulation -- “anonymity protection” -- reduces privacy concerns by allowing individuals to remove personally identifying information from state-operated immunization registry systems. We investigate the effects of these privacy-reducing and privacy-protecting regulations on U.S. state-level COVID-19 vaccination rates. Using a panel data set, we find that identification requirements decrease vaccine demand but that this negative effect is offset when individuals are able to remove information from an immunization registry. Our results remain consistent when controlling for CDC-defined barriers to vaccination, levels of misinformation, vaccine incentives, and states’ phased distribution of vaccine supply. These findings yield significant theoretical and practical contributions for privacy policy and public health.
Pandemic fatigue fueled political discontent during the COVID-19 pandemic
Frederik Jørgensen et al.
Proceedings of the National Academy of Sciences, 29 November 2022
Abstract:
Health authorities have highlighted “pandemic fatigue” as a psychological consequence of the COVID-19 pandemic and warned that “fatigue” could demotivate compliance with health-related policies and mandates. Yet, fatigue from following the policies of authorities may have consequences far beyond the health domain. Theories from the social sciences have raised that real and perceived costs of policies can also drive sentiments of discontent with the entire political establishment. Integrating theories from the health and social sciences, we ask how pandemic fatigue (i.e., perceived inability to “keep up” with restrictions) developed over the pandemic and whether it fueled political discontent. Utilizing longitudinal and panel surveys collected from September 2020 to July 2021 in eight Western countries (N = 49,116), we analyze: 1) fatigue over time at the country level, 2) associations between pandemic fatigue and discontent, and 3) the effect of pandemic fatigue on political discontent using panel data. Pandemic fatigue significantly increased with time and the severity of interventions but also decreased with COVID-19 deaths. When triggered, fatigue elicited a broad range of discontent, including protest support and conspiratorial thinking. The results demonstrate the significant societal impact of the pandemic beyond the domain of health and raise concerns about the stability of democratic societies, which were already strained by strife prior to the pandemic.
Is it possible to prepare for a pandemic?
Robert Tucker Omberg & Alex Tabarrok
Oxford Review of Economic Policy, Winter 2022, Pages 851–875
Abstract:
How effective were investments in pandemic preparation? We use a comprehensive and detailed measure of pandemic preparedness, the Global Health Security (GHS) Index produced by the Johns Hopkins Center for Health Security (JHU), to measure which investments in pandemic preparedness reduced infections, deaths, excess deaths, or otherwise ameliorated or shortened the pandemic. We also look at whether values or attitudinal factors such as individualism, willingness to sacrifice, or trust in government—which might be considered a form of cultural pandemic preparedness—influenced the course of the pandemic. Our primary finding is that almost no form of pandemic preparedness helped to ameliorate or shorten the pandemic. Compared to other countries, the United States did not perform poorly because of cultural values such as individualism, collectivism, selfishness, or lack of trust. General state capacity, as opposed to specific pandemic investments, is one of the few factors which appears to improve pandemic performance. Understanding the most effective forms of pandemic preparedness can help guide future investments. Our results may also suggest that either we aren’t measuring what is important or that pandemic preparedness is a global public good.
Covid in the nursing homes: The US experience
Markus Bjoerkheim & Alex Tabarrok
Oxford Review of Economic Policy, Winter 2022, Pages 887–911
Abstract:
The death toll in nursing homes accounted for almost 30 per cent of total Covid-19 deaths in the US during 2020. We examine the course of the pandemic in nursing homes focusing especially on whether nursing homes could have been better shielded. Across all nursing homes the key predictor of infections and deaths was community spread, i.e. a factor outside of the control of nursing homes. We find that higher-quality nursing homes, as measured by the CMS Five-Star Rating system, were not better able to protect their residents. Policy failures from the CDC and FDA, especially in the early stages of the pandemic, created extended waiting times for Covid-19 tests and slowed attempts to isolate infectious residents. But once infections were widespread, testing would have had to have been much greater to have had an appreciable effect on nursing home deaths. We find, however, that starting vaccinations just 5 weeks earlier could have saved in the order of 14,000 lives and starting them ten weeks earlier could have saved 40,000 lives.
Effects of the COVID-19 Pandemic on Mental Health and Brain Maturation in Adolescents: Implications for Analyzing Longitudinal Data
Ian Gotlib et al.
Biological Psychiatry Global Open Science, December 2022
Methods: In this study we compared carefully matched youth assessed before the pandemic (n=81) and after the pandemic-related shutdowns ended (n=82).
Results: We found that youth assessed after the pandemic shutdowns had more severe internalizing mental health problems, reduced cortical thickness, larger hippocampal and amygdala volume, and more advanced brain age.
Emergency Department Visits and Hospitalizations for Eating Disorders During the COVID-19 Pandemic
Carly Milliren, Tracy Richmond & Joel Hudgins
Pediatrics, forthcoming
Methods: We examined monthly trends in volume of patients with eating disorders (identified by principal International Classification of Diseases, 10th Revision, diagnosis codes) across 38 hospitals in the Pediatric Health Information System pre– (January 2018–March 2020) and post–COVID-19 onset (April 2020–June 2022). Using interrupted time series analysis, we examined the pre- and post monthly trends in eating disorder emergency and inpatient volume.
Results: Before the pandemic, eating disorder emergency visit volume was increasing by 1.50 visits per month (P = .006), whereas in the first year postonset, visits increased by 12.9 per month (P < .001), followed by a 6.3 per month decrease in the second year postonset (P < .001). Pre–COVID-19, eating disorder inpatient volume was increasing by 1.70 admissions per month (P = .01). In the first year postonset, inpatient volume increased by 11.9 per month (P < .001), followed by a 7.6 per month decrease in the second year postonset (P < .001).
Can Anti-Vaping Policies Curb Drinking Externalities? Evidence from E-Cigarette Taxation and Traffic Fatalities
Dhaval Dave et al.
NBER Working Paper, November 2022
Abstract:
Teenage drinking is a top public health concern, generating social costs of over $28 billion per year, including substantial external costs associated with alcohol-related traffic fatalities. At the same time, the high rate of electronic cigarette (“e-cigarette”) use among teenagers has become a public health concern, with state and local policymakers turning to e-cigarette taxes as a tool to curb consumption. This paper is the first to explore the spillover effects of e-cigarette taxes on teenage drinking and alcohol-related traffic fatalities. Using data from five nationally representative datasets (the state and national Youth Risk Behavior Surveys, the Behavioral Risk Factor Surveillance Survey, the National Survey on Drug Use and Health, and the Fatality Analysis Reporting System) spanning the period 2003-2019, and a difference-in-differences approach, we find that a one-dollar increase in e-cigarette taxes is associated with a 1-to-2 percentage-point reduction in the probability of teenage binge drinking, and a 0.4 to 0.6 decline in the number of alcohol-related traffic fatalities per 100,000 16-to-20-year-olds in a treated state-year. A causal interpretation of our estimates is supported by (1) event-study analyses that account for heterogeneous and dynamic treatment effects, and (2) null effects of e-cigarette taxes on non-alcohol-related traffic fatalities.
Trends in inequalities in the prevalence of dementia in the United States
Péter Hudomiet, Michael Hurd & Susann Rohwedder
Proceedings of the National Academy of Sciences, 15 November 2022
Abstract:
This paper presents estimates of the prevalence of dementia in the United States from 2000 to 2016 by age, sex, race and ethnicity, education, and a measure of lifetime earnings, using data on 21,442 individuals aged 65 y and older and 97,629 person-year observations from a nationally representative survey, the Health and Retirement Study (HRS). The survey includes a range of cognitive tests, and a subsample underwent clinical assessment for dementia. We developed a longitudinal, latent-variable model of cognitive status, which we estimated using the Markov Chain Monte Carlo method. This model provides more accurate estimates of dementia prevalence in population subgroups than do previously used methods on the HRS. The age-adjusted prevalence of dementia decreased from 12.2% in 2000 (95% CI, 11.7 to 12.7%) to 8.5% in 2016 (7.9 to 9.1%) in the 65+ population, a statistically significant decline of 3.7 percentage points or 30.1%. Females are more likely to live with dementia, but the sex difference has narrowed. In the male subsample, we found a reduction in inequalities across education, earnings, and racial and ethnic groups; among females, those inequalities also declined, but less strongly. We observed a substantial increase in the level of education between 2000 and 2016 in the sample. This compositional change can explain, in a statistical sense, about 40% of the reduction in dementia prevalence among men and 20% among women, whereas compositional changes in the older population by age, race and ethnicity, and cardiovascular risk factors mattered less.
Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data
Kate Kennedy-Moulton et al.
NBER Working Paper, November 2022
Abstract:
We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary non-monotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution -- who have the worst birth outcomes -- have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution. Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.
Demons of Density: Do Higher-Density Environments Put People at Greater Risk of Contagious Disease?
Ingrid Gould Ellen, Renata Howland & Sherry Glied
Journal of Housing Economics, forthcoming
Abstract:
We study the relationship between density and COVID during three distinct waves of the pandemic in New York City. Unlike prior work, our analysis uses individual Medicaid claims records, which include a rich array of demographic characteristics and pre-existing medical conditions and cover a near universe of low-income New Yorkers. In brief, our results suggest that living in higher density neighborhoods did not heighten the risk of COVID hospitalization. The size of a multifamily building made little difference either, and people living in public housing developments, which are typically highly dense environments, were less likely to be hospitalized for COVID. However, while neighborhood and building density do not seem to matter, we find significant, positive relationships between COVID hospitalization rates and household size. Specifically, we see that people living in large households or in neighborhoods with high levels of crowding were more likely to be hospitalized for COVID. In other words, our results suggest that crowded living quarters – which can occur at any level of population density – and not density itself, increase the risk of COVID hospitalization. We also see a strong correlation between being unstably housed or living in institutional settings and COVID hospitalizations.
Trial of Training to Reduce Driver Inattention in Teens with ADHD
Jeffery Epstein et al.
New England Journal of Medicine, 1 December 2022, Pages 2056-2066
Methods: We evaluated a computerized skills-training program designed to reduce long glances (lasting ≥2 seconds) away from the roadway in drivers 16 to 19 years of age with ADHD. Participants were randomly assigned in a 1:1 ratio to undergo either enhanced Focused Concentration and Attention Learning, a program that targets reduction in the number of long glances (intervention) or enhanced conventional driver’s education (control). The primary outcomes were the number of long glances away from the roadway and the standard deviation of lane position, a measure of lateral movements away from the center of the lane, during two 15-minute simulated drives at baseline and at 1 month and 6 months after training. Secondary outcomes were the rates of long glances and collisions or near-collisions involving abrupt changes in vehicle momentum (g-force event), as assessed with in-vehicle recordings over the 1-year period after training.
Results: During simulated driving after training, participants in the intervention group had a mean of 16.5 long glances per drive at 1 month and 15.7 long glances per drive at 6 months, as compared with 28.0 and 27.0 long glances, respectively, in the control group (incidence rate ratio at 1 month, 0.64; 95% confidence interval [CI], 0.52 to 0.76; P<0.001; incidence rate ratio at 6 months, 0.64; 95% CI, 0.52 to 0.76; P<0.001). The standard deviation of lane position (in feet) was 0.98 SD at 1 month and 0.98 SD at 6 months in the intervention group, as compared with 1.20 SD and 1.20 SD, respectively, in the control group (difference at 1 month, −0.21 SD; 95% CI, −0.29 to −0.13; difference at 6 months, −0.22 SD; 95% CI, −0.31 to −0.13; P<0.001 for interaction for both comparisons). During real-world driving over the year after training, the rate of long glances per g-force event was 18.3% in the intervention group and 23.9% in the control group (relative risk, 0.76; 95% CI, 0.61 to 0.92); the rate of collision or near-collision per g-force event was 3.4% and 5.6%, respectively (relative risk, 0.60, 95% CI, 0.41 to 0.89).
Living Alone and Suicide Risk in the United States, 2008‒2019
Mark Olfson et al.
American Journal of Public Health, December 2022, Pages 1774-1782
Methods: A nationally representative sample of adults from the 2008 American Community Survey (n = 3 310 000) was followed through 2019 for mortality. Cox models estimated hazard ratios of suicide across living arrangements (living alone or with others) at the time of the survey. Total and sociodemographically stratified models compared hazards of suicide of people living alone to people living with others.
Results: Annual suicide rates per 100 000 person-years were 23.0 among adults living alone and 13.2 among adults living with others. The age-, sex-, and race/ethnicity-adjusted hazard ratio of suicide for living alone was 1.75 (95% confidence interval = 1.64, 1.87). Adjusted hazards of suicide associated with living alone varied across sociodemographic groups and were highest for adults with 4-year college degrees and annual incomes greater than $125 000 and lowest for Black individuals.