Out to Get You

Kevin Lewis

June 14, 2022

Non-Covid Excess Deaths, 2020-21: Collateral Damage of Policy Choices?
Casey Mulligan & Robert Arnott
NBER Working Paper, June 2022

From April 2020 through at least the end of 2021, Americans died from non-Covid causes at an average annual rate 97,000 in excess of previous trends. Hypertension and heart disease deaths combined were elevated 32,000. Diabetes or obesity, drug-induced causes, and alcohol-induced causes were each elevated 12,000 to 15,000 above previous (upward) trends. Drug deaths especially followed an alarming trend, only to significantly exceed it during the pandemic to reach 108,000 for calendar year 2021. Homicide and motor-vehicle fatalities combined were elevated almost 10,000. Various other causes combined to add 18,000. While Covid deaths overwhelmingly afflict senior citizens, absolute numbers of non-Covid excess deaths are similar for each of the 18-44, 45-64, and over-65 age groups, with essentially no aggregate excess deaths of children. Mortality from all causes during the pandemic was elevated 26 percent for working-age adults (18-64), as compared to 18 percent for the elderly. Other data on drug addictions, non-fatal shootings, weight gain, and cancer screenings point to a historic, yet largely unacknowledged, health emergency. 

A community response approach to mental health and substance abuse crises reduced crime
Thomas Dee & Jaymes Pyne
Science Advances, 10 June 2022

Police officers often serve as first responders to mental health and substance abuse crises. Concerns over the unintended consequences and high costs associated with this approach have motivated emergency response models that augment or completely remove police involvement. However, there is little causal evidence evaluating these programs. This preregistered study presents quasi-experimental evidence on the impact of an innovative “community response” pilot in Denver that directed targeted emergency calls to health care responders instead of the police. We find robust evidence that the program reduced reports of targeted, less serious crimes (e.g., trespassing, public disorder, and resisting arrest) by 34% and had no detectable effect on more serious crimes. The sharp reduction in targeted crimes reflects the fact that health-focused first responders are less likely to report individuals they serve as criminal offenders and the spillover benefits of the program (e.g., reducing crime during hours when the program was not in operation).

The effects of recent minimum wage increases on self-reported health in the United States
Liam Sigaud et al.
Social Science & Medicine, forthcoming

Minimum wage policy continues to receive considerable popular and legislative attention in the United States. Despite a fast-growing empirical literature on the relationship between the minimum wage and health, previous studies generally use data from the 1990s to 2014. In this study, we estimate the impact of recent changes in state-level minimum wages on the self-reported health of adults in the post-Great Recession era. Using data from the Behavioral Risk Factor Surveillance System and a difference-in-differences design, we exploit more than 150 state-level increases in the minimum wage between 2011 and 2019. Our results indicate that a higher minimum wage increases men's physical and mental health burdens but has an ambiguous effect on a more general measure of health. Among women, the minimum wage improves general health and reduces their physical and mental health burdens. Compared to past studies, our work indicates that the relationship between the minimum wage and health has changed over time. It also illustrates the need for policymakers to consider the broader consequences of minimum wage policy, including health effects and gender differences therein. 

Cohort Trends in the Burden of Multiple Chronic Conditions Among Aging U.S. Adults
Nicholas Bishop, Steven Haas & Ana Quiñones
Journals of Gerontology: Series B, forthcoming

Multimorbidity, also referred to as multiple chronic conditions (MCCs), is the concurrent presence of 2 or more chronic health conditions. Increasing multimorbidity represents a substantial threat to the health of aging populations. Recent trends suggest greater risk of poor health and mortality among later-born cohorts, yet we are unaware of work examining cohort differences in multimorbidity among aging U.S. adults.

We examine intercohort variation in MCC burden in adults aged 51 years and older using 20 years (n = 33,598; 1998–2018) of repeated assessment drawn from the Health and Retirement Study. The index of MCCs included 9 chronic conditions (heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer excluding skin cancer, high depressive symptoms, and cognitive impairment). We used linear mixed models with various approaches to estimate age/period/cohort effects to model intercohort patterns in MCC burden. We also explored variation in the specific conditions driving cohort differences in multimorbidity.

More recent cohorts had greater MCC burden and developed multimorbidity at earlier ages than those born to prior generations. The burden of chronic conditions was patterned by life-course sociodemographic factors and childhood health for all cohorts. Among adults with multimorbidity, arthritis and hypertension were the most prevalent conditions for all cohorts, and there was evidence that high depressive symptoms and diabetes contributed to the observed cohort differences in multimorbidity risk. 

Prenatal substance use policies and newborn health
Angélica Meinhofer et al.
Health Economics, July 2022, Pages 1452-1467

We study the effect of punitive and priority treatment policies relating to illicit substance use during pregnancy on the rate of neonatal drug withdrawal syndrome, low birth weight, low gestational age, and prenatal care use. Punitive policies criminalize prenatal substance use, or define prenatal substance exposure as child maltreatment in child welfare statutes or as grounds for termination of parental rights. Priority treatment policies are supportive and grant pregnant women priority access to substance use disorder treatment programs. Our empirical strategy relies on administrative data from 2008 to 2018 and a difference-in-differences framework that exploits the staggered implementation of these policies. We find that neonatal drug withdrawal syndrome increases by 10%–18% following the implementation of a punitive policy. This growth is accompanied by modest reductions in prenatal care, which may reflect deterrence from healthcare utilization. In contrast, priority treatment policies are associated with small reductions in low gestational age (2%) and low birth weight (2%), along with increases in prenatal care use. Taken together, our findings suggest that punitive approaches may be associated with unintended adverse pregnancy outcomes, and that supportive approaches may be more effective for improving perinatal health. 

Accelerating Vaccine Innovation for Emerging Infectious Diseases via Parallel Discovery
Joseph Barberio et al.
NBER Working Paper, June 2022

We analyze the financial performance of a hypothetical portfolio of 120 mRNA vaccine candidates in the preclinical stage targeting 11 emerging infectious diseases. We calibrate the simulation parameters with input from domain experts in mRNA technology and an extensive literature review. We find that the portfolio generates an average annualized return on investment of –6.0% per annum and a net present value of –$9.5 billion, despite the scientific advantages of mRNA technology and the financial benefits of diversification. Clinical trial costs account for 94% of the total investment, with manufacturing costs accounting for only 6%. Sensitivity analysis reveals that the most important factor determining financial performance is the price per dose, while the increased probability of success due to mRNA technology, adjusting the size of the portfolio, and the possibility of conducting human challenge trials do not significantly improve financial performance. These results underscore that if the goal is to create a sustainable business model and robust global vaccine ecosystem, continued collaboration between government agencies and the private sector is likely to be necessary. 

Physiological aging around the World
Carl-Johan Dalgaard, Casper Worm Hansen & Holger Strulik
PLoS ONE, June 2022

We extract data on physiological aging by computing a frailty index for 201 countries over the period 1990–2019. Using panel estimation techniques, we show that the macro frailty index replicates basic regularities previously observed in related studies of aging at the individual level. We then use the frailty index to highlight trends of global physiological aging and its relationship to economic growth. Holding population age structure fixed, the global frailty index has on average increased by about 2 percent over the last 30 years. The average person has therefore aged by what corresponds to about one life-year of physiological aging. This overall trend is relatively similar across different geographical regions. We also document a negative relationship between physiological aging of the workforce and economic growth. According to our preferred specification, a one percent increase in the frailty index of the workforce is associated with a 1.5 percent decline of GDP per capita. This means that average annual growth of labor productivity would have been 0.1 percentage points higher without physiological aging in the period 1990-2019.

Opioid Use and Employment Outcomes: Evidence from the U.S. Military
Abby Alpert, Steve Schwab & Benjamin Ukert
NBER Working Paper, June 2022

There is significant interest in understanding the labor market consequences of the opioid epidemic, but little is known about how opioid use impacts on-the-job productivity. We analyze the impact of opioid initiation in the emergency department (ED) on workforce outcomes in the Military using linked medical and administrative personnel data for active duty service members from 2008 to 2017. Exploiting quasi-random assignment of patients to physicians in the ED, we find that assignment to a high-intensity opioid prescribing physician increases the probability of long-term opioid use and leads to subsequent negative effects on work capacity, job performance, and productivity. We also analyze the mechanisms underlying these negative workforce outcomes. While opioid use does not negatively affect measures of physical job performance, we find large increases in behavioral problems which lead to disciplinary actions and job separation.

Marijuana Liberalization and Public Finance: A Capital Market Perspective on the Passage of Medical Use Laws
Stephanie Cheng, Gus De Franco & Pengkai Lin
Journal of Accounting and Economics, forthcoming

We find that the staggered passage of state-level laws that legalize marijuana for medical use increases states’ borrowing costs by 7 to 9 basis points. Consistent with economic theory on substance use suggesting that marijuana legalization increases local consumption of the drug (by expanding its availability and reducing its perceived risks), we predict and find that increased consumption represents an important mechanism that explains the higher state bond spreads. We also show that following such laws’ passage, states incur higher marijuana-consumption-related expenditures, including for police, corrections, and public welfare. 

The Effects of Alcohol Excise Tax Increases by Drinking Level and by Income Level
Henry Saffer, Markus Gehrsitz & Michael Grossman
NBER Working Paper, May 2022

The alcohol industry argues that alcohol excise taxes do not reduce heavy drinking because of substitutions to lower-cost products and that these taxes disproportionately burden low-income drinkers. Alternatively, some economists have argued that increases in alcohol excise taxes reduce heavy alcohol consumption. Using data from the Nielsen Homescan we investigate the effects of a large excise tax increase that raised alcohol prices. The results show that heavy drinkers reduce purchases, and this reduction is no different than the reductions by other drinkers. The results also show that only low-income drinkers pay more for ethanol after the tax increase.


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