Macroeconomic conditions and health: Inspecting the transmission mechanism

Health status and the Great Recession. Evidence from electronic health records

We investigate the impact of the Great Recession in Italy on the incidence of chronic diseases using new individual longitudinal data from Electronic Health Records. We exploit the exogenous shock in the economic conditions occurred in 2008 to estimate heterogeneous effects of an unprecedented rise in local unemployment rates in an individual fixed-effects model. Our results document that harsh economic downturns have a negative long-lasting effect on cardiovascular disease and a temporary effect on depression. This effect is heterogeneous across gender, increases with age and is stronger right before the retirement age. An important policy recommendation emerging from this study is that prolonged economic downturns constitute an additional external risk for individual health and not a temporary benefit.

The business cycle, health behavior, and chronic disease: A study over Three decades

The effect of macroeconomic fluctuations on individual health remains highly debated. We estimate the effect of the business cycle on health and health behavior in the U.S. using the NLSY79 panel data for 11,406 respondents between 1979 and 2014. Most of our survey respondents have no chronic illness in 1979, and develop these conditions during the sample period. This allows us to estimate the true effect of economic fluctuation on the likelihood of developing chronic conditions. The results indicate a considerable difference in the cyclic variation of chronic diseases. After controlling for innate individual characteristics such as family health history, and unobserved regional characteristics, we find that obesity decreases during economic downturns, while diabetes, hypertension, and congestive heart failure increase. Sub-sample analyses show that Blacks are more likely to develop diabetes and hypertension and are less likely to develop obesity during economic downturns than other racial groups. The incidence of obesity declines during recessions for women, while males are more likely to develop diabetes. Income loss, particularly among Blacks, and lack of change in physical activity mediate these differential effects.

The association between unemployment trajectories and alcohol consumption patterns. Evidence from a large prospective cohort in The Netherlands

Unemployment is expected to influence alcohol consumption, but studies show mixed results, partly because most studies concentrate on current employment status. However, unemployment could be particularly consequential if it is part of a trajectory of employment precariousness. Moreover, the association between unemployment and alcohol consumption may not be homogeneous across the population, but differ by subgroups (e.g. socioeconomic status). This study longitudinally analyses the association between different employment trajectories and alcohol consumption, and examines if the association is moderated by socioeconomic status (SES), partner status, age and gender. Four waves of data of the Lifelines Cohort study are used. Sample consists of individuals from 18-50 years old, active in the labor market (n = 104,766) from the northern provinces of the Netherlands. Employment trajectories are defined by employment status in each wave, duration of unemployment, and number of exposures to unemployment. Drinking patterns are divided into "abstainers", "moderate drinking" (<1.5 drinks/day), "heavy drinking" (≥1.5 drinks/day) and "binge drinking" (≥5 drinks/occasion; 4 for women). The associations are estimated with multinomial logistic regression models. Results show that recent, long-term unemployment (≥ 6 months) is associated with higher rates of heavy drinking (RRR = 1.26 [95 % CI 1.03-1.54]), whereas short-term unemployment does not show any association with the outcome. Being continuously unemployed throughout the observation period shows a strong association with binge drinking (RRR = 1.43 [95 % CI 1.06-1.93]), as well as reporting 2 or more long unemployment spells (RRR = 1.49 [95 % CI 1.21-1.83]). The group of abstainers (77.95 % women) have significantly lower SES, and poorer health than their peers. For some individuals, recent unemployment increases the likelihood for abstinence (RRR = 1.23 [95 % CI 1.00-1.51]). Evidence suggests that length of unemployment is key in order to grasp its effects in terms of changing drinking patterns.

The mechanism between mortality, population growth and ageing of the population in the European lower and upper middle income countries

This paper analyses the effect of mortality rates (under-five and adult mortality) and population growth on the population ageing in a pooled sample of nine lower and upper middle European countries. Therefore, the main goal of this research is to investigate the ageing process of the population in the context of mortality mechanisms (under five and adult mortality) and of population growth in nine European LUMIs. The analysis is implemented in terms of Pooled least squares with cross-section fixed effects methodology. The novelty used within this research is White two-way cluster standard errors & covariance. This study is based on a database from the World Bank and UN covering the period 1995-2019. The expected results are making available quantitative analysis and insights in the context of mechanisms between the ageing process of population, mortality and population growth across these European LUMIs. Results are consistent with the notion that the increasing ageing process within these countries may be a consequence of the negative impact of population growth and from the influence of adult mortality for both sexes. The research results confirm the presence of solid ties of the mechanism between mortality, population growth and population ageing. Therefore, a clear point was provided that mortality acceleration will depend primarily on the level of population growth.

A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage

BACKGROUND

International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample.

METHODS

Records from a sample of the Scottish Longitudinal Study (N=86 500) were linked to monthly primary care antidepressant prescriptions (2009-15). Regional economic trends were characterized by annual full-time employment data (2004-14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010-15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms.

RESULTS

Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08-1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7-61%) of this association was explained by the impact of welfare benefit reforms on average incomes.

CONCLUSIONS

Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.

Leisure-time physical activity is associated with socio-economic status beyond income - Cross-sectional survey of the Northern Finland Birth Cohort 1966 study

We apply neoclassical economic modelling augmented with behavioral aspects to provide a detailed empirical investigation into indicators of socio-economic status (SES) as determinants of leisure-time physical activity. We utilize the data from the Northern Finland Birth Cohort 1966 obtained at the most recent time point during 2012-2014 (response rate 67 %), at which time the participants were approximately 46 years old. Our final study sample consists of 3,335 employed participants (1520 men, 1815 women; 32.3 % of the target population). We apply logistic regression methods for estimating how the probability of being physically active is related to various indicators of socio-economic status, taking into account physical activity at work and individual lifestyle, family- and health-related factors. Overall, our findings show that belonging to a higher socio-economic group, whether defined by income level, educational attainment, or occupational status, is associated with higher leisure-time physical activity. However, when we analyze different socio-economic groups, defined in terms of education, income and occupation, separately, we find that income is not a significant determinant of leisure-time physical activity within any of the particular SES groups. Further, we find that leisure-time physical activity is negatively associated with higher screen time (i.e., watching TV and sitting at a computer), and other aspects of unhealthy lifestyle, and positively associated with self-assessed health. In addition, we note that proxies for individual motivational factors and childhood physical activity, such as the grade point average and the grade achieved in physical education when leaving basic education, are strongly correlated with leisure-time physical activity in middle age among men, but not among women. Our results are in line with behavioral economics reasoning that social comparisons and environments affect behaviors. We emphasize the importance of considering behavioral economic factors when designing policies to promote physical activity.

Diabetes, employment and behavioural risk factors in China: Marginal structural models versus fixed effects models

We use longitudinal data from the China Health and Nutrition Survey, covering the years 1997-2011, to estimate the effect of a diabetes diagnosis on an economic outcome (employment probabilities) and behavioural risk factors (alcohol consumption, smoking cessation, body mass index (BMI), physical activity and hypertension) for men and women. We apply two complementary statistical techniques-marginal structural models (MSMs) and fixed effects (FE) models-to deal with confounding. Both methods suggest, despite their different underlying assumptions, similar patterns that indicate important differences between men and women. Employment probabilities decline substantially after the diagnosis for women (-12.4 (MSM) and -15.5 (FE) percentage points), but do not change significantly for men. In particular, the MSM estimates indicate an increase in hypertension (13 percentage points) and a decrease in physical activity for women, while men have small and statistically insignificant changes in these outcomes. For BMI, the MSM results indicate statistically significant changes for men (-.76), but not for women, while the FE estimates show similar reductions for men and women (-.80 and -.73 respectively). Men also reduce their alcohol consumption, but do not cease to smoke. For women these risk factors have a prevalence close to zero to begin with, though women seem to still reduce alcohol consumption somewhat. These results suggest important gender differences in the impact of diabetes in China. To narrow these inequities policies supporting women to reduce diabetes related risk factors are likely important.

The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan

This study examined the associations between area-level unemployment rates and lower back pain using large-scale data provided by the Japanese working population. We analyzed data from a nationally representative, repeated, cross-sectional study across three waves from 2010, 2013, and 2016 in 47 Japanese subnational level areas. Workers aged 18-64 years (n = 962,586) were eligible to participate in the study. A multilevel logistic model was used to examine the association between the unemployment rate and lower back pain. The self-report of lower back pain was a dependent variable. The prefecture-level unemployment rate was analyzed as an independent variable, adjusted for individual-level covariates (e.g., gender, age, socioeconomic status). After adjusting for all covariates, the main effect of the prefecture-level unemployment rate was statistically significant: the odds ratio (OR) (95% credible interval (CrI)) was 1.01 (1.002, 1.03). Additionally, the OR (95% CrI) for the interaction between gender and the prefecture-level unemployment rate was 1.02 (1.01, 1.03) indicating that women were more affected by area-level employment status than men. In conclusion, a significant association between the unemployment rate and lower back pain was observed in the Japanese working population. Women were more sensitive to the unemployment rate.

Fracking and risky behaviors: Evidence from Pennsylvania

In the past decade, the technological developments in the oil and natural gas extraction industry made the extraction of shale gas economically feasible and prompted local economic booms across the US. Anecdotal evidence suggests that areas with unconventional gas development experience a disproportionate increase in the young male population who are more likely to be involved in risk-taking behavior. Moreover, the sudden income gains or demographic shifts might increase the demand for various goods and services, including entertainment and illegal activities provided by the adult entertainment industry. We investigate the relationship between unconventional gas development and a variety of risk-taking outcomes such as sexually transmitted infections, and prostitution-related arrests. Our identification strategy exploits the variation in shale gas or unconventional well drilling across time and counties in conjecture with a number of datasets that allow us to investigate the potential mechanisms. Our findings indicate that Pennsylvania counties with fracking activities have higher rates of gonorrhea and chlamydia infections (7.8% and 2.6%, respectively), as well as higher prostitution related arrests (19.7%). We posit that changes in the labor market and associated impacts to income or composition of workers may play a role in the estimated effects, but we do not find evidence in support of these hypotheses.

Changing labour market conditions during the 'great recession' and mental health in Scotland 2007-2011: an example using the Scottish Longitudinal Study and data for local areas in Scotland

This paper reports research exploring how trends in local labour market conditions during the period 2007-2011 (early stages of the 'great recession') relate to reported mental illness for individuals. It contributes to research on spatio-temporal variation in the wider determinants of health, exploring how the lifecourse of places relates to socio-geographical inequalities in health outcomes for individuals. This study also contributes to the renewed research focus on the links between labour market trends and population health, prompted by the recent global economic recession. We report research using the Scottish Longitudinal Study (SLS), a 5.3% representative sample of the Scottish population, derived from census data (https://sls.lscs.ac.uk/). In Scotland, (2011) census data include self-reported mental health. SLS data were combined with non-disclosive information from other sources, including spatio-temporal trends in labour market conditions (calculated using trajectory modelling) in the 32 local authority areas in Scotland. We show that, for groups of local authorities in Scotland over the period 2007-2011, trends in employment varied. These geographically variable trends in employment rates were associated with inequalities in self-reported mental health across the country, after controlling for a number of other individual and neighbourhood risk factors. For residents of regions that had experienced relatively high and stable levels of employment the odds ratio for reporting a mental illness was significantly lower than for the 'reference group', living in areas with persistently low employment rates. In areas where employment declined markedly from higher levels, the odds ratio was similar to the reference group. The findings emphasise how changes in local economic conditions may influence people's health and wellbeing independently of their own employment status. We conclude that, during the recent recession, the economic life course of places across Scotland has been associated with individual mental health outcomes.

Smoking and local unemployment: Evidence from Germany

In this paper, we use data from the German Socio-Economic Panel to investigate the effect of macro-economic conditions (in the form of local unemployment rates) on smoking behavior. The results from our panel data models, several of which control for selection bias, indicate that the propensity to become a smoker increases significantly during an economic downturn, with an approximately 0.7 percentage point increase for each percentage point rise in the unemployment rate. Conversely, conditional on the individual being a smoker, cigarette consumption decreases with rising unemployment rates, with a one percentage point increase in the regional unemployment rate leading to a decrease in consumption up to 0.8 percent.