Socialized Health

Kevin Lewis

December 16, 2020

The social patterning of autism diagnoses reversed in California between 1992 and 2018
Alix Winter et al.
Proceedings of the National Academy of Sciences, 1 December 2020, Pages 30295-30302


As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California’s Department of Developmental Services. California’s diagnosed autism incidence rate rose from 0.49 per 1,000 3–6 y olds in 1998 to 3.49 per 1,000 3–6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.

Why Is All COVID-19 News Bad News?
Bruce Sacerdote, Ranjan Sehgal & Molly Cook
NBER Working Paper, November 2020


We analyze the tone of COVID-19 related English-language news articles written since January 1, 2020. Ninety one percent of stories by U.S. major media outlets are negative in tone versus fifty four percent for non-U.S. major sources and sixty five percent for scientific journals. The negativity of the U.S. major media is notable even in areas with positive scientific developments including school re-openings and vaccine trials. Media negativity is unresponsive to changing trends in new COVID-19 cases or the political leanings of the audience. U.S. major media readers strongly prefer negative stories about COVID-19, and negative stories in general. Stories of increasing COVID-19 cases outnumber stories of decreasing cases by a factor of 5.5 even during periods when new cases are declining. Among U.S. major media outlets, stories discussing President Donald Trump and hydroxychloroquine are more numerous than all stories combined that cover companies and individual researchers working on COVID-19 vaccines.

Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality
Kathryn Leifheit et al.
University of California Working Paper, December 2020

Methods: The study included 44 U.S. states that instituted eviction moratoriums., followed from March 13th to September 3rd, 2020. We modeled associations using a difference-in-difference approach with an event study specification. Negative binomial regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. We then used model predictions to estimate cumulative cases and deaths associated with expiring eviction moratoriums.

Findings: Twenty-seven states lifted eviction moratoriums during the study period. COVID-19 incidence in states that lifted their moratoriums was 1.6 (95% CI 1.0,2.3) times the incidence of states that maintained their moratoriums at 10 weeks post-lifting and grew to a ratio of 2.1 (CI 1.1,3.9) at ≥16 weeks. Mortality in states that lifted their moratoriums was 1.6 (CI 1.2,2.3) times the mortality of states that maintained their moratoriums at 7 weeks post-lifting and grew to a ratio of 5.4 (CI 3.1,9.3) at ≥16 weeks. These results translate to an estimated 433,700 excess cases (CI 365200,502200) and 10,700 excess deaths (CI 8900,12500) nationally.

Heard Immunity: Effective Persuasion for a Future COVID-19 Vaccine
Nicolas Duquette
University of Southern California Working Paper, September 2020


A survey experiment exposes treatment groups to four messages supporting future vaccination against COVID-19. These treatments emphasize either the risks of the virus or the safety of vaccination, to the respondent personally or to others. For a nationally representative sample, self-reported intent to vaccinate is not significantly different from the control for any message. However, there is a substantial divergence between white non-Hispanic respondents, whose response to all four treatments is close to zero, and non-white or Hispanic respondents, whose intention to vaccinate is over 50% higher in response to a message emphasizing pro-sociality and the safety of others.

Urban Flight Seeded the COVID-19 Pandemic Across the United States
Joshua Coven, Arpit Gupta & Iris Yao
NYU Working Paper, October 2020


We document large-scale urban flight in the United States in the wake of the COVID-19 pandemic. Populations that flee are disproportionately younger, whiter, and wealthier. Regions that saw migrant influx experience greater subsequent COVID-19 case growth, suggesting that urban flight was a vector of disease spread. Urban residents fled to socially connected areas, consistent with the notion that individuals were sheltering with friends and family or in second homes. The association of migration and subsequent case growth persists when instrumenting for migration with social networks, pointing to a causal association.

Relative Obesity and the Formation of Non-cognitive Abilities During Adolescence
Wei Huang, Elaine Liu & Andrew Zuppann
Journal of Human Resources, forthcoming


We study the role of relative childhood and adolescent obesity in the development of non- cognitive abilities. We employ a novel identification strategy, utilizing the fact that one’s body size is a relative concept and there are large variations in body sizes across MSAs. We focus on children who move between MSAs. Controlling for origin-destination state pair fixed effects, we find that a 10 percentile point increase in relative body size would increase behavioral problems by 2 percentile points. This effect is of a similar magnitude to a two-year reduction in maternal education.

Revenge of the Experts: Will Covid-19 Renew or Diminish Public Trust in Science?
Barry Eichengreen, Cevat Giray Aksoy & Orkun Saka
NBER Working Paper, November 2020


It is sometimes said that an effect of the COVID-19 pandemic will be heightened appreciation of the importance of scientific research and expertise. We test this hypothesis by examining how exposure to previous epidemics affected trust in science and scientists. Building on the “impressionable years hypothesis” that attitudes are durably formed during the ages 18 to 25, we focus on individuals exposed to epidemics in their country of residence at this particular stage of the life course. Combining data from a 2018 Wellcome Trust survey of more than 75,000 individuals in 138 countries with data on global epidemics since 1970, we show that such exposure has no impact on views of science as an endeavor but that it significantly reduces trust in scientists and in the benefits of their work. We also illustrate that the decline in trust is driven by the individuals with little previous training in science subjects. Finally, our evidence suggests that epidemic-induced distrust translates into lower compliance with health-related policies in the form of negative views towards vaccines and lower rates of child vaccination.

Diagnostic errors in child mental health: Assessing treatment selection and its long-term consequences
Jill Furzer
University of Toronto Working Paper, December 2020


The subjective nature of mental health diagnoses may cause missed diagnoses in some children and over-treatment in others, with differences by gender, race and socioeconomic status. To test for this, I estimate mental health risk in childhood using nationally representative health data. I calculate over-diagnosis by estimating risk-specific jumps in diagnosis by a child's school starting age. I find diagnosed young-for-grade children have a lower risk of mental illness, while many high-risk kids remain undiagnosed. Underdiagnosis appears to be driven by internalized mental health symptoms and pro-social behaviours leading to symptom masking, which is especially common in females. I investigate the impact of over- and under-treatment on longer-run outcomes — including educational attainment and the likelihood of social assistance receipt — using linked tax records. My results suggest that adverse treatment effects on education, social assistance receipt and income are concentrated in low-risk, over-treated individuals. However, mental health treatments improve these outcomes for high-risk children and accrue sizable improvements in the form of reduced rates of workplace injuries and suicide ideation. As missed or delayed diagnoses represent a larger misallocation of scarce support resources, these results suggest that targeted screening before age 11 would reduce inequities in diagnosing mental illness and downstream socioeconomic inequalities.

Can Unearned Income Make Us Fitter? Evidence from Lottery Wins
Joan Costa-Font & Mario Gyori
London School of Economics Working Paper, November 2020


Although lower income is associated with overweight (and obesity), such an association is explained by a number of other confounding effects such as omitted variables (e.g., time preferences) explaining that income effect on overweight. We study the effect of unearned income shocks resulting from a lottery win (windfall income) on both overweight (alongside obesity and body mass index) distribution. We draw upon longitudinal data from the United Kingdom, a country where about half of a population plays the lottery. Our results suggest no evidence of contemporaneous effects of income on overweight, but a significant lagged effect. We find a reduction in overweight 12 months after a lottery win. A 10,000-sterling win reduces overweight by 2-3 percentage points. Furthermore, we document a nonlinear effect up to 36 months after the lottery win, suggesting that small wins increase overweight and large wins reduce it. The effect of a lottery win varies depending on an individual's working hours and educational attainment. A lottery win among low education individuals decreases the risk of overweight.

The Long-term Impact of Preventative Public Health Programs
Lauren Hoehn-Velasco
Economic Journal, forthcoming


This paper estimates the long-term impact of childhood exposure to a preventative public health programme on adult human capital. From 1908 to 1933, local governments in the United States instituted county-level health departments (CHDs) that provided preventative health services geared towards children. This paper estimates the long-term benefits of childhood exposure to this public programme using variation in CHD location, timing and age of exposure. CHD operation before the age of 5 increases men’s later-life earnings by 2% to 5%. Exposed boys not only perform better than later- and never-treated groups, but, after adding household fixed effects, exposed men earn more than their brothers.

Eating meat and not vaccinating: In defense of the analogy
Ben Jones
Bioethics, forthcoming


The devastating impact of the COVID‐19 (coronavirus disease 2019) pandemic is prompting renewed scrutiny of practices that heighten the risk of infectious disease. One such practice is refusing available vaccines known to be effective at preventing dangerous communicable diseases. For reasons of preventing individual harm, avoiding complicity in collective harm, and fairness, there is a growing consensus among ethicists that individuals have a duty to get vaccinated. I argue that these same grounds establish an analogous duty to avoid buying and eating most meat sold today, based solely on a concern for human welfare. Meat consumption is a leading driver of infectious disease. Wildlife sales at wet markets, bushmeat hunting, and concentrated animal feeding operations (CAFOs) are all exceptionally risky activities that facilitate disease spread and impose immense harms on human populations. If there is a moral duty to vaccinate, we also should recognize a moral duty to avoid most meat. The paper concludes by considering the implications of this duty for policy.

Killing in the Stock Market: Evidence From Organ Donations
Spencer Barnes
Florida State University Working Paper, October 2020


Daily individual patient records for every organ transplant capable hospital in the United States from 1987 to 2018 indicate a negative relationship between stock market returns and deaths. Stress related deaths, such as heart attacks, strokes, and suicides, are the most pronounced around stock market movements. Market shifts also alter the availability of organ transplants creating life altering consequences for organ wait list patients. A geographic effect exists within states as well. An interrupted time series specification mitigates some endogeneity concerns. The findings imply that wealth shocks alter current utility even at the extremes emphasizing the spillover effects of finance.

Family structure and the gender gap in ADHD
Kelly Bedard & Allison Witman
Review of Economics of the Household, December 2020, Pages 1101–1129


We document the large, excess male-female gap in ADHD diagnosis and treatment rates for non-traditional families. Pre-teen boys in traditional families are 2.9 percentage points more likely to have been medicated for ADHD in the past two years than girls in traditional families, while the same gap for non-traditional families is 5.4 percentage points. We also document a similar pattern of boys in non-traditional families for ADHD-related outcomes such as attention span, learning disability, emotional difficulties and unhappiness. Examining alternative pathways to family structure, we rule out typical forms of disadvantage but find that school policies may interact with family structure to increase the male ADHD diagnosis and medication gap. We also highlight an important limitation of the family fixed effects models often used in family structure research, showing that the largest effects are for only children.


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