Morbidity
Will more organs save more lives? Cost‐effectiveness and the ethics of expanding organ procurement
Govind Persad
Bioethics, forthcoming
Abstract:
The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost‐effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used to save a greater number of other lives. This argument has not yet been advanced in debates over expanded procurement and could buttress existing concerns about expanded procurement. To support this argument, I review existing empirical data on the cost‐effectiveness of transplantation and compare them to data on interventions for other illnesses. These data should motivate utilitarians and others whose primary goal is maximizing population‐wide health benefits to doubt the merits of expanding organ procurement. I then consider two major objections: one makes the case that transplant candidates have a special claim to medical resources, and the other challenges the use of cost‐effectiveness to set priorities. I argue that there is no reason to conclude that transplant candidates’ medical interests should receive special priority, and that giving some consideration to cost‐effectiveness in priority setting requires neither sweeping changes to overall health priorities nor the adoption of any specific, controversial metric for assessing cost‐effectiveness. Before searching for more organs, we should first ensure the provision of cost‐effective care.
Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why
Thomas Niederkrotenthaler et al.
JAMA Psychiatry, forthcoming
Design, Setting, and Participants: For this time series analysis, monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention’s WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre–April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1) April 2017 and (2) April 1, 2017, to June 30, 2017. Data were analyzed in December 2018 and January 2019.
Results: Based on social media data, public interest in the show was highest in April 2017 and was negligible after June 2017. For 10- to 19-year-old males and females, increases in the observed values from April to June 2017 were outside the 95% confidence bands of forecasts. Models testing 3-month associated suicide mortality indicated 66 (95% CI, 16.3-115.7) excess suicides among males (12.4% increase; 95% CI, 3.1%-21.8%) and 37 (95% CI, 12.4-61.5) among females (21.7% increase; 95% CI, 7.3%-36.2%). No excess suicide mortality was seen in other age groups. The increase in the hanging suicide method was particularly high (26.9% increase; 95% CI, 15.3%-38.4%).
Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake
Kevin Hall et al.
Cell Metabolism, forthcoming
Abstract:
We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m2. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2 weeks immediately followed by the alternate diet for 2 weeks. Meals were designed to be matched for presented calories, energy density, macronutrients, sugar, sodium, and fiber. Subjects were instructed to consume as much or as little as desired. Energy intake was greater during the ultra-processed diet (508 ± 106 kcal/day; p = 0.0001), with increased consumption of carbohydrate (280 ± 54 kcal/day; p < 0.0001) and fat (230 ± 53 kcal/day; p = 0.0004), but not protein (−2 ± 12 kcal/day; p = 0.85). Weight changes were highly correlated with energy intake (r = 0.8, p < 0.0001), with participants gaining 0.9 ± 0.3 kg (p = 0.009) during the ultra-processed diet and losing 0.9 ± 0.3 kg (p = 0.007) during the unprocessed diet. Limiting consumption of ultra-processed foods may be an effective strategy for obesity prevention and treatment.
Relationship Between Poor Olfaction and Mortality Among Community-Dwelling Older Adults: A Cohort Study
Bojing Liu et al.
Annals of Internal Medicine, forthcoming
Participants: 2289 adults aged 71 to 82 years at baseline (37.7% black persons and 51.9% women).
Measurements: Brief Smell Identification Test in 1999 or 2000 (baseline) and all-cause and cause-specific mortality at 3, 5, 10, and 13 years after baseline.
Results: During follow-up, 1211 participants died by year 13. Compared with participants with good olfaction, those with poor olfaction had a 46% higher cumulative risk for death at year 10 (risk ratio, 1.46 [95% CI, 1.27 to 1.67]) and a 30% higher risk at year 13 (risk ratio, 1.30 [CI, 1.18 to 1.42]). Similar associations were found in men and women and in white and black persons. However, the association was evident among participants who reported excellent to good health at baseline (for example, 10-year mortality risk ratio, 1.62 [CI, 1.37 to 1.90]) but not among those who reported fair to poor health (10-year mortality risk ratio, 1.06 [CI, 0.82 to 1.37]). In analyses of cause-specific mortality, poor olfaction was associated with higher mortality from neurodegenerative and cardiovascular diseases. Mediation analyses showed that neurodegenerative diseases explained 22% and weight loss explained 6% of the higher 10-year mortality among participants with poor olfaction.
Conclusion: Poor olfaction is associated with higher long-term mortality among older adults, particularly those with excellent to good health at baseline. Neurodegenerative diseases and weight loss explain only part of the increased mortality.
Teen driver licensure provisions, licensing, and vehicular fatalities
Gregory Gilpin
Journal of Health Economics, July 2019, Pages 54-70
Abstract:
Between 1996 and 2015, vehicular fatalities per capita involving 16- to 17-year-old drivers declined by 68.7%. During this same period, states enacted teen driver licensure provisions in an á la carte fashion, now collectively referred to as graduated driver licensing (GDL) programs, that restricted teen driving. While the literature demonstrates that ‘good’ GDL programs reduce vehicular fatalities, how these reductions occur remains open. In this study, separate GDL provisions and no pass, no drive laws are studied to understand reduction mechanisms. The evaluation is based on a state-by-year panel and uses difference-in-difference and triple-difference specifications to identify causal impacts on rates of licensing, vehicular fatalities, and fatalities per licensee. The empirical results find that the minimum intermediate licensing age of 16.5 or older provision reduces licensing of 16- to 17-year-old teens by 20.1%, and no other licensure provision consistently impacts licensing. In addition, vehicular fatalities decrease from the minimum intermediate licensing age of 16.5 or older provision by 22.7%, the driver’s education reduces supervised hours provision by 5.9%, and no pass, no drive laws by 7.3%, while vehicular fatalities increase from the supervised driving hours required provision by 6.3%. Furthermore, only teen driver cellphone or texting bans have impacts on vehicular fatalities per 16- to 17-year-old licensed female and few long-term impacts are identified on those ages 18-20 who ‘graduated’ from licensing programs. This research suggests that GDL programs affect vehicular fatalities mostly through incapacitation, rather than programmatically.
Neonatal amygdalae and hippocampi are influenced by genotype and prenatal environment, and reflected in the neonatal DNA methylome
Mei‐Lyn Ong et al.
Genes, Brain and Behavior, forthcoming
Abstract:
The amygdala and hippocampus undergo rapid development in early life. The relative contribution of genetic and environmental factors to the establishment of their developmental trajectories has yet to be examined. We performed imaging on neonates and examined how the observed variation in volume and microstructure of the amygdala and hippocampus varied by genotype, and compared with prenatal maternal mental health and socioeconomic status. Gene × Environment models outcompeted models containing genotype or environment only to best explain the majority of measures but some, especially of the amygdaloid microstructure, were best explained by genotype only. Models including DNA methylation measured in the neonate umbilical cords outcompeted the Gene and Gene × Environment models for the majority of amygdaloid measures and minority of hippocampal measures. This study identified brain region‐specific gene networks associated with individual differences in fetal brain development. In particular, genetic and epigenetic variation within CUX1 was highlighted.
The Price of Ultra-processed Foods and Beverages and Adult Body Weight: Evidence from U.S. Veterans
Lisa Powell et al.
Economics & Human Biology, forthcoming
Abstract:
The consumption of ultra-processed foods in the U.S. and globally has increased and is associated with lower diet quality, higher energy intake, higher body weight, and poorer health outcomes. This study drew on individual-level data on measured height and weight from U.S. Department of Veterans Affairs medical records for adults aged 20 to 64 from 2009 through 2014 linked to food and beverage price data from the Council for Community and Economic Research to examine the association between the price of ultra-processed foods and beverages and adult body mass index (BMI). We estimated geographic fixed effects models to control for unobserved heterogeneity of prices. We estimated separate models for men and women and we assessed differences in price sensitivity across subpopulations by socioeconomic status (SES). The results showed that a one-dollar increase in the price of ultra-processed foods and beverages was associated with 0.08 lower BMI units for men (p ≤ 0.05) (price elasticity of BMI of -0.01) and 0.14 lower BMI units for women (p ≤ 0.10) (price elasticity of BMI of -0.02). Higher prices of ultra-processed foods and beverages were associated with lower BMI among low-SES men (price elasticity of BMI of -0.02) and low-SES women (price elasticity of BMI of -0.07) but no statistically significant associations were found for middle- or high-SES men or women. Robustness checks based on the estimation of an individual-level fixed effects model found a consistent but smaller association between the price of ultra-processed foods and beverage and BMI among women (price elasticity of BMI of -0.01) with a relatively larger association for low-SES women (price elasticity of BMI of -0.04) but revealed no association for men highlighting the importance of accounting for individual-level unobserved heterogeneity.
Infant health impacts of freshwater algal blooms: Evidence from an invasive species natural experiment
Benjamin Jones
Journal of Environmental Economics and Management, July 2019, Pages 36-59
Abstract:
Economists are increasingly interested in causally interpretable estimates of environmental health externalities, particularly on infant health. This paper focuses on a specific case by investigating microcystin, a toxin produced by freshwater blue-green algal blooms. We exploit a natural experiment caused by a zebra mussel die-off in a large lake located in the state of Michigan, USA to identify changes in microcystin-related infant outcomes surrounding the lake. Using both the synthetic control method and a difference-in-differences strategy, we find that instances of low birth weight around the lake fell by 1.4 percentage points after lake water quality improved. Along the intensive margin, birth weight and length of gestation increased by 17.1 g and 0.47 weeks, respectively. Improvements to low birth weight result in $768,500 in average annual hospitalization cost savings. Many robustness and falsification tests are performed including using both annual and monthly data and accounting for possible weather confounders and seasonality. Results suggest that microcystin can affect infant health at levels below current water advisory guidelines.
Infant Mortality and Adult Wellbeing: Evidence from Wartime Britain
Jeffrey Schiman, Robert Kaestner & Anthony Lo Sasso
Labour Economics, October 2019, Pages 12-29
Abstract:
A growing literature argues that early environments affecting childhood health may influence significantly later-life health and socioeconomic status. In this article, we present new evidence on the relationship between infant mortality and later-life outcomes using variation in infant mortality in England and Wales at the onset of World War II. We exploit the variation in infant mortality across birth cohorts and regions to estimate associations between infant mortality and adult outcomes, such as health, disability, and employment. Our findings suggest that exposure to a higher infant mortality environment is significantly associated with higher likelihood of reporting poor health, a higher likelihood of reporting a disability, a lower probability of employment, and a higher probability of reporting no earned income. We also find that the effects of the infant health environment do not become manifest until after age 55.