1
|
Lowenstein C. "Deaths of despair" over the business cycle: New estimates from a shift-share instrumental variables approach. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101374. [PMID: 38518546 PMCID: PMC11060774 DOI: 10.1016/j.ehb.2024.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
This study presents new evidence of the effects of short-term economic fluctuations on suicide, fatal drug overdose, and alcohol-related mortality among working-age adults in the United States from 2003-2017. Using a shift-share instrumental variables approach, I find that a one percentage point increase in the aggregate employment rate decreases current-year non-drug suicides by 1.7 percent. These protective effects are concentrated among working-age men and likely reflect a combination of individual labor market experiences as well as the indirect effects of local economic growth. I find no consistent evidence that short-term business cycle changes affect drug or alcohol-related mortality. While the estimated protective effects are small relative to secular increases in suicide in recent decades, these findings are suggestive of important, short-term economic factors affecting specific causes of death and should be considered alongside the longer-term and multifaceted social, economic, and cultural determinants of America's "despair" epidemic.
Collapse
Affiliation(s)
- Christopher Lowenstein
- University of California, Berkeley School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, United States.
| |
Collapse
|
2
|
Won D, Workman C, Walker J, Zordani E, Bajaj P, Chen Z, Asthana S, Liu T, Christopher Malaisrie S, McCarthy DM, Adams JG, Lundberg A. When the economy falters, hearts suffer: Economic recessions as a social determinant of health in cardiovascular emergencies. Am J Emerg Med 2024; 76:155-163. [PMID: 38086181 DOI: 10.1016/j.ajem.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established. OBJECTIVES This retrospective observational study aimed to assess the relationship between macroeconomic trends and CVD ED visits. METHODS This study uses data from the National Hospital Ambulatory Care Survey (NHAMCS), Federal Reserve Economic Database (FRED), National Bureau of Economic Research (NBER), and CVD groupings from National Vital Statistics (NVS) and Center for Medicare and Medicaid Services (CMS) from 1999 to 2020 to analyze ED visits in relation to macroeconomic indicators and NBER defined recessions and expansions. RESULTS CVD ED visits grew by 79.7% from 1999 to 2020, significantly more than total ED visits (27.8%, p < 0.001). A national estimate of 213.2 million CVD ED visits, with 22.9 million visits in economic recessions were analyzed. A secondary group including a 6-month period before and after each recession (defined as a "broadened recession") was also analyzed to account for potential leading and lagging effects of the recession, with a total of 50.0 million visits. A significantly higher proportion of CVD ED visits related to heart failure (HF) and other acute ischemic heart diseases (IHD) was observed during recessionary time periods both directly and with a 6-month lead and lag (p < 0.05). The proportion of aortic aneurysm and dissection (AAA) and atherosclerosis (ASVD) ED visits was significantly higher (p = 0.024) in the recession period with a 6-month lead and lag. When controlled for common demographic factors, economic approximations of recession such as the CPI, federal funds rate, and real disposable income were significantly associated with increased CVD ED visits. CONCLUSION Macroeconomic trends have a significant relationship with the overall mix of CVD ED visits and represent an understudied social determinant of health.
Collapse
Affiliation(s)
- Daniel Won
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Connor Workman
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - James Walker
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth Zordani
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Pranav Bajaj
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Zhanlin Chen
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shravan Asthana
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tom Liu
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Christopher Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Danielle M McCarthy
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James G Adams
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alex Lundberg
- Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
3
|
Singh P, Gailey S, Das A, Bruckner TA. National Trends in Suicides and Male Twin Live Births in the US, 2003 to 2019: An Updated Test of Collective Optimism and Selection in Utero. Twin Res Hum Genet 2023; 26:1-8. [PMID: 38099411 PMCID: PMC11178679 DOI: 10.1017/thg.2023.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2024]
Abstract
Prior research based on Swedish data suggests that collective optimism, as measured by monthly incidence of suicides, correlates inversely with selection in utero against male twins in a population. We test this finding in the US, which reports the highest suicide rate of all high-income countries, and examine whether monthly changes in overall suicides precede changes in the ratio of male twin to male singleton live births. Consistent with prior work, we also examine as a key independent variable, suicides among women aged 15-49 years. We retrieved monthly data on suicides and the ratio of male twin to singleton live births from CDC WONDER, 2003 to 2019, and applied Box-Jenkins iterative time-series routines to detect and remove autocorrelation from both series. Results indicate that a 1% increase in monthly change in overall suicides precedes a 0.005 unit decline in male twin live births ratio 6 months later (coefficient = -.005, p value = .004). Results remain robust to use of suicides among reproductive-aged women as the independent variable (coefficient = -.0012, p value = .014). Our study lends external validity to prior research and supports the notion that a decline in collective optimism corresponds with greater selection in utero.
Collapse
Affiliation(s)
- Parvati Singh
- Division of Epidemiology, College of Public Health, The Ohio State University, Ohio, USA
| | - Samantha Gailey
- Department of Forestry, Michigan State University, East Lansing, Michigan, USA
| | - Abhery Das
- Program in Public Health, University of California, Irvine, California, USA
| | - Tim A. Bruckner
- Program in Public Health, University of California, Irvine, California, USA
- Center for Population, Inequality, and Policy, University of California, Irvine, California, USA
| |
Collapse
|
4
|
Zheng F, Xiong H, Jin Y, Zhang M. Exploring the relationship between unemployment perception and health during COVID-19: a comparative study of rural and urban adults in China. Front Psychol 2023; 14:1169845. [PMID: 37388659 PMCID: PMC10301762 DOI: 10.3389/fpsyg.2023.1169845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction The COVID-19 pandemic has significantly impacted global economies and individual health. This study uses data from the China Family Panel Data (CFPS) in 2018 (before the pandemic) and 2020 (during the pandemic) to a) estimate the relationships between the perceived risk of unemployment and individuals' mental health, physical health, and health behaviors; and b) explore the variations of these relationships between rural and urban adults in China. Methods Ordinary linear regression models or Logit models are employed, depending on the nature (continuous vs. discrete) of the dependent variables. Results We find that the perceived risk of unemployment was statistically and positively associated with the risk of depression, and the association was greater for rural adults than for urban adults. Rural-urban variations were observed in various dimensions. For rural adults, the perceived risk of unemployment was statistically and negatively associated with life satisfaction, the probability of gaining weight and becoming obese, the probability of having adequate sleep, and computer-based screen time. These associations were statistically insignificant for urban adults. On the other hand, the perceived risk of unemployment was statistically and negatively associated with self-rated very-good-to-excellent health condition and health-compromising behaviors (e.g., smoking and drinking) for urban adults; but such associations were statistically insignificant for rural adults. Discussion These findings suggest that rural and urban adults exhibited different psychological and behavioral responses to the unemployment risk during the COVID-19 pandemic. Public policies aiming to improve health and employment should be strategically designed to address the unique needs of urban and rural populations.
Collapse
Affiliation(s)
- Fengtian Zheng
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Huanhuan Xiong
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Yanhong Jin
- Department of Agricultural, Food and Resource Economics, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Man Zhang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| |
Collapse
|
5
|
Kanavos P, Vandoros S. Road traffic mortality and economic uncertainty: Evidence from the United States. Soc Sci Med 2023; 326:115891. [PMID: 37100029 DOI: 10.1016/j.socscimed.2023.115891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/20/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Previous studies have shown that financial turbulence is associated with a short-term increase in road traffic collisions, largely due to drivers' emotional state, distraction, sleep deprivation and alcohol consumption. In this paper we advance this debate by studying the association between economic uncertainty and road traffic mortality in the United States. We used a State-level uncertainty index and State fatalities for the period 2008-2017 and found that a one standard deviation increase in economic uncertainty is associated with an additional 0.013 monthly deaths per 100,000 people per State, on average (a 1.1% increase) - or 40 more monthly deaths in total nationwide. Results are robust to different model specifications. Our findings show that, similar to drink-driving, it is important to raise awareness about driving when distracted due to financial worries and during periods of economic uncertainty.
Collapse
|
6
|
Lange S, Jiang H, Štelemėkas M, Tran A, Cherpitel C, Giesbrecht N, Midttun NG, Jasilionis D, Kaplan MS, Manthey J, Xuan Z, Rehm J. Evaluating the Impact of Alcohol Policy on Suicide Mortality: A Sex-Specific Time-Series Analysis for Lithuania. Arch Suicide Res 2023; 27:339-352. [PMID: 34779348 PMCID: PMC9098693 DOI: 10.1080/13811118.2021.1999873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It is reasonable to believe that the alcohol policy environment can impact the suicide mortality rates in a given country, considering the well-known link between alcohol use and death by suicide. The current literature, albeit limited, suggests that an increase in alcohol taxation may result in a decrease in deaths by suicide and that the effect is sex-specific. Therefore, the objective of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on suicide mortality among adults 25-74 years of age in Lithuania, by sex. METHODS To estimate the unique impact of three alcohol control policies, we conducted interrupted time-series analyses by employing a generalized additive mixed model on monthly sex-specific age-standardized suicide mortality rates from January 2001 to December 2018. RESULTS Analyses showed a significant impact of the 2017 (p = 0.016) alcohol control policy on suicide mortality for men only. Specifically, we estimated that in the year following the 2017 policy enactment, approximately 57 (95% CI: 9-107) deaths by suicide were prevented among men, 25-74 years of age. The three policy enactments tested were not found to significantly impact the suicide mortality rate among women. CONCLUSION Alcohol control policies involving pricing, which result in a notable decrease in alcohol affordability, could be a cost-effective indirect suicide prevention mechanism in not only countries of the former Soviet Union, but in other high-income countries with a comparable health care system to that in Lithuania. HIGHLIGHTSIncreasing excise tax on alcohol was found to have a sex-specific impact on suicide mortalityThe 2017 alcohol policy prevented 57 deaths by suicide among men, 25-74 years of age, in the following yearAlcohol pricing policies may be a cost-effective indirect suicide prevention mechanism.
Collapse
Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON, Canada
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
| | - Cheryl Cherpitel
- Public Health Institute, Alcohol Research Group, Emeryville CA, USA
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | | | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
- Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Mark S. Kaplan
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles CA, USA
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston MA, USA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, University of Toronto, Toronto ON, Canada
- Institute of Medical Science, University of Toronto, Toronto ON, Canada
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| |
Collapse
|
7
|
Salokangas H, Böckerman P, Huikari S, Korhonen M, Korpelainen R, Svento R. Did the Finnish depression of the early 1990s have a silver lining? The effect of unemployment on long-term physical activity. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101139. [PMID: 35525102 DOI: 10.1016/j.ehb.2022.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
This paper studies the impact of long-term unemployment on physical activity. We examined the effects 6 and 15 years following a severe business cycle downturn in Finland over the period 1991-1994. The study sample comprised residents of Northern Finland. The unemployed individuals were 23-26 years old during the downturn. Physical activity, measured by MET minutes and meeting WHO guidelines, was higher 15 years later among those people who experienced the longest periods of unemployment in 1991-1994. Physical activity was somewhat lower among people with relatively shorter periods of unemployment.
Collapse
Affiliation(s)
- Henri Salokangas
- Department of Economics, University of Turku, FI-20100 Turku, Finland; Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland.
| | - Petri Böckerman
- Labour Institute for Economic Research LABORE, FI-00530 Helsinki, Finland; Department of Economics, University of Jyväskylä, FI-40014 Jyväskylä, Finland; IZA Institute of Labor Economics, Bonn, Germany
| | - Sanna Huikari
- Department of Economics, University of Oulu, FI-90014 Oulu, Finland
| | - Marko Korhonen
- Department of Economics, University of Oulu, FI-90014 Oulu, Finland
| | - Raija Korpelainen
- Center for Life Course Health Research, University of Oulu, FI-90014 Oulu, Finland; Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, FI-90101 Oulu, Finland
| | - Rauli Svento
- Department of Economics, University of Oulu, FI-90014 Oulu, Finland
| |
Collapse
|
8
|
Acharya B, Dhakal C. Risky health behaviors during the COVID-19 pandemic: Evidence from the expenditures on alcohol, non-alcoholic beverages, and tobacco products. PLoS One 2022; 17:e0268068. [PMID: 35587483 PMCID: PMC9119561 DOI: 10.1371/journal.pone.0268068] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background The COVID-19 pandemic has increased mental stress among the population and, at the same time, has lowered consumer income. Alcohol, non-alcoholic beverages, and tobacco consumption are associated with multiple health conditions but the information on how the consumption pattern of these goods shifted during the pandemic remains limited. Objective To examine the consumer spending on alcohol, non-alcoholic beverages, and tobacco products during the COVID-19 pandemic compared to the pre-pandemic period. Design An observational study utilizing the expenditures data on alcohol, non-alcoholic beverages, and tobacco between 2017 and 2020 obtained from the US Consumer Expenditure Diary Survey. Participants 18,808 respondents aged ≥ 21 years who answered the Consumer Expenditure Diary Survey. Main Outcome Measure(s): Bi-weekly expenditure on alcohol, non-alcoholic beverages, and tobacco products. Analysis Multivariable linear regression models. Results A total of 18,808 respondents (mean [SD] age = 52.5[16.9] years; 53.8% females) were included. Compared to the pre-pandemic levels, household expenditures on alcohol, non-alcoholic beverages, and tobacco products significantly decreased during the pandemic period by 28.6%, 7.9%, and 15.5%, respectively, after controlling for the state-, individual-, and household-level characteristics. Individual age, race/ethnicity, income, and education were significant predictors of spending. Heterogeneities in expenditures were evident across subgroups, with less educated and low-income households cutting their alcohol expenses while the wealthy and more educated consumers spent more during the pandemic. Conclusions and implications Household expenditures on alcohol, non-alcoholic beverages, and tobacco products significantly decreased. The results might be beneficial in understanding consumer spending habits concerning risky health behaviors during the period of economic disruption.
Collapse
Affiliation(s)
- Binod Acharya
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Chandra Dhakal
- Department of Agricultural and Applied Economics, University of Georgia, Athens, Georgia, United States of America
| |
Collapse
|
9
|
De Cao E, McCormick B, Nicodemo C. Does unemployment worsen babies' health? A tale of siblings, maternal behaviour, and selection. JOURNAL OF HEALTH ECONOMICS 2022; 83:102601. [PMID: 35255439 DOI: 10.1016/j.jhealeco.2022.102601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
We study in-utero exposure to economic fluctuations on birth outcomes by exploiting geographical variation in the unemployment rate across local areas in England, and by comparing siblings born to the same mother. Using rich individual data from hospital administrative records for 2003-2012, babies' health is found to be strongly pro-cyclical. This overall result masks marked differences between babies born in the most affluent areas whose health at birth improves in a recession, and babies born in the average-to-lowest income deprived areas whose health deteriorates. Maternal alcohol consumption, smoking, and delay in the first antenatal care assessment - combined with parental income loss, are found to drive the results. While differences in maternal risky behaviours can explain the heterogenous effects.
Collapse
Affiliation(s)
- Elisabetta De Cao
- LSE: The London School of Economics and Political Science United Kingdom.
| | - Barry McCormick
- LSE: The London School of Economics and Political Science United Kingdom
| | - Catia Nicodemo
- LSE: The London School of Economics and Political Science United Kingdom
| |
Collapse
|
10
|
Peng L, Chen J, Guo X. Macroeconomic conditions and health-related outcomes in the United States: A metropolitan and micropolitan statistical area-level analysis between 2004 and 2017. HEALTH ECONOMICS 2022; 31:3-20. [PMID: 34482584 DOI: 10.1002/hec.4420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
We study the relationship between macroeconomic conditions and health in the United States using data from the Behavioral Risk Factor Surveillance System between 2004 and 2017. Unlike many existing studies that use state or county as the level of aggregation, our analysis uses a sample of metropolitan and micropolitan statistical areas. Our results suggest strong associations between worsening macroeconomic conditions and reduced access to care and health insurance coverage. While we do not detect any robust relationships between business cycles and health outcomes in the general population, we do find consistent evidence of worse self-reported health during economic downturns among minorities and less-educated individuals. In addition, there is some suggestive evidence of countercyclicality of healthier lifestyle choices. However, the findings for health behavior outcomes are not robust to adjusting for multiple hypothesis testing.
Collapse
Affiliation(s)
- Lizhong Peng
- Department of Economics, University of West Georgia, Carrollton, Georgia, USA
| | - Jie Chen
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Xiaohui Guo
- International School of Economics and Management, Capital University of Economics and Business, Beijing, China
- School of Insurance and Economics, University of International Business and Economics, Beijing, China
| |
Collapse
|
11
|
Kim B, Thomsen MR, Nayga RM, Goudie A. The effect of gender-specific labor market conditions on children's weight. HEALTH ECONOMICS REVIEW 2021; 11:44. [PMID: 34855042 PMCID: PMC8641227 DOI: 10.1186/s13561-021-00345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Macroeconomic conditions are widely known to influence health outcomes through direct behavioral change or indirect mental effects of individuals. However, they have not received much attention in relation to childhood obesity. METHODS Using gender-specific predicted employment growth rates as an index for labor market conditions, we analyze how economic shocks affect children's weight status in Arkansas. To understand the underlying mechanisms behind these results, we use data on individual time use to examine how economic shocks are related to activities related to children's weight. RESULTS Improvement in the female labor market is associated with an increase in body mass index (BMI) and the probability that a child is overweight or obese, while an improvement in the male labor market has no significant effects on children's weight. This impact is particularly evident among female children, older children, and African-American children. We also find a negative effect of improvements in the female labor market on time spent on preparation for foods at home. CONCLUSIONS These results suggest that a decrease in time spent preparing home-cooked foods might be a plausible explanation for the pro-cyclical relationship between children's weight and improvement in the labor market conditions. Thus, the policy implications of our paper should be aimed at mitigating the adverse effects of women's labor participation.
Collapse
Affiliation(s)
- Bongkyun Kim
- Department of Eonomics, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwondo Republic of Korea 25913
| | - Michael R. Thomsen
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR 72205 USA
| | - Rodolfo M. Nayga
- Department of Agricultural Economics, Texas A&M University, 600 John Kimbrough Blvd, Suite 309, College Station, TX 77843 USA
| | - Anthony Goudie
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Director of Research and Evaluation Arkansas Center for Health Improvement, 1401 West Capitol Suite 300, Little Rock, AR 72201 USA
| |
Collapse
|
12
|
Gehrsitz M, Saffer H, Grossman M. The Effect of Changes in Alcohol Tax Differentials on Alcohol Consumption. JOURNAL OF PUBLIC ECONOMICS 2021; 204:104520. [PMID: 35530722 PMCID: PMC9075414 DOI: 10.1016/j.jpubeco.2021.104520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We show that tax-induced increases in alcohol prices can lead to substantial substitution and avoidance behavior that limits reductions in alcohol consumption. Causal estimates are derived from a natural experiment in Illinois where spirits and wine taxes were raised sharply and unexpectedly in 2009. Beer taxes were increased by only a trivial amount. We construct representative and consistent measures of alcohol prices and sales from scanner data collected for hundreds of products in thousands of stores across the US. Using several difference-in-differences models, we show that alcohol excise taxes are instantly over-shifted. That is, a $1 tax increase translates into a price increase of up to $1.50. We find evidence suggesting that consumers react by switching to less expensive products. In particular, they increase purchases of beer, thus significantly moderating any tax-induced reductions in total ethanol consumption. Our study highlights the importance of tax-induced substitution, the implications of differential tax increases by beverage group and the impacts on public health of alternative types of tax hikes whose main aims are to increase revenue.
Collapse
|
13
|
Giri JK, Kumaresan T. The business cycle, health behavior, and chronic disease: A study over Three decades. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101029. [PMID: 34174514 DOI: 10.1016/j.ehb.2021.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jeeten Krishna Giri
- Department of Economics, Union College, Lippman Hall 103, 807 Union St, Schenectady, NY, 12308, USA.
| | | |
Collapse
|
14
|
De PK, Segura-Escano R. Drinking during downturn: New evidence from the housing market fluctuations in the United States during the Great Recession. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101070. [PMID: 34700198 DOI: 10.1016/j.ehb.2021.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
We investigate how the decline in home prices over the Great Recession in the U.S. impacted drinking behavior. We match data on actual and shadow home prices (from Zillow Research) to individuals' drinking behavior from the Behavioral Risk Factor Surveillance System (BRFSS) by county of residence and year/month of the interview. We improve upon the existing literature by using new measures of exogenous macroeconomic shocks captured by fluctuations in home prices and finding heterogeneous impacts of the downturn based on homeownership. We find that decline in home prices is commonly associated with increases in alcohol consumption, both on extensive and intensive margins. Additionally, we find that the effects are more consistent among homeowners compared to renters. Given that alcohol consumption is one of the leading causes of death in the U.S. and that the COVID-19 pandemic has triggered an economic crisis in many societies, the results have important public health implications.
Collapse
Affiliation(s)
- Prabal K De
- Department of Economics, Colin Powell School at City College and The Graduate Center, City University of New York, New York, New York, USA; The Graduate Center, City University of New York, 365 5th Ave, New York, NY 10016, USA.
| | - Raul Segura-Escano
- The Graduate Center, City University of New York, 365 5th Ave, New York, NY 10016, USA.
| |
Collapse
|
15
|
Fernández Guerrico S. The effects of trade-induced worker displacement on health and mortality in Mexico. JOURNAL OF HEALTH ECONOMICS 2021; 80:102538. [PMID: 34634695 DOI: 10.1016/j.jhealeco.2021.102538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Recent research in the U.S. links trade-induced job displacement to deaths of despair. Should we expect the same mortality response in developing countries? This paper analyzes the effect of a trade-induced negative shock to manufacturing employment on leading causes of mortality in Mexico between 1998 and 2013. I exploit cross-municipality variation in trade exposure based on differences in industry specialization before China's accession to the WTO in 2001 to identify labor-demand shocks that are concentrated in manufacturing. I find trade-induced job loss increased mortality from diabetes, raised obesity rates, reduced physical activity, and lowered access to health insurance. These deaths were offset by declines in mortality from ischemic heart disease and chronic pulmonary disease. These findings highlight that negative employment shocks have heterogeneous impacts on mortality in developing countries, where falling incomes lead to less access to health care and nutritious food, but also reduce alcohol and tobacco use.
Collapse
Affiliation(s)
- Sofía Fernández Guerrico
- Université Libre de Bruxelles, Department of Applied Economics (Dulbea), Avenue Franklin Roosevelt 50, Brussels 1050, Belgium.
| |
Collapse
|
16
|
Azagba S, Shan L, Wolfson M, Hall M, Chaloupka F. Problem drinking as intentional risky behavior: Examining the association between state health insurance coverage and excessive alcohol consumption. Prev Med Rep 2021; 24:101556. [PMID: 34976624 PMCID: PMC8683933 DOI: 10.1016/j.pmedr.2021.101556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2021] [Accepted: 09/04/2021] [Indexed: 11/26/2022] Open
Abstract
The moral hazard theory asserts that having health insurance may increase individual risk-taking behaviors. We examined the association between state health insurance coverage and excessive alcohol use among U.S. adults. We used 2001-2017 Behavioral Risk Factor Surveillance System data to estimate annual binge and heavy drinking rates for each state. In a multivariable regression analysis, we used difference-in-difference (DID) models to assess the association between state-level insurance coverage and binge and heavy drinking. Additionally, we assess the potential asymmetric effect and whether economic recessions (2001, 2008-09) had a moderation effect. In the multivariable DID analysis, aggregate state insurance coverage was not significantly associated with binge drinking rates in baseline analysis with state-fixed effects (Model 1), and in the analysis that extends the baseline model to include state unique time trend (Model 2). A similar result was found for heavy drinking in Model 1. In contrast, the result showed a significant association between health insurance coverage and heavy drinking rates in Model 2. However, we found no significant association for binge and heavy drinking rates in both models in the analyses restricting data to periods before the methodological change in the BRFSS sampling frame. The results did not show asymmetric effects, and the association between health insurance and excessive alcohol use did not differ during economic recessions. These findings largely do not support assertions that health insurance may lead to moral hazards (risk-taking behaviors), especially binge drinking.
Collapse
Affiliation(s)
- Sunday Azagba
- Ross and Carol Nese College of Nursing, Penn State, University Park, PA 16802, USA
| | - Lingpeng Shan
- Division of Biostatistics, College of Public Health, The Ohio State University, Riverside, CA 92501, USA
| | - Mark Wolfson
- Department of Social Medicine, Population and Public Health, University of California Riverside School of Medicine, Riverside, CA 92501, USA
| | - Mark Hall
- Department of Social Science and Health Policy, Wake Forest School of Medicine, USA
| | - Frank Chaloupka
- School of Public Health, The University of Illinois at Chicago, USA
| |
Collapse
|
17
|
Castellari E, Tiboldo G, Moro D, Bimbo F. La Dolce Vita in times of harshness: Prevalence of health-related behaviors during the great recession in Italy. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101062. [PMID: 34536660 DOI: 10.1016/j.ehb.2021.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
The current work investigates the heterogeneous effect of the 2008 recession on health outcomes in the Italian population across the main geographic areas. Health outcomes were proxied by individual-level information on healthy/risky behaviors, such as individual fruit and vegetable consumption, frequency of bodyweight monitoring, smoking, and alcohol intake. These health outcomes were employed as dependent variables in the empirical model that included some socioeconomic individual aspects (e.g., age, gender, education, and income source), as well as consumer price index data for tobacco products, alcoholic beverages, and fruit and vegetables. In this work, we used twelve years of data (2005-2016) from the Italian Multipurpose Household Survey (MHS), which collects individual self-reported characteristics, augmented with information on unemployment rates at the regional level, as well as with consumer price indexes for the goods analyzed. The results indicated that the 2008 economic crisis lowered the probability that individuals engage in healthy behaviors, such as self-monitoring their bodyweight, mostly among individuals in northern and central areas. Likewise, the economic downturn increased the probability of smoking regardless of the geographic area, with a larger magnitude in individuals in northern and central areas, whose health outcomes were more impacted by the economic downturn than individuals living in the southern and island areas.
Collapse
Affiliation(s)
- Elena Castellari
- Università Cattolica del Sacro Cuore, Via Emilia Parmense, 84, 29122 Piacenza, PC, Italy
| | - Giulia Tiboldo
- Università Cattolica del Sacro Cuore, Via Emilia Parmense, 84, 29122 Piacenza, PC, Italy.
| | - Daniele Moro
- Università Cattolica del Sacro Cuore, Via Emilia Parmense, 84, 29122 Piacenza, PC, Italy
| | - Francesco Bimbo
- Università degli Studi di Foggia, Via Napoli 25, 71121 Foggia, FG, Italy
| |
Collapse
|
18
|
Afoakwah C, Nghiem S, Scuffham P, Byrnes J. Rising unemployment reduces the demand for healthcare services among people with cardiovascular disease: an Australian cohort study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:643-658. [PMID: 33740154 DOI: 10.1007/s10198-021-01281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases (CVDs) remain a global health challenge due to number of deaths and use of healthcare services related to the condition. Although a plethora of studies have shown the impact of unemployment on health outcomes, evidence on the unemployment effects on the demand for expensive cardiac healthcare services is rare. This study exploits longitudinal cohort dataset to examine the impact of variations in local level unemployment rate on the demand for healthcare services among working aged people with CVD in Australia. Our findings show an inverse relationship between unemployment and the demand for healthcare services. Specifically, we find that a rising unemployment reduces the demand for primary and secondary healthcare services, with the largest effect observed for hospital admissions and hospitalisation days. We further show that rising unemployment at the local level has a greater impact on CVD patients with comorbidities and those who live in nonremote areas. Finally, our estimates suggest that increasing local level unemployment averts a substantial number of healthcare services use, leading to an unintended cost savings of $1.2 million to the health sector.
Collapse
Affiliation(s)
- Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Son Nghiem
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| |
Collapse
|
19
|
Disney L. The Impact of Employment on Immigrant Mental Health: Results from a National Survey. SOCIAL WORK 2021; 66:93-100. [PMID: 33842958 DOI: 10.1093/sw/swab005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
Mental illness and unemployment are both well documented in the literature as potentially having harmful and even detrimental impacts on individuals' lives. However, less is known about the intersections of mental illness and unemployment in the U.S. immigrant population. This study examined whether unemployment is a predictor of mental illness in a sample of immigrants in the United States (N = 3,732). Data were from the National Epidemiologic Survey on Alcohol and Related Conditions, a three-wave, nationally representative dataset. Multivariate logistical regression analysis examined whether the main effects of a negative employment status were associated with a mental health diagnosis at Wave 2. Negative employment status was a significant predictor of all mental health diagnoses in the multivariate logistic regression models. The results from this study indicate that unemployment is associated with mental health problems among immigrants. This article presents discussion and implications for social work practice, policy, and research.
Collapse
|
20
|
French MT, Gumus G. Death on the job: The Great Recession and work-related traffic fatalities. Soc Sci Med 2021; 280:113979. [PMID: 34022584 DOI: 10.1016/j.socscimed.2021.113979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
In light of recent discussions about shifting employees from traditional workplaces to virtual employment, we are motivated by the question of whether this phenomenon will end up saving lives even in the absence of an infectious disease outbreak. Motor vehicle incidents are the leading cause of work-related fatalities in the US, killing more than 1200 workers each year, which make up about a quarter of all work-related deaths. Not only are motor vehicle crashes the top killer at work, but economic expansions can further increase occupational and traffic deaths as they both tend to be procyclical. In this paper, we examine the effects of business cycles on traffic fatalities in the US with a special focus on work-related deaths. Specifically, we implement a longitudinal design across all 50 states by compiling quarterly data for 2004-2012 and consider macroeconomic fluctuations around the Great Recession. Our findings show that traffic deaths during prosperous times are not solely due to an increase in risky behaviors such as drunk driving, but directly related to work. Given the highly preventable nature of traffic crashes, policy makers, public health advocates, and employers can develop effective strategies, including remote work arrangements, to improve both occupational and traffic safety.
Collapse
Affiliation(s)
- Michael T French
- University of Miami, Miami Herbert Business School, Department of Health Management and Policy, USA.
| | - Gulcin Gumus
- Department of Management Programs, Florida Atlantic University, USA; IZA, Bonn, Germany.
| |
Collapse
|
21
|
Arthi V, Parman J. Disease, downturns, and wellbeing: Economic history and the long-run impacts of COVID-19. EXPLORATIONS IN ECONOMIC HISTORY 2021; 79:101381. [PMID: 33162564 PMCID: PMC7606070 DOI: 10.1016/j.eeh.2020.101381] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 05/04/2023]
Abstract
How might COVID-19 affect human capital and wellbeing in the long run? The COVID-19 pandemic has already imposed a heavy human cost-taken together, this public health crisis and its attendant economic downturn appear poised to dwarf the scope, scale, and disruptiveness of most modern pandemics. What evidence we do have about other modern pandemics is largely limited to short-run impacts. Consequently, recent experience can do little to help us anticipate and respond to COVID-19's potential long-run impact on individuals over decades and even generations. History, however, offers a solution. Historical crises offer closer analogues to COVID-19 in each of its key dimensions-as a global pandemic, as a global recession-and offer the runway necessary to study the life-course and intergenerational outcomes. In this paper, we review the evidence on the long-run effects on health, labor, and human capital of both historical pandemics (with a focus on the 1918 Influenza Pandemic) and historical recessions (with a focus on the Great Depression). We conclude by discussing how past crises can inform our approach to COVID-19-helping tell us what to look for, what to prepare for, and what data we ought to collect now.
Collapse
|
22
|
Vandoros S, Gong X, Kawachi I. The link between unemployment and opioid prescribing. An instrumental variable approach using evidence from England. J Epidemiol Community Health 2020; 75:jech-2020-213897. [PMID: 33093186 DOI: 10.1136/jech-2020-213897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/03/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unemployment has been associated with chronic pain, which is often treated with prescription opioids. Opioid mortality has been included in the so-called category of 'deaths of despair' due to the role of lack of opportunity. While previous studies have found an association between unemployment and opioids, the relationship is endogenous and examining any effect is challenging. OBJECTIVE The objective of this paper is to study the association between unemployment and opioid prescribing in England. DATA AND METHODS We used data from the GP prescribing database in England for the period 2011-2017 and followed ordinary least squares (OLS) and Instrumental Variable econometric approaches, controlling for other confounders. We used the number of foreign direct investment projects and the number of registered companies as instruments for unemployment, taking population size into account. RESULTS The OLS model suggests that an increase in the unemployment rate by 1 percentage point is associated with 0.017 additional opioid defined daily doses per capita-a 0.9% increase compared with the mean of 1.745. According to the instrumental variable model, an increase in unemployment by 1 percentage point leads to an increase in the number of opioid doses prescribed per capita by between 0.315 and 0.437, which constitutes a 18-25% increase compared with the mean of 1.745. CONCLUSIONS Unemployment appears to have an impact on opioid prescribing volume in England. This reveals yet another negative effect of unemployment on health. Relevant labour market policies may play a protective role with regards to opioid use.
Collapse
Affiliation(s)
- Sotiris Vandoros
- King's College London, London, UK
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| |
Collapse
|
23
|
Zasimova L, Kolosnitsyna M. Exploring the relationship between drinking preferences and recorded and unrecorded alcohol consumption in Russian regions in 2010-2016. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102810. [PMID: 32535540 DOI: 10.1016/j.drugpo.2020.102810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND In recent years, Russia has seen a decline in alcohol consumption per capita (APC) accompanied by a significant reduction in the share of spirits in total APC. Our aim was to investigate regional variation in alcohol consumption and the association between the share of spirits in APC, and recorded and unrecorded APC. METHODS Data on recorded APC were taken from Rosstat. Our estimates on unrecorded APC were based on the guidelines of the Ministry of Health of the Russian Federation and data on alcoholic psychoses and mortality from external causes (546 observations for 78 regions from 2010 to 2016). We estimated fixed effects models with the dependent variables of recorded and unrecorded APC of the population 15+. Independent variables included share of spirits in recorded APC, vodka prices, average income, duration of alcohol sales hours, and others. RESULTS During the 2010-2016 period, recorded APC varied by regions from 1.1 to 17.8 litres; unrecorded - from almost zero to 21 litres; the share of spirits in recorded APC - from 20.6% to 89.3%. A 1% increase in the share of spirits was attributed to a 0.2% increase in recorded APC and to a 2.1% increase in unrecorded APC. Various factors were related to regional APC: vodka prices (with elasticity coefficient -0.46 for recorded and 1.67 for unrecorded APC); income (0.23 for recorded and -2.23 for unrecorded APC); duration of sales hours (-0.9 for unrecorded APC); and shares of working age and of urban population. CONCLUSION Taking into account a strong correlation between the share of spirits in the recorded APC and consumption of recorded and unrecorded APC, the price of spirits should be increased. In the regions with pronounced preference for spirits, stricter availability restrictions on the alcohol sales are needed, along with strict control of shadow markets.
Collapse
Affiliation(s)
- Liudmila Zasimova
- Associate Professor, Faculty of Economic Sciences, National Research University Higher School of Economics (HSE). Moscow, Russia.
| | - Marina Kolosnitsyna
- Professor, Faculty of Economic Sciences, National Research University Higher School of Economics (HSE). Moscow, Russia
| |
Collapse
|
24
|
Casal B, Storti CC, Morgan D. Expenditure on the treatment of drug and alcohol disorders in hospitals: How much and what explain it? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102750. [PMID: 32339887 DOI: 10.1016/j.drugpo.2020.102750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/22/2020] [Accepted: 04/06/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The role of hospitals in providing treatment for drug and alcohol abuse varies markedly across countries. Knowing public expenditure on drug treatment in hospitals is an essential input for any cost-effectiveness and policy analysis. However, information on the level and trend in spending is often unavailable. This study aims firstly to estimate the expenditure on hospital treatment for illicit drug and alcohol use as primary diagnoses across Europe for the 2013-2015 period, secondly to explain recent expenditure trends and lastly to analyse their impact on policy. METHODS The study uses annual health expenditure data from Eurostat which complies with the 'System of Health Accounts' framework and covers the countries of the European Union as well as Norway. Data on hospital activities exist for 'Mental and Behavioural Disorders', which includes a breakdown into disorders caused by the use of alcohol and other psychoactive substances. The study uses 'attributable fractions' to estimate the proportion of hospital expenditure allocated to drug and alcohol treatments, based on data about this activity. Last, but not least, a panel data approach for the 2006-2015 period is used to explain expenditure determinants. RESULTS In 2015, it is estimated that EUR 5.8 thousand million and EUR 2.9 thousand million were spent on the treatment of alcohol and drug disorders in hospitals as primary diagnoses, respectively, for a set of 24 European countries with available data. Cross-country differences can be explained by the level of income, the burden of disease and the structures of health systems - for instance, the proportion of public spending and the level (or share) of resources allocated for outpatient care. CONCLUSION These estimates allow a better evaluation of treatment provision and, therefore, a better allocation of scarce resources. This information can support service providers, health policymakers and taxpayers. In this sense, it is a first step in developing policy evaluation and cost-effectiveness analysis.
Collapse
Affiliation(s)
- Bruno Casal
- Business and Economy School, University of A Coruña, Elviña Campus, 15071 A Coruña, Spain.
| | | | - David Morgan
- OECD - Organisation for Economic Co-operation and Development, Paris, France
| |
Collapse
|
25
|
Tejada CAO, Triaca LM, Liermann NH, Ewerling F, Costa JC. Crises econômicas, mortalidade de crianças e o papel protetor do gasto público em saúde. CIENCIA & SAUDE COLETIVA 2019; 24:4395-4404. [DOI: 10.1590/1413-812320182412.25082019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/12/2019] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo do estudo foi analisar como as crises econômicas afetam a saúde infantil a nível global e entre subgrupos de países com diferentes níveis de renda. Foram utilizados dados do Banco Mundial e da OMS para 127 países entre os anos de 1995 e 2014. Foi utilizado um modelo de efeitos fixos, avaliando o efeito da mudança em indicadores macroeconômicos (PIB per capita, taxa de desemprego e de inflação, e taxa de desconforto) na taxa de mortalidade neonatal, infantil, e de menores de cinco anos. Adicionalmente, avaliou-se a modificação do efeito da associação de acordo com a renda dos países e também a influência do gasto público em saúde nessa relação. As evidências mostraram que piores indicadores econômicos (menor PIB per capita e maiores inflação, taxa de desemprego e taxa de desconforto) estão associados com maiores taxas de mortalidade infantil. Nas subamostras por estrato de renda, observa-se a mesma relação, porém com efeitos de maior magnitude entre os países de renda baixa e média. Verificou-se ainda que um maior percentual nos gastos públicos em saúde ameniza os efeitos dos indicadores econômicos nas taxas de mortalidade infantil. Desta forma, é necessário aumentar a atenção aos efeitos nocivos das crises macroeconômicas para garantir melhorias na saúde infantil.
Collapse
Affiliation(s)
| | - Lívia Madeira Triaca
- Universidade Federal de Pelotas, Brazil; Universidade Federal do Rio Grande, Brazil
| | | | | | | |
Collapse
|
26
|
Brüning M, Thuilliez J. Mortality and Macroeconomic Conditions: What Can We Learn From France? Demography 2019; 56:1747-1764. [DOI: 10.1007/s13524-019-00811-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
This study uses aggregate panel data on French départements to investigate the relationship between macroeconomic conditions and mortality from 1982 to 2014. We find no consistent relationship between macroeconomic conditions and all-cause mortality in France. The results are robust across different specifications, over time, and across different geographic levels. However, we find that heterogeneity across age groups and mortality causes matters. Furthermore, in areas with a low average educational level, a large population, and a high share of migrants, mortality is significantly countercyclical. Similar to the case in the United States, the relationship between the unemployment rate and mortality seems to have moved from slightly procyclical to slightly countercyclical over the period of analysis.
Collapse
Affiliation(s)
- Max Brüning
- Department of Economics, School of Business and Economics, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Josselin Thuilliez
- CNRS – Centre d’économie de la Sorbonne, 106-112, Boulevard de l’Hôpital, 75013 Paris, France
| |
Collapse
|
27
|
Markowitz S, Nesson E, Robinson JJ. The effects of employment on influenza rates. ECONOMICS AND HUMAN BIOLOGY 2019; 34:286-295. [PMID: 31097347 DOI: 10.1016/j.ehb.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/05/2019] [Accepted: 04/11/2019] [Indexed: 05/25/2023]
Abstract
The seasonal influenza virus afflicts millions of people in the U.S. population each year, imposing significant costs on those who fall ill, their families, employers, and the health care system. The flu is transmitted via droplet spread or close contact, and certain environments, such as schools or offices, promote transmission. In this paper, we examine whether increases in employment are associated with increased incidence of the flu. We use state-level data on the prevalence of the flu from the Centers for Disease Control and Prevention. In our preferred specification, we find that a one percentage point increase in the employment rate increases the number of influenza related outpatient health care visits by 19%, and these effects are highly pronounced in the retail sector and healthcare sector, the sectors with the highest levels of interpersonal contact.
Collapse
Affiliation(s)
- Sara Markowitz
- Department of Economics, Emory University, Atlanta, GA, USA; NBER, USA.
| | - Erik Nesson
- Department of Economics, Miller College of Business, Ball State University, Muncie, IN, USA; NBER, USA.
| | - Joshua J Robinson
- Department of Marketing, Industrial Distribution, and Economics, Collat School of Business, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
28
|
Abstract
Objectives: We evaluate the extent to which subjective and objective measures of economic distress account for differences in substance abuse between the mid-1990s and early-2010s. Methods: We use cross-sectional survey data for national samples of Americans aged 25-74 in 1995-96 (N = 3034) and 2011-14 (N = 2598). Using a logit model, we regress dichotomous indicators of drug and alcohol abuse on economic distress. Results: After adjusting for sociodemographic characteristics, the odds of drug abuse in the early-2010s among older individuals (aged 50+) were 2.9 times (95%CI 1.9-4.2) those of the mid-1990s, but there was no statistically significant period difference in drug abuse among younger individuals. Measures of model performance demonstrate that subjective measures of economic distress are better predictors of drug abuse than objective measures. The subjective measures also account for a larger share (26%) of the increase in drug abuse at ages 50+ than the objective measures (6%). We cannot draw clear conclusions regarding alcohol abuse because results are sensitive to specification. Conclusions: The rise in drug abuse among midlife Americans may relate to perceived economic distress that is not captured by standard economic measures.
Collapse
Affiliation(s)
- Dana A Glei
- Senior Research Investigator, Georgetown University, Center for Population and Health, Washington, DC;,
| | - Maxine Weinstein
- Distinguished Professor, Georgetown University, Center for Population and Health, Washington, DC
| |
Collapse
|
29
|
Vandoros S, Kawachi I. The relative risk of motor vehicle collision on cannabis celebration day in Great Britain. ACCIDENT; ANALYSIS AND PREVENTION 2019; 128:248-252. [PMID: 30902341 DOI: 10.1016/j.aap.2019.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/30/2018] [Accepted: 02/10/2019] [Indexed: 06/09/2023]
Abstract
Cannabis celebration day, also known as "420 day", takes place at 4:20pm on April 20 every year. The objective of this paper is to study whether there is an increase in road traffic collisions in Great Britain on that day. We used daily car crash data resulting in death or injury from all 51 local police forces covering Great Britain over the period 2011-2015. We compared crashes from 4:20pm onwards on April 20 to control days on the same day of the week in the preceding and succeeding two weeks, using panel data econometric models. On the average cannabis celebration day in Britain, there were an additional 23 police-reported collisions compared to control days, corresponding to a 17.9% increase in the relative risk of collision.
Collapse
Affiliation(s)
- Sotiris Vandoros
- King's College London, 30 Aldwych, London WC2B 4BG, United Kingdom; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| |
Collapse
|
30
|
Moreno-Lostao A, Barrio G, Sordo L, Cea-Soriano L, Martínez D, Regidor E. Mortality in working-age population during the Great Recession and austerity in Spain. PLoS One 2019; 14:e0218410. [PMID: 31247019 PMCID: PMC6597056 DOI: 10.1371/journal.pone.0218410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/31/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To analyze the mortality trend in Spain before, during and after the economic crisis and austerity policies in the working-age population. METHODS From 2005 to 2016 we calculated the annual all-cause mortality rate and the annual mortality rate from the main causes of death in the population aged 15 to 64. We also estimated the linear trends in mortality rates during four time intervals-2005-2007 (before crisis), 2008-2010 (first part of the crisis), 2011-2013 (second part of the crisis and implementation of austerity policies) and 2014-2016 (after the crisis)- by the annual percentage change (APC). RESULTS The all-cause mortality rate in men and women showed the greatest decline in 2008-2010 and the smallest decline in 2014-2016. The decline in 2011-2013 was higher than in 2014-2016. The APCs in 2005-2007, 2008-2010, 2011-2013 and 2014-2016 were -2.8, -4.1, -3.0 and -1.5 in men and -1.0. -2.1, -1.1 and -0.6 in women, respectively, although the APC in 2014-2016 in women was not significant. In 2014-2016, cancer mortality showed the largest decrease, mortality from cardiovascular diseases (men), respiratory diseases and traffic accidents reversed and showed an upward trend, and the downward trend in mortality from infectious diseases and digestive diseases was equal to or greater than that observed before the crisis. CONCLUSION The decline in all-cause mortality in the working-age population during the economic crisis and the introduction of austerity measures was greater than that observed before and after the economic crisis. The slowing of the decline after the crisis was due to the reversal of the trend in mortality from cardiovascular and respiratory diseases.
Collapse
Affiliation(s)
| | - Gregorio Barrio
- Health National School, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Sordo
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Martínez
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
31
|
Blázquez-Fernández C, Cantarero-Prieto D, Perez P. Do the unemployed hit the bottle during economic downturns? An empirical approach for Spain. BMC Public Health 2019; 19:523. [PMID: 31064373 PMCID: PMC6505297 DOI: 10.1186/s12889-019-6882-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper analyses the 2008 economic collapse in Spain with its long-lasting effects. Precisely, the ones associated with lifestyles. Thus, the aim of this paper is to examine to what extent economic downturns affect individual's drinking behavior when focusing on unemployed people. METHODS We use discrete-choice models and matching techniques. Data from the National Health Survey for 2006 and 2011-2012 provides a clear picture before and after the 2008 breakdown in Spain. RESULTS We find that drinking over the business cycle is a function of individual socio-demographic status. Besides, our empirical findings are consistent with the idea that following the crisis differences between unemployed and non-unemployed fell to at least in accordance with a lower overall consumption of alcoholic beverages. CONCLUSIONS Public policy design for drinkers would require both prevention and recovery from alcohol use strategies to be met towards health and labour pillars.
Collapse
Affiliation(s)
- Carla Blázquez-Fernández
- Department of Economics, Universidad de Cantabria, Av. Los Castross/n, 39005, Santander, CP, Spain. .,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain. .,GEN Governance and Economics Network, Universidad de Vigo, Vigo, Spain.
| | - David Cantarero-Prieto
- Department of Economics, Universidad de Cantabria, Av. Los Castross/n, 39005, Santander, CP, Spain.,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.,GEN Governance and Economics Network, Universidad de Vigo, Vigo, Spain
| | - Patricio Perez
- Department of Economics, Universidad de Cantabria, Av. Los Castross/n, 39005, Santander, CP, Spain
| |
Collapse
|
32
|
Regidor E, Albaladejo R, Mateo A, de la Fuente L, Barrio G, Ortega P. Macroeconomic fluctuations, changes in lifestyles and mortality from diabetes: a quasiexperimental study. J Epidemiol Community Health 2019; 73:317-323. [PMID: 30700493 DOI: 10.1136/jech-2018-211464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND To evaluate trends in diabetes-related health behaviours and mortality from diabetes and other chronic diseases in the Spanish population before, during and after the 2008 economic crisis. METHODS Annual population measurements were obtained from national surveys and administrative registries for 2004-2016. Using segmented regression analysis, we calculated the annual percentage change (APC) in 2004-2007, 2008-2010, 2011-2013 and 2014-2016 in risk behaviours (smoking, alcohol consumption, obesity and meals away from home), in healthy behaviours (fruit and vegetable intake and physical activity) and in mortality rates from diabetes, cardiovascular disease and cancer. RESULTS In general, during the economic crisis (2008-2013), the Spanish population reduced risk behaviours and improved healthy behaviours as compared with the trend observed before and afterwards. Diabetes mortality decreased more during the crisis than before or afterwards. The APC in each time interval was -3.3, -3.7, -4.4 and -2.6 in all-age mortality and -2.9, -5.2, -6.7 and -1.3 in premature mortality (less than 75 years). Only in older people (≥75 years) diabetes mortality showed similar decline before and during the crisis. Mortality from cardiovascular disease also declined more during the crisis, except for all-age mortality and older people in the second part of the crisis, whereas the downward trend in cancer mortality was smaller during the crisis years. CONCLUSIONS During the 6 years of the economic crisis in Spain, the favourable changes in health behaviours were accompanied by an important reduction in diabetes mortality in the population.
Collapse
Affiliation(s)
- Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Romana Albaladejo
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Mateo
- School of Public Health, Health Education North West, Manchester, UK.,National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Paloma Ortega
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
33
|
The association between economic uncertainty and suicide in the short-run. Soc Sci Med 2019; 220:403-410. [DOI: 10.1016/j.socscimed.2018.11.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/03/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022]
|
34
|
Kvasnicka M, Siedler T, Ziebarth NR. The health effects of smoking bans: Evidence from German hospitalization data. HEALTH ECONOMICS 2018; 27:1738-1753. [PMID: 30022556 DOI: 10.1002/hec.3798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/22/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
This paper studies the short-term impact of public smoking bans on hospitalizations in Germany. It exploits the staggered implementation of smoking bans over time and across the 16 federal states along with the universe of hospitalizations from 2000 to 2008 and daily county-level weather and pollution data. Smoking bans in bars and restaurants have been effective in preventing 1.9 hospital admissions (-2.1%) due to cardiovascular diseases per day, per 1 million population. We also find a decrease by 0.5 admissions (-6.5%) due to asthma per day, per 1 million population. The health prevention effects are more pronounced on sunny days and days with higher ambient pollution levels.
Collapse
Affiliation(s)
- Michael Kvasnicka
- Faculty of Economics and Management, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
- RWI, Essen, Germany
- IZA, Bonn, Germany
| | - Thomas Siedler
- IZA, Bonn, Germany
- Faculty of Economics and Social Sciences, Universität Hamburg, Hamburg, Germany
- DIW, Berlin, Germany
| | - Nicolas R Ziebarth
- IZA, Bonn, Germany
- Policy Analysis and Management (PAM), Cornell University, Ithaca, New York
- DIW, Berlin, Germany
| |
Collapse
|
35
|
Betz MR, Jones LE. Wage and Employment Growth in America's Drug Epidemic: Is All Growth Created Equal? AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS 2018; 100:1357-1374. [PMID: 30344331 PMCID: PMC6182977 DOI: 10.1093/ajae/aay069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The rise in drug overdose deaths in the United States since the turn of the millennium has been extraordinary. A popular narrative paints a picture whereby opioid overdoses among white, male, less-educated, rural workers have been caused by reduced economic opportunities borne by such people. In this article, we causally test the validity of this theory by using Bartik-type variables to explore the relationship between local economic conditions and county opioid overdose death rates. We add to the literature by exploring how both employment and wage growth in different types of industries are related to opioid overdose deaths for the population as a whole, as well as for rural (vs. urban), male (vs. female) and white (vs. black) populations. We find mixed evidence. Our results confirm that wage and employment growth in industries more likely to employ low-skill workers are important protective factors for rural, white males. However, we also find evidence that economic improvements in low-skill industries are just as important in protecting blacks and women against opioid overdoses, and for workers in metro counties. We also find evidence that employment growth in high-paying industries has led to increases in opioid overdoes rates.
Collapse
|
36
|
Kaiser M, Reutter M, Sousa-Poza A, Strohmaier K. Smoking and local unemployment: Evidence from Germany. ECONOMICS AND HUMAN BIOLOGY 2018; 29:138-147. [PMID: 29649780 DOI: 10.1016/j.ehb.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
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.
Collapse
Affiliation(s)
- Micha Kaiser
- University of Hohenheim, Institute for Health Care and Public Management, Stuttgart, Germany
| | - Mirjam Reutter
- University of Hohenheim, Department of Economics, Econometrics and Empirical Economics, Stuttgart, Germany.
| | - Alfonso Sousa-Poza
- University of Hohenheim, Institute for Health Care and Public Management, Stuttgart, Germany
| | - Kristina Strohmaier
- University of Tuebingen, Department of Economics, Public Economics, Tuebingen, Germany
| |
Collapse
|
37
|
Di Pietro G. Revisiting the impact of macroeconomic conditions on health behaviours. ECONOMICS AND HUMAN BIOLOGY 2018; 28:173-181. [PMID: 29153871 DOI: 10.1016/j.ehb.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
This paper estimates the average population effect of macroeconomic conditions on health behaviours accounting for the heterogeneous impact of the business cycle on individuals. While previous studies use models relying on area-specific unemployment rates to estimate this average effect, this paper employs a model based on area-specific unemployment rates by gender and age group. The rationale for breaking down unemployment rates is that the severity of cyclical upturns and downturns does not only significantly vary across geographical areas, but also across gender and age. The empirical analysis uses microdata from the Italian Multipurpose Household Survey on Everyday Life Issues. The estimates suggest that models employing aggregated and disaggregated unemployment rate measures as a proxy for the business cycle produce similar findings for some health behaviours (such as smoking), whereas different results are obtained for others. While using unemployment rates by gender and age group, fruits and/or vegetables consumption turns out to be procyclical (a 1pp increase in this unemployment rate decreases the probability of consuming at least five daily fruit and/or vegetable servings by 0.0016pp), the opposite effect, though statistically insignificant, is observed once general unemployment rates are used. While both models conclude that physical activity declines during economic downturns, the size of the procyclical effect is much smaller when employing disaggregated rather than aggregated unemployment rates (a 1pp increase in the unemployment rate by gender and age group decreases the probability of doing any physical activity by 0.0017pp).
Collapse
Affiliation(s)
- Giorgio Di Pietro
- Westminster Business School, Department of Economics and Quantitative Methods, 35 Marylebone Road, London NW1 5LS, United Kingdom; IZA, Schaumburg-Lippe-Straße 5-9, 53113 Bonn, Germany.
| |
Collapse
|
38
|
Colombo E, Rotondi V, Stanca L. Macroeconomic conditions and health: Inspecting the transmission mechanism. ECONOMICS AND HUMAN BIOLOGY 2018; 28:29-37. [PMID: 29197240 DOI: 10.1016/j.ehb.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
We study the relationship between macroeconomic conditions and self-reported health in a large sample of Italian individuals, focusing on the mediating role played by health behaviors (smoking, alcohol consumption, physical activity, eating habits) and economic stress. Our findings indicate that, overall, higher local unemployment is negatively related to individuals' health conditions. A one percentage point increase in the province-level unemployment rate is associated with a significant increase in the probability of experiencing diabetes (0.03 percentage points), infarction (0.01), ulcer (0.06), cirrhosis (0.01) and nervous disorders (0.07), with a time lag that differs across individual health conditions. Employment status and educational level play a significant role as moderators of these relationships. Eating habits, in addition to economic stress, play a key role as mediators, by enhancing the negative relationship between macroeconomic conditions and health outcomes, while physical exercise is found to play a dampening role.
Collapse
Affiliation(s)
- Emilio Colombo
- Università Cattolica del Sacro Cuore, DISEIS, Largo Gemelli 1, 20123 Milano, Italy.
| | - Valentina Rotondi
- Bocconi University, Dondena Centre for Research on Social Dynamics and Public Policy, Italy.
| | - Luca Stanca
- University of Milan Bicocca, Department of Economics Management and Statistics and Neuro-MI, Piazza dell'Ateneo Nuovo 1, 20126 Milan, Italy.
| |
Collapse
|
39
|
Rathmann K, Pförtner TK, Elgar FJ, Hurrelmann K, Richter M. The Great Recession, Adolescent Smoking, and Smoking Inequalities: What Role Does Youth Unemployment Play in 24 European Countries? Nicotine Tob Res 2018; 19:1284-1291. [PMID: 27794036 DOI: 10.1093/ntr/ntw298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/25/2016] [Indexed: 11/14/2022]
Abstract
Introduction Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. No study has yet investigated young people's smoking and inequalities in smoking during economic recessions. This study examines the association between country-level youth unemployment due to the economic recession and adolescent smoking and smoking inequalities in Europe. Methods The WHO collaborative "Health Behaviour in School-aged Children" study in 2009/2010 included 15-year-old adolescents from 24 European countries (N = 43 093). Socioeconomic position (SEP) was measured by the Family Affluence Scale. Logistic multilevel models were conducted. The absolute rate of youth unemployment in 2010 (during the recession) and the relative change rate in youth unemployment (2005/2006-2009/2010) were regressed on smoking and SEP inequalities in smoking in 2010, respectively. Results Youth unemployment rates were not significantly associated with overall smoking in adolescents. A higher absolute youth unemployment rate in 2010 related to lower likelihoods of smoking among middle (OR: 0.99; 95% CI: 0.98-0.99) and low affluent adolescents (OR: 0.99; 95% CI: 0.98-0.99) compared to high affluent adolescents. In contrast, an increase in youth unemployment (2005/2006-2009/2010) was not associated with overall likelihoods of smoking and inequalities in smoking. Conclusions Our findings indicate that an increase in youth unemployment was not related to smoking and smoking inequalities. However, higher absolute levels of youth unemployment are related to lower likelihoods of smoking in lower SEP adolescents. Thus, smoking among vulnerable groups is more linked to the overall insecure circumstances and the affordability of cigarettes rather than to the economic recession itself. Implications Economic recessions have often led to increases in adult and youth unemployment rates. Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. This study examines for the first time the impact of the economic recession on young people's smoking and socioeconomic inequalities in smoking. Findings highlight that rather than an increase in youth unemployment, the overall country-level youth unemployment rate is related to young people's tobacco use and particularly to lower odds in smoking among less affluent adolescents across Europe, a finding which is likely to be linked to the affordability of tobacco use.
Collapse
Affiliation(s)
- Katharina Rathmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany.,Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences and the Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Frank J Elgar
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | | | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
40
|
Jofre-Bonet M, Serra-Sastre V, Vandoros S. The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England. Soc Sci Med 2018; 197:213-225. [DOI: 10.1016/j.socscimed.2017.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 12/26/2022]
|
41
|
Ayllón S, Ferreira-Batista NN. Unemployment, drugs and attitudes among European youth. JOURNAL OF HEALTH ECONOMICS 2018; 57:236-248. [PMID: 28899566 DOI: 10.1016/j.jhealeco.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 08/10/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
This paper studies changes in the patterns of drug consumption and attitudes towards drugs in relation to sky-high (youth) unemployment rates brought about by the Great Recession. Our analysis is based on data for 28 European countries that refer to young people. We find that the consumption of cannabis and 'new substances' is positively related to increasing unemployment rates. An increase of 1% in the regional unemployment rate is associated with an increase of 0.7 percentage points in the ratio of young people who state that they have consumed cannabis at some point in time. Our findings also indicate that higher unemployment may be associated with more young people perceiving that access to drugs has become more difficult, particularly access to ecstasy, cocaine and heroin. According to young Europeans, when the economy worsens, anti-drug policies should focus on the reduction of poverty and unemployment, and not on implementing tougher measures against users.
Collapse
Affiliation(s)
- Sara Ayllón
- Department of Economics & EQUALITAS, University of Girona, Spain.
| | | |
Collapse
|
42
|
Nguyen HT, Connelly LB. Out of sight but not out of mind: Home countries' macroeconomic volatilities and immigrants' mental health. HEALTH ECONOMICS 2018; 27:189-208. [PMID: 28618448 DOI: 10.1002/hec.3532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/19/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
We provide the first empirical evidence that better economic performances by immigrants' countries of origin, as measured by lower consumer price index (CPI) or higher gross domestic product, improve immigrants' mental health. We use an econometrically-robust approach that exploits exogenous changes in macroeconomic conditions across immigrants' home countries over time and controls for immigrants' observable and unobservable characteristics. The CPI effect is statistically significant and sizeable. Furthermore, the CPI effect diminishes as the time since emigrating increases. By contrast, home countries' unemployment rates and exchange rate fluctuations have no impact on immigrants' mental health.
Collapse
Affiliation(s)
- Ha Trong Nguyen
- Bankwest Curtin Economics Centre, Curtin University, Perth, WA, Australia
| | - Luke Brian Connelly
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Australia
| |
Collapse
|
43
|
Richman JA, Brown RL, Rospenda KM. Age Cohort Variation in Drinking among People with Physical Impairments: Politically-oriented Coping in the Wake of the Great Recession. JOURNAL OF DRUG ISSUES 2017; 47:467-478. [PMID: 29217868 DOI: 10.1177/0022042617701254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People with physical impairments are at greater risk for economic hardship and more alcohol-related problems compared to the general population. We address age cohort differences in modes of coping with economic adversity and the extent to which modes of coping explain the relationships between age cohort membership and drinking outcomes among people with physical impairments. 176 respondents with physical impairments derived from a national sample completed a mail survey. Using SEM, we demonstrate that members of the Generation X age cohort manifest higher levels of alcohol consumption and problem-related drinking compared to baby boomers due to their lesser tendency to engage in politically-oriented coping to deal with economic adversity. Within the context of social movements contesting the disadvantaged social status of people with disabilities, the Generation X age cohort manifests both more limited political engagement and higher levels of alcohol consumption and problem-related drinking among people with physical impairments.
Collapse
Affiliation(s)
- Judith A Richman
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor Street, Chicago, IL 60612, U.S.A
| | - Robyn Lewis Brown
- Department of Sociology, University of Kentucky, 1529 Patterson Office Tower, Lexington, KY 40506, U.S.A
| | - Kathleen M Rospenda
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor Street, Chicago, IL 60612, U.S.A
| |
Collapse
|
44
|
van den Berg GJ, Gerdtham UG, von Hinke S, Lindeboom M, Lissdaniels J, Sundquist J, Sundquist K. Mortality and the business cycle: Evidence from individual and aggregated data. JOURNAL OF HEALTH ECONOMICS 2017; 56:61-70. [PMID: 28968530 PMCID: PMC6690392 DOI: 10.1016/j.jhealeco.2017.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/17/2017] [Accepted: 09/10/2017] [Indexed: 05/12/2023]
Abstract
There has been much interest recently in the relationship between economic conditions and mortality, with some studies showing that mortality is pro-cyclical, while others find the opposite. Some suggest that the aggregation level of analysis (e.g. individual vs. regional) matters. We use both individual and aggregated data on a sample of 20-64 year-old Swedish men from 1993 to 2007. Our results show that the association between the business cycle and mortality does not depend on the level of analysis: the sign and magnitude of the parameter estimates are similar at the individual level and the aggregate (county) level; both showing pro-cyclical mortality.
Collapse
Affiliation(s)
- Gerard J van den Berg
- School of Economics, Finance and Management, University of Bristol, Bristol, United Kingdom; The Institute for Evaluation of Labour Market and Education Policy (IFAU), Uppsala, Sweden
| | - Ulf-G Gerdtham
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Economics, Lund University, Lund, Sweden; Centre for Economic Demography, Lund University, Lund, Sweden
| | - Stephanie von Hinke
- School of Economics, Finance and Management, University of Bristol, Bristol, United Kingdom
| | - Maarten Lindeboom
- School of Business and Economics, Vrije University Amsterdam, Amsterdam, Netherlands
| | - Johannes Lissdaniels
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Sweden; The Swedish Agency for Health and Care Services Analysis, Stockholm, Sweden.
| | | | | |
Collapse
|
45
|
Hollingsworth A, Ruhm CJ, Simon K. Macroeconomic conditions and opioid abuse. JOURNAL OF HEALTH ECONOMICS 2017; 56:222-233. [PMID: 29128677 DOI: 10.1016/j.jhealeco.2017.07.009] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/31/2017] [Indexed: 05/25/2023]
Abstract
We examine how deaths and emergency department (ED) visits related to use of opioid analgesics (opioids) and other drugs vary with macroeconomic conditions. As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic shocks also increase the overall drug death rate, but this increase is driven by rising opioid deaths. Our findings hold when performing a state-level analysis, rather than county-level; are primarily driven by adverse events among whites; and are stable across time periods.
Collapse
Affiliation(s)
- Alex Hollingsworth
- School of Public and Environmental Affairs, Indiana University, United States
| | - Christopher J Ruhm
- Public Policy and Economics, Frank Batten School of Leadership and Public Policy, University of Virginia, United States; NBER, United States
| | - Kosali Simon
- School of Public and Environmental Affairs, Indiana University, United States; NBER, United States.
| |
Collapse
|
46
|
Paling T, Vall Castello J. Business cycle impacts on substance use of adolescents: A multi-country analysis. ECONOMICS AND HUMAN BIOLOGY 2017; 27:1-11. [PMID: 28472713 DOI: 10.1016/j.ehb.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/05/2017] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
Populations respond to changes in the economic climate in a variety of ways. The recent 'Great Recession' has brought attention to the vulnerability of many economies around the world to changes in non-domestic macroeconomic fluctuations. However, empirical evidence on the responses of adolescents' substance consumption behaviour when the economy deteriorates is very scarce. Thus, the focus of this paper is to analyse the substance consumption patterns displayed by adolescents in response to changes in macroeconomic conditions in a large number of countries. Our results show that beer and wine consumption vary counter-cyclically (a 1pp increase in the unemployment rate increases the probability of drinking beer (wine) by 3% (5.5%)) while adolescent smoking prevalence varies pro-cyclically (a 1pp increase in the unemployment rate decreases the probability of being a current smoker by 3.8%). More importantly, we find that the probability of ever being drunk increases by 1.3% for a 1pp increase in the unemployment rate. Further to this, substantial heterogeneous effects from the aggregate-level results were found when analysing a variety of demographic and geographic dimensions. In light of the existing empirical evidence which outlines that early substance initiators demonstrate worse neurological deficits and suffer stronger labour market penalties (compared to later initiators or abstainers) these findings can aid policy makers in reducing these lasting adverse outcomes.
Collapse
Affiliation(s)
| | - Judit Vall Castello
- Centre for Research in Health and Economics, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, Barcelona, Spain.
| |
Collapse
|
47
|
Chan YS, Chen CS, Huang L, Peng YI. Sanction changes and drunk-driving injuries/deaths in Taiwan. ACCIDENT; ANALYSIS AND PREVENTION 2017; 107:102-109. [PMID: 28818681 DOI: 10.1016/j.aap.2017.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 07/23/2017] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
Driving under the influence (DUI) is one of the major causes of traffic accidents in Taiwan. About 5% of injuries involve DUI, and nearly 20% of deaths are due to alcohol-related crashes. During early 2006 to the end of 2014, the authorities in Taiwan increased the severity of fine and jail penalties for DUI offenders three times. At the same time, the monthly drunk-driving injures decreased nearly 40% and the monthly alcohol-related traffic death dropped more than 80%. In this paper, we examine the effects of sanction changes on the reduction of drunk-driving casualties during this period. We find that drunk-driving injuries and deaths significantly dropped after the statutory changes. The reduction was immediate following all sanction changes that raised the maximum fines or jail terms of DUI offenders. Policies that increased the maximum jail terms of DUI offenders seem to have a better gradual effect on the reduction of alcohol-related traffic casualties. Although increased sanctions are found to be effective in reducing drunk-driving casualties, we need more future research to examine the policy-to-perception and the policy-to-behavior links.
Collapse
Affiliation(s)
- Yun-Shan Chan
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia District, New Taipei City, 23741 Taiwan.
| | - Chin-Shyan Chen
- Department of Economics, National Taipei University, 151, University Rd., San Shia District, New Taipei City, 23741 Taiwan.
| | - Lanying Huang
- Graduate School of Criminology, National Taipei University, 151, University Rd., San Shia District, New Taipei City, 23741 Taiwan.
| | - Yu-I Peng
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia District, New Taipei City, 23741 Taiwan.
| |
Collapse
|
48
|
Milicic S, DeCicca P. The Impact of Economic Conditions on Healthy Dietary Intake: Evidence From Fluctuations in Canadian Unemployment Rates. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:632-638.e1. [PMID: 28889852 DOI: 10.1016/j.jneb.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study examined the impact of economic conditions on fruit and vegetable consumption using multiple waves of the Canadian Community Health Survey. DESIGN By using metropolitan-area variation in the unemployment rate as a proxy for economic conditions, various measures of fruit and vegetable consumption were regressed on this unemployment rate, using a 2-way fixed effect estimation strategy. MAIN OUTCOME MEASURES The following measures of fruit and vegetable consumption were considered: (1) total number of times per day respondents ate fruits and vegetables and (2) servings of fruit of vegetable consumption (<5 times/d, 5-10 times/d, and >10 times/d). ANALYSIS Regression models with location and time-fixed effects were estimated to explore the impact of the unemployment rate with the measures of fruit and vegetable consumption. Pearson's chi-square tests were used to examine subgroup differences by gender. RESULTS Findings suggested that increases in the unemployment rate (ie, worse economic conditions) reduced fruit and vegetable consumption, and this result was robust across gender and education levels. CONCLUSIONS AND IMPLICATIONS These findings contribute to a small but important body of literature that focuses specifically on the relationship between economic conditions and fruit and vegetable consumption.
Collapse
Affiliation(s)
- Sandra Milicic
- Propel Centre for Population Health Impact, Faculty of Applied Health Science, University of Waterloo, Waterloo, Ontario, Canada.
| | - Philip DeCicca
- Faculty of Arts Department of Economics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
49
|
Bosque-Prous M, Kunst AE, Brugal MT, Espelt A. Changes in alcohol consumption in the 50- to 64-year-old European economically active population during an economic crisis. Eur J Public Health 2017; 27:711-716. [PMID: 28472296 PMCID: PMC5881701 DOI: 10.1093/eurpub/ckx044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The aim was to compare alcohol drinking patterns in economically active people aged 50-64 years before the last economic crisis (2006) and during the crisis (2013). Methods Cross-sectional study with data from 25 479 economically active people aged 50-64 years resident in 11 European countries who participated in wave 2 or wave 5 of the SHARE project (2006 and 2013). The outcome variables were hazardous drinking, abstention in previous 3 months and the weekly average number of drinks per drinker. The prevalence ratios of hazardous drinking and abstention, comparing the prevalence in 2013 vs. 2006, were estimated with Poisson regression models with robust variance, and the changes in the number of drinks per week with Poisson regression models. Results The prevalence of hazardous drinking decreased among both men (PR = 0.75; 95%CI = 0.63-0.92) and women (PR = 0.91; 95%CI = 0.72-1.15), although the latter decrease was smaller and not statistically significant. The proportion of abstainers increased among both men (PR = 1.11; 95%CI = 0.99-1.29) and women (PR = 1.18; 95%CI = 1.07-1.30), although the former increase was smaller and not statistically significant. The weekly average number of drinks per drinker decreased in men and women. The decreases in consumption were larger in Italy and Spain. Conclusion From 2006 to 2013, the amount of alcohol consumed by late working age drinkers decreased in Europe, with more pronounced declines in the countries hardest hit by the economic crisis.
Collapse
Affiliation(s)
- Marina Bosque-Prous
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M. Teresa Brugal
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Albert Espelt
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centros de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| |
Collapse
|
50
|
The Effects of the Global Economic Recession and a Reduced Alcohol Tax on Hospitalizations Due to Alcohol-Attributed Diseases in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060580. [PMID: 28556807 PMCID: PMC5486266 DOI: 10.3390/ijerph14060580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 12/01/2022]
Abstract
This study is to assess the effects of the 2008 economic crisis and a 2009 alcohol tax reduction on alcohol-related morbidity for men of different socioeconomic statuses in Taiwan. Admissions data for the period from 2007 to 2012 for men aged 24–59 years in 2007 was retrieved from the National Health Insurance Research Database. With stratification over three income levels, an interrupted time-series analysis examining the effects of the crisis and taxation reduction on incidence rates of hospitalization for alcohol-attributed diseases (AADs) was employed. The low income group showed a significant (p < 0.05) change in the rate of AAD-related hospitalizations in July 2008; specifically, an abrupt 7.11% increase that was then sustained for several months thereafter. In contrast, while the middle income group exhibited a significant 22.9% decline in the rate of AAD-related hospitalizations over the course of the crisis, that downward trend was gradual. The reduction of the alcohol tax resulted in increased rates of AADs among both the low and high income groups. The economic recession and the reduction of the alcohol tax resulted in an increased rate of AAD among low income men.
Collapse
|