Using machine learning to link electronic health records in cancer registries: On the tradeoff between linkage quality and manual effort

BACKGROUND

Cancer registries link a large number of electronic health records reported by medical institutions to already registered records of the matching individual and tumor. Records are automatically linked using deterministic and probabilistic approaches; machine learning is rarely used. Records that cannot be matched automatically with sufficient accuracy are typically processed manually. For application, it is important to know how well record linkage approaches match real-world records and how much manual effort is required to achieve the desired linkage quality. We study the task of linking reported records to the matching registered tumor in cancer registries.

METHODS

We compare the tradeoff between linkage quality and manual effort of five machine learning methods (logistic regression, random forest, gradient boosting, neural network, and a stacked method) to a deterministic baseline. The record linkage methods are compared in a two-class setting (no-match/ match) and a three-class setting (no-match/ undecided/ match). A cancer registry collected and linked the dataset consisting of categorical variables matching 145,755 reported records with 33,289 registered tumors.

RESULTS

In the two-class setting, the gradient boosting, neural network, and stacked models have higher accuracy and F1 score (accuracy: 0.968-0.978, F1 score: 0.983-0.988) than the deterministic baseline (accuracy: 0.964, F1 score: 0.980) when the same records are manually processed (0.89% of all records). In the three-class setting, these three machine learning methods can automatically process all reported records and still have higher accuracy and F1 score than the deterministic baseline. The linkage quality of the machine learning methods studied, except for the neural network, increase as the number of manually processed records increases.

CONCLUSION

Machine learning methods can significantly improve linkage quality and reduce the manual effort required by medical coders to match tumor records in cancer registries compared to a deterministic baseline. Our results help cancer registries estimate how linkage quality increases as more records are manually processed.

Beyond the smoke: Historical analysis of the revenue implications of state cigarette tax policies, 1989 to 2019

INTRODUCTION

While cigarette taxes are a vital tobacco control tool, their impact on cigarette tax revenue has been largely understudied in the extant literature. This study examines how the level of cigarette taxes affects the revenue generated from cigarettes in the United States over a thirty-year period.

METHODS

We obtained the Tax Burden Data from the Centers for Disease Control and Prevention (1989-2019). Our dependent variables were gross cigarette tax revenue and per capita gross cigarette tax revenue, and our independent variable was state tax per pack. We used two-way fixed effects to estimate the relationship between state cigarette tax revenue and cigarette taxes, adjusting for state-level sociodemographic characteristics, state-fixed effects, and time trends.

RESULTS

The study reveals that raising cigarette state tax by 10 % led to a 7.2 % to 7.5 % increase in cigarette tax revenue. We also found state and regional variation in taxes and revenue, with the Northeast region having the highest taxes per pack and tax revenues. In 2019, most states had low or moderate taxes per pack and tax revenues per capita, while a few states had high taxes per pack and tax revenues per capita.

CONCLUSIONS

Our research demonstrates the positive impact of increased cigarette taxes on state tax revenue over three decades. Not only do higher taxes aid in tobacco control, but they also enhance state revenues that can be reinvested in state initiatives. Some states could potentially optimize their tax rates.

A person-centered approach to financial capacity: early memory loss, financial management and decision-making

OBJECTIVES

Previous research has noted that a person-centered approach to financial capacity assessment is feasible. This study of personal finance included a review of 12 months of checking account statements followed by research interviews to investigate income, spending, financial literacy, and financial decision-making. The objective of the study was to determine the convergent validity of excess spending to contextual aspects of financial decision-making, financial literacy, and early memory loss.

METHOD

Participants were 114 adults over the age of 60 who came primarily from two research registries; the Healthier Black Elders registry and the Michigan Alzheimer's Disease Research Center registry. After sharing their checking statements participants completed two telephone interviews. Bivariate and multivariate analyses were used to compare those with no memory loss to the memory loss group, and to determine which measures were significantly related to excess spending.

RESULTS

There was a significant difference in excess spending between those with early memory loss and those with no memory loss. There was a significant difference in financial decision-making risk scores between the groups, as well as on a memory measure and a financial literacy measure. In a hierarchical regression analysis financial decision-making was the only measure significantly related to excess spending.

CONCLUSION

This study documented the convergent validity of person-centered measures of personal spending and financial decision-making with early memory loss. Early memory loss was related to both excess spending and contextual aspects of financial decision-making.

Attribute latencies causally shape intertemporal decisions

Intertemporal choices - decisions that play out over time - pervade our life. Thus, how people make intertemporal choices is a fundamental question. Here, we investigate the role of attribute latency (the time between when people start to process different attributes) in shaping intertemporal preferences using five experiments with choices between smaller-sooner and larger-later rewards. In the first experiment, we identify attribute latencies using mouse-trajectories and find that they predict individual differences in choices, response times, and changes across time constraints. In the other four experiments we test the causal link from attribute latencies to choice, staggering the display of the attributes. This changes attribute latencies and intertemporal preferences. Displaying the amount information first makes people more patient, while displaying time information first does the opposite. These findings highlight the importance of intra-choice dynamics in shaping intertemporal choices and suggest that manipulating attribute latency may be a useful technique for nudging.

Assessing the properties of patient-specific treatment effect estimates from causal forest algorithms under essential heterogeneity

BACKGROUND

Treatment variation from observational data has been used to estimate patient-specific treatment effects. Causal Forest Algorithms (CFAs) developed for this task have unknown properties when treatment effect heterogeneity from unmeasured patient factors influences treatment choice - essential heterogeneity.

METHODS

We simulated eleven populations with identical treatment effect distributions based on patient factors. The populations varied in the extent that treatment effect heterogeneity influenced treatment choice. We used the generalized random forest application (CFA-GRF) to estimate patient-specific treatment effects for each population. Average differences between true and estimated effects for patient subsets were evaluated.

RESULTS

CFA-GRF performed well across the population when treatment effect heterogeneity did not influence treatment choice. Under essential heterogeneity, however, CFA-GRF yielded treatment effect estimates that reflected true treatment effects only for treated patients and were on average greater than true treatment effects for untreated patients.

CONCLUSIONS

Patient-specific estimates produced by CFAs are sensitive to why patients in real-world practice make different treatment choices. Researchers using CFAs should develop conceptual frameworks of treatment choice prior to estimation to guide estimate interpretation ex post.

The (temporary) Covid-19 baby bust in Mexico

In this paper, we investigate whether fertility and newborn health changed during the Covid-19 pandemic in Mexico. We use national administrative data and an event-study design to examine the impact of the Covid-19 pandemic on fertility and newborn health characteristics. Our findings suggest that Mexico's fertility declined temporarily as measured by conceptions that likely occurred during the stay-at-home order. Initially, the general fertility rate fell by 11-12 per cent but quickly rebounded and returned close to its original levels by the end of 2021. Newborn health also deteriorated during the pandemic. Instances of low birthweight and prematurity substantially increased, with both remaining elevated over the entire pandemic period.

A new look at physicians' responses to financial incentives: Quality of care, practice characteristics, and motivations

There is considerable controversy about what causes (in)effectiveness of physician performance pay in improving the quality of care. Using a behavioral experiment with German primary-care physicians, we study the incentive effect of performance pay on service provision and quality of care. To explore whether variations in quality are based on the incentive scheme and the interplay with physicians' real-world profit orientation and patient-regarding motivations, we link administrative data on practice characteristics and survey data on physicians' attitudes with experimental data. We find that, under performance pay, quality increases by about 7pp compared to baseline capitation. While the effect increases with the severity of illness, the bonus level does not significantly affect the quality of care. Data linkage indicates that primary-care physicians in high-profit practices provide a lower quality of care. Physicians' other-regarding motivations and attitudes are significant drivers of high treatment quality.

Risk preferences over health: Empirical estimates and implications for medical decision-making

Mainstream health economic theory implies that an expected gain in health-related quality of life (HRQoL) produces the same value for consumers, regardless of baseline health. Several strands of recent research call this implication into question. Generalized Risk-Adjusted Cost-Effectiveness (GRACE) demonstrates theoretically that baseline health status influences value, so long as consumers are not risk-neutral over health. Prior empirical literature casts doubt on risk-neutral expected utility-maximization in the health domain. We estimate utility over HRQoL in a nationally representative U.S. population and use our estimates to measure risk preferences over health. We find that individuals are risk-seeking at low levels of health, become risk-averse at health equal to 0.485 (measured on a 0-1 scale), and are most risk-averse at perfect health (coefficient of relative risk aversion = 4.51). We develop the resulting implications for medical decision making, cost-effectiveness analyses, and the proper theory of health-related decision making under uncertainty.

How Does Enlistment Motivation Shape Organizational Commitment? The Role of Career Identity and Organizational Support

This study, based on the integrative model of commitment and motivation and organizational support theory, examined the mechanism of intrinsic and extrinsic enlistment motivation on three facets of organizational commitment. A three-wave field questionnaire survey was conducted among 1606 Reserve Officers' Training Corps cadets from Chinese universities. The results showed that both intrinsic and extrinsic motivation positively predicted affective commitment, normative commitment, and continuous commitment. The positive effect of intrinsic motivation was stronger than extrinsic motivation. However, the interactive effect of intrinsic and extrinsic motivation negatively predicted the three aspects of organizational commitment. Career identity mediated all the direct effects above. Moreover, organizational support moderated the effects of intrinsic and extrinsic motivation on career identity. When organizational support was low, the positive effect of intrinsic motivation on career identity was stronger; whereas, when organizational support was high, the positive effect of extrinsic motivation on career identity was stronger. Furthermore, extrinsic motivation and organizational support jointly moderated the effect of intrinsic motivation on career identity and the mediating effects between intrinsic motivation and the three facets of organizational commitment. Specifically, when extrinsic motivation and organizational support were low, the direct and mediating effects above were stronger.

Research on the impact and mechanism of digital capabilities and digital finance on household wealth in the context of aging

China has entered a period of synchronous development between digitalization and aging. Based on the data from the China Household Finance Survey (CHFS), the partial least squares structural equation model (PLS-SEM) and multi-group analysis were used to analyze the impact mechanism of digital capabilities and digital finance on the wealth of elderly households. The results indicate that digital capabilities and digital finance can improve the wealth level of households headed by the elderly through direct and indirect paths. The indirect effects of digital capabilities and digital finance on elderly household wealth are all exerted through the node of business and property income, and entrepreneurship/investment are mediating variables. Moreover, digital capabilities have a greater impact on the wealth of elderly households in the central and western China regions, while digital finance has a greater impact in the eastern China regions. In addition, there is no significant difference in the effect of digital capabilities on business and property income across regions, while digital finance has a larger effect in the eastern region. The above conclusions can provide theoretical and practical support for realizing active aging and common prosperity in different countries and regions.

Novel linkage approach to join community-acquired and national data

BACKGROUND

Community optometrists in Scotland have performed regular free-at-point-of-care eye examinations for all, for over 15 years. Eye examinations include retinal imaging but image storage is fragmented and they are not used for research. The Scottish Collaborative Optometry-Ophthalmology Network e-research project aimed to collect these images and create a repository linked to routinely collected healthcare data, supporting the development of pre-symptomatic diagnostic tools.

METHODS

As the image record was usually separate from the patient record and contained minimal patient information, we developed an efficient matching algorithm using a combination of deterministic and probabilistic steps which minimised the risk of false positives, to facilitate national health record linkage. We visited two practices and assessed the data contained in their image device and Practice Management Systems. Practice activities were explored to understand the context of data collection processes. Iteratively, we tested a series of matching rules which captured a high proportion of true positive records compared to manual matches. The approach was validated by testing manual matching against automated steps in three further practices.

RESULTS

A sequence of deterministic rules successfully matched 95% of records in the three test practices compared to manual matching. Adding two probabilistic rules to the algorithm successfully matched 99% of records.

CONCLUSIONS

The potential value of community-acquired retinal images can be harnessed only if they are linked to centrally-held healthcare care data. Despite the lack of interoperability between systems within optometry practices and inconsistent use of unique identifiers, data linkage is possible using robust, almost entirely automated processes.

Socioeconomic Disparities in Surgical Care for Congenital Hand Differences

BACKGROUND

The purpose of this study was to evaluate the influence of socioeconomic factors on access to congenital hand surgery care, hospital admission charges, and analyze these geographic trends across regions of the country.

METHODS

Retrospective cohort study was conducted of congenital hand surgery performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Multivariate regression was used to analyze the impact of socioeconomic factors.

RESULTS

During the study interval, 5531 pediatric patients underwent corrective surgery for congenital hand differences, including syndactyly repair (n = 2439), polydactyly repair (n = 2826), and pollicization (n = 266). Patients underwent surgery at significantly earlier age when treated at above-median case volume hospitals (P < .001). Patients with above-median income (P < .001), non-white race (P < .001), commercial insurance (P < .001), living in an urban community (P < .001), and not living in an underserved area (P < .001) were more likely to be treated at high-volume hospitals. Nearly half of patients chose to seek care at a distant hospital rather than the one locally available (49.5%, n = 1172). Of those choosing a distant hospital, most patients chose a higher-volume facility (80.9%, n = 948 of 1172). On multivariate regression, white patients were significantly more likely to choose a more distant, higher-volume hospital (P < .001).

CONCLUSIONS

Socioeconomic and geographic factors significantly contribute to disparate access to congenital hand surgery across the country. Patients with higher socioeconomic status are more likely to be treated at high-volume hospitals. Treatment at hospitals with higher case volume is associated with earlier age at surgery and decreased hospital admission charges.

Do risk, time and prosocial preferences predict risky sexual behaviour of youths in a low-income, high-risk setting?

Young people in sub-Saharan Africa are particularly at high risk of sexually transmitted infections. Little is known about their preferences and even less about their association with risky sexual behaviour. We conducted incentivized economic experiments to measure risk, time and prosocial preferences in Zimbabwe. Preferences measured at baseline predict biomarker and self-reported measures of risky sexual behaviour gathered 12 months later. We find robust evidence that individuals more altruistic at baseline are more likely to be Herpes Simplex Virus Type-2 (HSV-2) positive 12 months later. Analysis by sex shows this association is driven by our sample of women. Having more sexual partners is associated with greater risk tolerance amongst men and greater impatience amongst women. Results highlight heterogeneity in the association between preferences and risky sexual behaviour.

People are less myopic about future than past collective outcomes

Myopia involves giving disproportionate weight to outcomes that occur close to the present. Myopia in people's evaluations of political outcomes and proposals threatens effective policymaking. It can lead to inefficient spending just before elections, cause inaction on important future policy challenges, and create incentives for government interventions aimed at boosting short-term performance at the expense of long-term welfare. But, are people generally myopic? Existing evidence comes mostly from studies that disregard either the future or collective outcomes. Political science characterizes people as myopic based on how they retrospectively evaluate collective outcomes, such as the state of the economy. Behavioral economics and psychology find that people make myopic choices involving future individual outcomes, such as money or personal health. To characterize myopia more generally, we offer two innovations: First, we adapt measurement approaches from behavioral economics and psychology to precisely gauge myopia over politically relevant collective outcomes. Second, we estimate myopia using the same approach for collective political outcomes in both past and future. We conduct two surveys on three different samples (including a large probability-based sample) asking respondents to evaluate national conditions randomly described as past or future while holding constant the domain, information about conditions, and the elicitation method. Results show that prospective evaluations are significantly less myopic than retrospective evaluations. People are often not myopic at all when looking to the future. This surprising pattern calls for more research to probe its robustness and spell out how low prospective myopia might lead to forward-looking policy.

Impact of financial literacy on household stock profit level in China

The popularization of financial literacy has become a global trend, with governments across the world expressing commitment to continuously enhancing the financial literacy of their citizens to improve the country's overall financial well-being. However, there is a lack of research evaluating the actual effects of financial literacy on Chinese households. This study first investigated the micro impact of financial literacy on the household stock profit level using data from the 2019 China Household Finance Survey. As most existing studies use factor analysis to measure financial literacy from a single dimension of financial knowledge, our study additionally used the entropy method to construct a composite evaluation system of financial literacy from four dimensions: financial skills, knowledge, attitudes, and behaviors. The ordinary least squares model was utilized as the primary regression model to estimate the correlation, and the average financial literacy of other households in the same community was selected as an instrumental variable. Further instrumental variable regression analysis was conducted using the two-stage least squares method. Three robustness tests were performed to ensure the reliability of the research findings. The results demonstrate that financial literacy significantly enhances household stock profit levels. The mediation effect analysis indicates that financial literacy affects stock profit levels through financial information attention. Moreover, financial literacy has a more substantial promoting effect on stock profit levels for households with members working for state-owned enterprises and those living in first-tier cities. This study confirms the value of financial literacy; identifies important channels for residents to increase their property income; and provides important guidance for the government, educational organizations, and financial institutions. This also injects more vigor into market participation to improve the persistently sluggish Chinese stock market.

Do Tobacco Companies Have an Incentive to Promote "Harm Reduction" Products?: The Role of Competition

INTRODUCTION

Some cigarette companies have started to talk about replacing cigarettes with less harmful alternatives, which might include nicotine vaping products (NVPs), heated tobacco products (HTPs), and oral nicotine delivery products. We consider market competition as a primary driver of whether cigarette companies follow through on their stated intentions.

AIMS AND METHODS

We focus on the behavior of cigarette companies in the United States. We compare competition in the pre- and post-2012 time periods, analyze the impact of the growth in NVPs on smoking prevalence and cigarette company profits, and examine the potential future role of competition.

RESULTS

Since 2006, consumers have broadened their use of non-combustible nicotine delivery products (NCNDPs) to include, inter alia, NVPs, HTPs, and oral nicotine pouches. U.S. cigarette companies have acquired major stakes in each of these product categories which corresponds to a period of rapidly declining adult smoking prevalence, especially among younger adults (ages 18-24 years). The shifting dynamics of the nicotine product marketplace are also reflected in cigarette company stock prices. While cigarette companies are likely to promote HTPs and nicotine delivery products over NVPs, their incentives will be directly related to competition from independent firms, which in turn will depend on government regulation.

CONCLUSIONS

Although cigarette companies will back alternatives to combusted tobacco when threatened by competition, the prospects for their lasting conversion to NCNDPs will depend on the extent of such competition, which will be influenced by government regulation of tobacco products.

IMPLICATIONS

Regulations that limit competition from independent firms while also protecting cigarette company profits risk slowing or even reversing recent declines in smoking, especially among youth and young adults. Regulations that reduce the appeal and addictiveness of combusted tobacco products, such as higher cigarette taxes or a reduced nicotine standard, will encourage smokers to quit and/or switch to less harmful non-combusted forms of tobacco. The regulation of non-combustible nicotine delivery products and cigarettes should be proportionate to their relative risks, so that smokers have incentives to switch from combustibles to safer alternatives, and cigarette companies have incentives to promote safer products.

CenSoc: Public Linked Administrative Mortality Records for Individual-level Research

In the United States, much has been learned about the determinants of longevity from survey data and aggregated tabulations. However, the lack of large-scale, individual-level administrative mortality records has proven to be a barrier to further progress. We introduce the CenSoc datasets, which link the complete-count 1940 U.S. Census to Social Security mortality records. These datasets-CenSoc-DMF (N = 4.7 million) and CenSoc-Numident (N = 7.0 million)-primarily cover deaths among individuals aged 65 and older. The size and richness of CenSoc allows investigators to make new discoveries into geographic, racial, and class-based disparities in old-age mortality in the United States. This article gives an overview of the technical steps taken to construct these datasets, validates them using external aggregate mortality data, and discusses best practices for working with these datasets. The CenSoc datasets are publicly available, enabling new avenues of research into the determinants of mortality disparities in the United States.

Know thyself: Executive functioning and sex predict self-appraisal of functional abilities in community-dwelling older adults

Objective: The capacity for accurate self-appraisals of age-related changes in cognitive and functional abilities is integral to the maintenance of independence in later life, yet there is little understanding of the factors that place nondemented older adults at risk for poor self-awareness. This study examined the potential contributions of executive functioning (EF), crystallized intelligence (IQ-Cr), and sex in predicting congruence between performance and self-appraisals of instrumental activities of daily living (IADL) in a group of community-dwelling older adults. Method: A group of 150 nondemented, community-dwelling older adults (White and majority highly educated) completed measures of EF and IQ-Cr. Participants also completed five timed IADL tasks and self-appraised their performance relative to others of similar age. Results: Sex [F(1,148)  =  7.75, p = .006, ηp2 = .05] and EF [(F(1,147) = 5.30, p = .02, ηp2 = .04)], but not IQ-Cr, predicted the relationship between performance and self-appraisals, such that those with lower EF and those of male sex overestimated their performance more than those with higher EF and females. Conclusions: Findings indicate that having average to below average EF abilities and being of male sex are risk factors for less accurate self-report of IADL abilities and as such might represent important considerations when assessing IADL abilities via self-report among largely independent, community-dwelling older adults.

Age-dependent differences in using FinTech products and services-Young customers versus other adults

The purpose of this paper was to identify and evaluate differences in the attitudes to using FinTech products and services in Poland adopted by two study cohorts-one comprised of young customers, born no earlier than in 1990, and the other comprised of other adults. The main motivation for our research was to answer the question if young people growing up in the market economy will behave differently in the use of FinTech than older generations living in the former political and economic system. We also wanted to find the factors that determine the perception and willingness to use FinTech in the mentioned age groups. The data discussed in the paper were provided by the CAWI survey that was conducted in 2020 and covered a sample of 1,153 adult Poles. To achieve our goal, we used nonparametric statistical testing and the backward stepwise logistic regression models. The research demonstrated that young customers showed considerably more interest in all the aspects of the use of FinTech within the framework of our study than the other adults. Regarding the experience of using FinTech, such determinants as the male gender, the larger household in which a given respondent lives, and the possibility of making financial decisions independently exerted more impact on the young customers cohort than on the other adults. Irrespective of their opinion about FinTech, the persons under 30 years of age are more likely to use FinTech beyond average than the other adults whereas the persons over 30 years of age will do so only if they evaluate FinTech very well.

The Role of Healthy Diet and Lifestyle in Centenarians

Life expectancy at birth (hereafter, life expectancy) and longevity are established indicators of population health [...].

The availability of non-instrumental information increases risky decision-making

Contemporary models of decision-making under risk focus on estimating the final value of each alternative course of action. According to such frameworks, information that has no capacity to alter a future payoff (i.e., is "non-instrumental") should have little effect on one's preference for risk. Importantly, however, recent work has shown that information, despite being non-instrumental, may nevertheless exert a striking influence on behavior. Here, we tested whether the opportunity to passively observe the sequence of events following a decision could modulate risky behavior, even if that information could not possibly influence the final result. Across three experiments, 71 individuals chose to accept or reject gambles on a five-window slot machine. If a gamble was accepted, each window was sequentially revealed prior to the outcome being declared. Critically, we informed participants about which windows would subsequently provide veridical information about the gamble outcome, should that gamble be accepted. Our analyses revealed three key findings. First, the opportunity to observe the consequences of one's choice significantly increased the likelihood of gambling, despite that information being entirely non-instrumental. Second, this effect generalized across different stakes. Finally, choices were driven predominantly by the likelihood that information could result in an earlier resolution of uncertainty. These findings demonstrate the importance of anticipatory information to decision-making under risk. More broadly, we provide strong evidence for the utility of non-instrumental information, by demonstrating its capacity to modulate primary economic decisions that should be driven by more motivationally salient variables associated with risk and reward.

"If I don't have credit, I don't have anything": Perspectives on the credit scoring system among mothers with low incomes

This mixed-methods study examines consumer perspectives on the credit scoring system drawn from in-depth interviews with 72 mothers with low incomes and national survey data from the National Financial Capability Study. Interviewees express strong awareness of credit scoring and a desire to have good credit. National survey data corroborate these findings, showing that most mothers with low incomes are knowledgeable about their credit scores. They know what behaviors improve credit standing and recognize the tradeoffs between present consumption and longer-run goals. They do not reject the credit scoring system's legitimacy and seek to work within this system to pursue their financial goals, despite obstacles to success. This evidence enriches our understanding of the perspectives and values that motivate consumer financial behaviors and highlights the systemic challenges to people's financial well-being that are embedded in a seemingly widely accepted credit scoring system.

Financial Fraud and Deception in Aging

Financial exploitation among older adults is a significant concern with often devastating consequences for individuals and society. Deception plays a critical role in financial exploitation, and detecting deception is challenging, especially for older adults. Susceptibility to deception in older adults is heightened by age-related changes in cognition, such as declines in processing speed and working memory, as well as socioemotional factors, including positive affect and social isolation. Additionally, neurobiological changes with age, such as reduced cortical volume and altered functional connectivity, are associated with declining deception detection and increased risk for financial exploitation among older adults. Furthermore, characteristics of deceptive messages, such as personal relevance and framing, as well as visual cues such as faces, can influence deception detection. Understanding the multifaceted factors that contribute to deception risk in aging is crucial for developing interventions and strategies to protect older adults from financial exploitation. Tailored approaches, including age-specific warnings and harmonizing artificial intelligence as well as human-centered approaches, can help mitigate the risks and protect older adults from fraud.

Overweight grandsons and grandfathers' starvation exposure

Much of the increase in the prevalence of overweight and obesity has been in developing countries with a history of famines and malnutrition. This paper is the first to examine overweight among adult grandsons of grandfathers exposed to starvation during developmental ages. I study grandsons born to grandfathers who served in the Union Army during the US Civil War (1861-5) where some grandfathers experienced severe net malnutrition because they suffered a harsh POW experience. I find that male-line but not female-line grandsons of grandfathers who survived a severe captivity during their growing years faced a 21% increase in mean overweight and a 2% increase in mean BMI compared to grandsons of non-POWs. Male-line grandsons descended from grandfathers who experienced a harsh captivity faced a 22%-28% greater risk of dying every year after age 45 relative to grandsons descended from non-POWs, with overweight accounting for 9%-14% of the excess risk.

Model uncertainty quantification in Cox regression

We consider covariate selection and the ensuing model uncertainty aspects in the context of Cox regression. The perspective we take is probabilistic, and we handle it within a Bayesian framework. One of the critical elements in variable/model selection is choosing a suitable prior for model parameters. Here, we derive the so-called conventional prior approach and propose a comprehensive implementation that results in an automatic procedure. Our simulation studies and real applications show improvements over existing literature. For the sake of reproducibility but also for its intrinsic interest for practitioners, a web application requiring minimum statistical knowledge implements the proposed approach.

Childhood Obesity and Health Care Utilization: Empirical Evidence from Austrian Administrative Data

Background: Increases in pediatric obesity have been associated with higher levels of health care utilization. There is currently a lack of knowledge on the therapeutic drivers of increased health care use. Objective: To examine the association between different measures of health care utilization and BMI among children. Methods: We linked cross-sectional administrative data from a regional health insurance fund in Austria with objectively measured BMI from routine school health examinations in 6-15-year-old children (n = 13,493). Differences in probabilities of annual health care utilization (drug prescriptions by therapeutic classification, physician visits by medical specialty, and hospitalizations) were compared between children with normal weight, overweight, or obesity using Probit regressions. Results: Children with obesity had a 1.6 and 8.6 percentage points (pp) higher probability of outpatient doctor visits and prescribed medication, respectively (all p < 0.05). Children with overweight were intermediate. There was a higher probability of consulting a general practitioner, pediatrician, or orthopedist, and higher levels of prescribing for children with obesity across most common drug groups. Children with obesity were ∼40% more likely to receive medication for musculoskeletal and for mental health problems. This was reflected in orthopedic clinic appointments but not in psychology clinics. There were no major differences by gender or age, or parental socioeconomic status. Conclusions: Our data show clear and objective evidence of higher health care utilization by children with obesity. This highlights the importance of policy interventions to curb obesity in children and young people.

Assessing financial literacy and food and nutritional security relationship in an African country

This study investigates the relationship between rural Ghanaian household food and nutrition security and financial literacy. We used the endogenous treatment regression (ETR) technique to address the analysis's potential selection bias problem. The findings of our study demonstrated a beneficial relationship between food and nutrition security and financial literacy. According to further studies, the relationship between food security and financial literacy is heterogeneous. Our findings may have some ramifications for promoting food and nutritional security while preserving rural development methods.

Clarifying Eudaimonia and Psychological Functioning to Complement Evaluative and Experiential Well-Being: Why Basic Psychological Needs Should Be Measured in National Accounts of Well-Being

Measuring subjective well-being as a key indicator of national wellness has increasingly become part of the international agenda. Current recommendations for measuring well-being at a national level propose three separate dimensions: evaluative well-being, experiential well-being, and eudaimonia. Whereas the measurement of the first two dimensions is relatively standardized, the third category has remained undertheorized, lacking consensus on how to define and operationalize it. To remedy the situation, we propose that the third dimension should focus on psychological functioning and the identification of key psychological factors humans generally need to live well. A key part of psychological functioning is the satisfaction of basic psychological needs-specific types of satisfying experiences that are essential for psychological health and well-being. Psychological needs as a category provides a parsimonious set of elements with clear inclusion criteria that are strongly anchored in theory and our current understanding of human nature-and could thus form a core part of the third, "eudaimonic" dimension of well-being. The needs for autonomy, competence, and relatedness have especially received broad empirical support. Accordingly, national accounts of well-being should include measures for key psychological needs to gain an enriched and practically useful understanding of the well-being of the citizens.

Biological Differences between Late 19th and Early 20th Century Urban and Rural Residence

Communities urbanize when the net benefits to urbanization exceed rural areas. Body mass, height, and weight are biological welfare measures that reflect the net difference between calories consumed and calories required for work and to withstand the physical environment. Individuals of African-decent had greater BMIs, heavier weights, and shorter statures. Urban farmers had lower BMIs, shorter statures, and lower weight than rural farmers. Over the late 19th and early 20th centuries, urban and rural BMIs, height, and weight were constant, and rural farmers had greater BMIs, taller statures, and heavier weights than urban farmers and workers in other occupations.

Well-Being and Aging-Related Decline in Financial and Health Literacy in Advanced Age

OBJECTIVES

Emerging evidence suggests that financial and health literacy deteriorates in advanced age. By contrast, well-being promotes health in aging. This study tested the hypothesis that well-being is associated with slower aging-related literacy decline.

METHODS

Participants were 1,099 community-based older adults without dementia at baseline. Financial and health literacy was assessed at baseline and annually thereafter via a 32-item measure. Well-being was assessed at baseline via the 18-item version of Ryff's Scales of Psychological Well-Being.

RESULTS

During up to 12 years of annual follow-up, literacy declined about 1 percentage point per year on average (β = -0.91, standard error [SE] = 0.08, p < .001); however, there was considerable variation in change in literacy between participants (random slopes variance = 1.24, SE = 0.15, p < .001). In a linear mixed-effects model adjusted for age, sex, and education, higher well-being was associated with higher starting level of literacy (β = 2.31, SE = 0.67, p = .001) and, critically, slower literacy decline (β = 0.29, SE = 0.11, p = .01). The association of higher well-being with slower literacy decline persisted in models that additionally adjusted for income, medical conditions, depressive symptoms, and a robust measure of global cognition.

DISCUSSION

This study suggests that well-being helps stave off aging-related literacy decline.

The Creation of LIFE-M: The Longitudinal, Intergenerational Family Electronic Micro-Database Project

This paper describes the creation of the Longitudinal, Intergenerational Family Electronic Micro-Database (LIFE-M), a new data resource linking vital records and decennial censuses for millions of individuals and families living in the late 19th and 20th centuries in the United States. This combination of records provides a life-course and intergenerational perspective on the evolution of health and economic outcomes. Vital records also enable the linkage of women, because they contain a crosswalk between women's birth (i.e., "maiden") and married names. We describe (1) the data sources, coverage, and linking sequence; (2) the process and supervised machine-learning methods to linking records longitudinally and across generations; and (3) the resulting linked samples, including linking rates, representativeness, and weights.

The Hippocampus Contributes to Temporal Discounting When Delays and Rewards Are Experienced in the Moment

Temporal discounting (TD) represents the mental devaluation of rewards that are available after a delay. Whether the hippocampus is critical for TD remains unclear, with marked discrepancies between animal and human studies: although animals with discrete hippocampal lesions display impaired TD, human participants with similar lesions show intact performance on classic intertemporal choice tasks. A candidate explanation for this discrepancy is that delays and rewards are experienced in the moment in animal studies but tend to be hypothetical in human studies. We tested this hypothesis by examining the performance of amnesic participants with hippocampal lesions (one female, six males) on a novel experiential intertemporal choice task that used interesting photographs occluded by thick lines as rewards (Patt et al., 2021). Using a logistic function to model indifference points data, we compared performance to that on a classic intertemporal choice task with hypothetical outcomes. Participants with hippocampal lesions displayed impaired patterns of choices in the experiential task but not in the hypothetical task. Specifically, hippocampal lesions were associated with decreased amplitude of the delay-reward trade-off, with persistent choice of the delayed option despite delay increase. These results help explain previous discrepancies across animal and human studies, indicating that the hippocampus plays a critical role in temporal discounting when the outcomes of decisions are experienced in the moment, but not necessarily when they are hypothetical.SIGNIFICANCE STATEMENT Impaired temporal discounting (TD) has been related to maladaptive behaviors, including substance dependence and nonadherence to medical treatment. There is consensus that TD recruits the brain valuation network but whether the hippocampal memory system is additionally recruited remains unclear. This study examined TD in hippocampal amnesia, providing a unique opportunity to explore the role of the hippocampus in cognition. Whereas most human studies have used hypothetical outcomes, this study used a novel experiential task with real-time delays and rewards. Results demonstrated hippocampal involvement in the experiential task, but not in a classic hypothetical task administered for comparison. These findings elucidate previous discrepancies between animal and human TD studies. This reconciliation is critical as animals serve as models of human neurocognition.

An economic model and evidence of the evolution of human intelligence in the Middle Pleistocene: Climate change and assortative mating

A main objective of this paper is to provide the first model of how climate change, working through sexual selection, could have led to dramatic increases in hominin brain size, and presumably intelligence, in the Middle Pleistocene. The model is built using core elements from the field of family economics, including assortative mating and specialization and complementarities between mates. The main assumptions are that family public goods (e.g., conversation, shelter, fire) were particularly cognitively intensive to produce and became increasingly important for child survival during glacial phases. Intermediate climates (e.g., not the depths of severe glacial phases) create the largest gains from specialization, encouraging negative assortative mating. In contrast, severe glacial phases encourage positive assortative mating because of the rising importance of family public goods. One testable hypothesis is that absence of severe glacial phases should have led to stasis in brain size. Two other testable hypotheses are that severe glacial phases should have led to speciation events, as well as increases in brain size. The evidence shows that there was a million-year stasis in cranial size prior to the start of the severe glacial phases. This stasis is broken by a speciation event (Homo heidelbergensis), with the oldest fossil evidence dated near the close of the first severe glacial phase. In the next 300 kyr, there are two additional severe glacial phases, accompanied by considerable increases in cranial capacity. The last speciation event is Homo sapiens, with the earliest fossils dated near the end of the last of these two glacial phases.

Determinants of individuals' objective and subjective financial fragility during the COVID-19 pandemic

We examine determinants of the objective and subjective financial fragility of 2100 individuals across Australia, France, Germany, and South Africa during the COVID-19 pandemic. Objective financial fragility reflects individuals' (in)ability to deal with unexpected expenses, while subjective financial fragility reflects their emotional response to financial demands. Controlling for an extensive set of socio-demographics, we find that negative personal experiences during the pandemic (i.e., reduced or lost employment; COVID-19 infection) are associated with higher objective and subjective financial fragility. However, individuals' cognitive (i.e., financial literacy) as well as non-cognitive abilities (i.e., internal locus of control; psychological resilience) help to counteract this higher financial fragility. Finally, we examine the role of government financial support (i.e., income support; debt relief) and find that it is negatively related to financial fragility only for the economically weakest households. Our results have implications for public policymakers, providing levers for reducing individuals' objective and subjective financial fragility.

The effect of e-cigarette taxes on prepregnancy and prenatal smoking

E-cigarette taxes are an active area of legislation and have important regulatory implications by proxying e-cigarette accessibility. We examine the effect of e-cigarette taxes on prepregnancy and prenatal smoking using the near-universe of births to mothers conceiving between 2013 and 2019 in the United States. Using fixed effect regressions, we show that e-cigarette taxes increase prepregnancy and prenatal smoking. We also find evidence that e-cigarette taxes reduce prepregnancy and 3rd trimester e-cigarette use. Finally, we show that e-cigarette taxes increase news coverage of e-cigarettes and raise perceptions of risk of e-cigarettes.

Financial literacy, behavioral traits, and ePayment adoption and usage in Japan

This study investigates how financial literacy and behavioral traits affect the adoption of electronic payment (ePayment) services in Japan. We construct a financial literacy index using a representative sample of 25,000 individuals from the Bank of Japan's 2019 Financial Literacy Survey. We then analyze the relationship between this index and the extensive and intensive usage of two types of payment services: electronic money (e-money) and mobile payment apps. Using an instrumental variable approach, we find that higher financial literacy is positively associated with a higher likelihood of adopting ePayment services. The empirical results suggest that individuals with higher financial literacy use payment services more frequently. We also find that risk-averse people are less likely to adopt and use ePayment services, whereas people with herd behavior tend to adopt and use ePayment services more. Our empirical results also suggest that the effects of financial literacy on the adoption and use of ePayment differ among people with different behavioral traits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40854-023-00504-3.

Age differences in the neural basis of decision-making under uncertainty

Humans globally are reaping the benefits of longer lives. Yet, longer life spans also require engaging with consequential but often uncertain decisions well into old age. Previous research has yielded mixed findings with regards to life span differences in how individuals make decisions under uncertainty. One factor contributing to the heterogeneity of findings is the diversity of paradigms that cover different aspects of uncertainty and tap into different cognitive and affective mechanisms. In this study, 175 participants (53.14% females, mean age = 44.9 years, SD = 19.0, age range = 16 to 81) completed functional neuroimaging versions of two prominent paradigms in this area, the Balloon Analogue Risk Task and the Delay Discounting Task. Guided by neurobiological accounts of age-related changes in decision-making under uncertainty, we examined age effects on neural activation differences in decision-relevant brain structures, and compared these across multiple contrasts for the two paradigms using specification curve analysis. In line with theoretical predictions, we find age differences in nucleus accumbens, anterior insula, and medial prefrontal cortex, but the results vary across paradigm and contrasts. Our results are in line with existing theories of age differences in decision making and their neural substrates, yet also suggest the need for a broader research agenda that considers how both individual and task characteristics determine the way humans deal with uncertainty.

Gender Differences in Perceived Working Conditions of General Practitioners During the COVID-19 Pandemic-a Cross-Sectional Study

BACKGROUND

The ongoing COVID-19 pandemic has revealed gender-specific differences between general practitioners in adapting to the posed challenges. As primary care workforce is becoming increasingly female, in many countries, it is essential to take a closer look at gender-specific influences when the global health care system is confronted with a crisis.

OBJECTIVE

To explore gender-specific differences in the perceived working conditions and gender-specific differences in challenges facing GPs at the beginning of the COVID-19 pandemic in 2020.

DESIGN

Online survey in seven countries.

PARTICIPANTS

2,602 GPs from seven countries (Austria, Australia, Switzerland, Germany, Hungary, Italy, Slovenia). Of the respondents, 44.4% (n = 1,155) were women.

MAIN MEASURES

Online survey. We focused on gender-specific differences in general practitioners' perceptions of working conditions at the beginning of the COVID-19 pandemic in 2020.

KEY RESULTS

Female GPs rated their skills and self-confidence significantly lower than male GPs (f: 7.1, 95%CI: 6.9-7.3 vs. m: 7.6, 95%CI 7.4-7.8; p < .001), and their perceived risk (concerned about becoming infected or infecting others) higher than men (f: 5.7, 95%CI: 5.4-6.0 vs. m: 5.1, 95%CI: 4.8-5.5; p = .011). Among female GPs, low self-confidence in the treatment of COVID-19 patients appear to be common. Results were similar in all of the participating countries.

CONCLUSIONS

Female and male GPs differed in terms of their self-confidence when dealing with COVID-19-related issues and their perceptions of the risks arising from the pandemic. To ensure optimal medical care, it is important that GPs realistically assess their own abilities and overall risk.

Communicating risk: How relevant and irrelevant probabilistic information influences risk perception in medical decision-making

Patients rely on knowing potential risks before accepting medical treatments, but risk perception can be distorted by cognitive biases and irrelevant information. We examined the interactive effects of subjective processes, objective knowledge, and demographic characteristics on how individuals estimate risks when provided with relevant and irrelevant probabilistic information. Participants read medical scenarios describing potential adverse effects associated with declining and accepting preventative treatment, as well as the objective likelihood of experiencing adverse effects associated with one of these two courses of action. We found that the perceived negativity of outcomes influenced perceptions of risk regardless of whether relevant probabilities were available and that the use of affect heuristics to estimate risk increased with age. Introducing objective estimates ameliorated age-related increases in affective distortions. Sensitivity to relevant probabilities increased with greater perceived outcome severity and was greater for men than for women. We conclude that relevant objective information may reduce the propensity to conflate outcome severity with likelihood and that medical judgments of risk vary depending on exposure to relevant and irrelevant probabilities. Implications for how medical professionals should communicate risk information to patients are considered.

It's time to take a sustainable approach to health care in the face of the challenges of the 21st century

Health challenges in the 21st century have become increasingly complex and global. The recent COVID-19 pandemic has only exacerbated the many problems faced by health care systems around the world and sadly, exposed various flaws. With ageing populations, particularly in Canada, as well as unavoidable factors such as globalization and accelerating climate change, it is becoming imperative to implement a new health care approach based on intersectorality and interdisciplinarity. Furthermore, links must be forged between all the stakeholders, i.e. the researchers, the health system and its specialists, the communities and the individuals themselves. It is in this perspective, where everyone concerned must be equally involved in attaining a better quality of life, that the concepts of One Health and sustainable health must be deployed.

The impact of labour market shocks on mental health: evidence from the Covid-19 first wave

In this study, we estimate the effect of a negative labour market shock on individuals' levels of stress, anxiety, and depression. We use a dataset collected during the first wave of the Covid-19 pandemic, on a representative sample of citizens from Italy, Spain, and the United Kingdom, interviewed on three occasions. We measure stress, anxiety and depression and labour shocks using validated scales. Our research design is a standard difference-in-differences model: we leverage the differential timing of shocks to identify the impact on mental health. In our estimations, a negative labour shock increases the measure of stress, anxiety, and depression by 16% of a standard deviation computed from the baseline.

The intracortical myelin content of impulsive choices: results from T1- and T2-weighted MRI myelin mapping

Delay discounting (DD) refers to a phenomenon that humans tend to choose small-sooner over large-later rewards during intertemporal choices. Steep discounting of delayed outcome is related to a variety of maladaptive behaviors and is considered as a transdiagnostic process across psychiatric disorders. Previous studies have investigated the association between brain structure (e.g. gray matter volume) and DD; however, it is unclear whether the intracortical myelin (ICM) influences DD. Here, based on a sample of 951 healthy young adults drawn from the Human Connectome Project, we examined the relationship between ICM, which was measured by the contrast of T1w and T2w images, and DD and further tested whether the identified associations were mediated by the regional homogeneity (ReHo) of brain spontaneous activity. Vertex-wise regression analyses revealed that steeper DD was significantly associated with lower ICM in the left temporoparietal junction (TPJ) and right middle-posterior cingulate cortex. Region-of-interest analysis revealed that the ReHo values in the left TPJ partially mediated the association of its myelin content with DD. Our findings provide the first evidence that cortical myelination is linked with individual differences in decision impulsivity and suggest that the myelin content affects cognitive performances partially through altered local brain synchrony.

Numeracy, gist, literal thinking and the value of nothing in decision making

The onus on the average person is greater than ever before to make sense of large amounts of readily accessible quantitative information, but the ability and confidence to do so are frequently lacking. Many people lack practical mathematical skills that are essential for evaluating risks, probabilities and numerical outcomes such as survival rates for medical treatments, income from retirement savings plans or monetary damages in civil trials. In this Review, we integrate research on objective and subjective numeracy, focusing on cognitive and metacognitive factors that distort human perceptions and foment systematic biases in judgement and decision making. Paradoxically, an important implication of this research is that a literal focus on objective numbers and mechanical number crunching is misguided. Numbers can be a matter of life and death but a person who uses rote strategies (verbatim representations) cannot take advantage of the information contained in the numbers because 'rote' strategies are, by definition, processing without meaning. Verbatim representations (verbatim is only surface form, not meaning) treat numbers as data as opposed to information. We highlight a contrasting approach of gist extraction: organizing numbers meaningfully, interpreting them qualitatively and making meaningful inferences about them. Efforts to improve numerical cognition and its practical applications can benefit from emphasizing the qualitative meaning of numbers in context - the gist - building on the strengths of humans as intuitive mathematicians. Thus, we conclude by reviewing evidence that gist training facilitates transfer to new contexts and, because it is more durable, longer-lasting improvements in decision making.

Evolutionarily stable preferences

The 50-year old concept of an evolutionarily stable strategy provided a key tool for theorists to model ultimate drivers of behaviour in social interactions. For decades, economists ignored ultimate drivers and used models in which individuals choose strategies based on their preferences-a proximate mechanism for behaviour-and the distribution of preferences in the population was taken to be fixed and given. This article summarizes some key findings in the literature on evolutionarily stable preferences, which in the past three decades has proposed models that combine the two approaches: individuals inherit their preferences, the preferences determine their strategy choices, which in turn determine evolutionary success. One objective is to highlight complementarities and potential avenues for future collaboration between biologists and economists. This article is part of the theme issue 'Half a century of evolutionary games: a synthesis of theory, application and future directions'.