Chronic health conditions and their impact on the labor market. A cross-country comparison in Europe

Objectives

To estimate the effect of having a chronic disease on the weekly working hours and the associated monetary losses.

Design

Longitudinal data Survey of Health, Aging and Retirement (SHARE) in Europe. We analyzed 7 waves from 9 countries in Europe. A total of 80.672 observations.

Setting

Participants who have their regular domicile in the respective SHARE country were interviewed face-to-face.

Participants

Data from individuals aged between 50 and 65 years old in European countries were collected over seven years. A person was excluded from the survey if incarcerated, hospitalized or out of the country during the entire survey period, unable to speak the country's language(s) or moved to an unknown address.

Interventions

Not applicable.

Main outcome measurements

We applied a difference-in-differences with multiple time periods approach to estimate the effect of having a chronic condition on the number of working hours per week. We monetized the estimated productivity losses using the legal minimum wage in each country.

Results

Persons with a chronic condition consistently reduced their weekly working hours compared to their healthy counterparts in the same country. This effect was more pronounced for men (6,78 hours per week or 352 hours per year) than women (3,97 hours per week or 206 hours per year). Persons with stroke, vascular, and lung disease showed the highest impact. On average, the reduced working hours represent about USD 12,80 billion annually in productivity losses in our sample.

Conclusion

Having a chronic condition leads to people decreasing their working hours, which has significant economic losses. More severe health conditions showed the highest effects. This trend is observed in all the analyzed countries, highlighting the relevance of health and social systems to go beyond mortality and morbidity and the need to incorporate functioning in their target goals.

Effect of marine ecological compensation policy on coastal water pollution: Evidence from China based on a multiple period difference-in-differences approach

With the development and utilization of marine resources, coastal water pollution has become increasingly prominent. The marine ecological compensation (MEC) is a key measure to balance the utilization of marine resources and the protection of marine environment. This paper attempts to explore the governance effect of MEC policy on coastal water pollution. Based on panel data of coastal cities in China from 2006 to 2020, a multiple period difference-in-differences (DID) model is used to estimate the impact of MEC policy on coastal water pollution. The research results show that the coastal water pollution has decreased significantly in the polit cities after implementing the MEC policy. The governance effect of MEC policy on coastal water pollution will last for three year and cover areas within a geographical distance of 200 km. The transmission mechanisms of MEC policy on coastal water pollution are the reduction of land-based sewage, marine technological progress and optimization of industrial structure. Further, this paper provides operational suggestions for strengthening the governance effect of MEC policy on coastal water pollution.

Relationships between long-term exposure to major PM2.5 constituents and outpatient visits and hospitalizations in Guangdong, China

Ambient fine particulate matter (PM2.5) has attracted considerable attention due to its crucial role in the rising global disease burden. Evidence of health risks associated with exposure to PM2.5 and its major constituents is important for advancing hazard assessments and air pollution emission policies. We investigated the relationship between exposure to major constituents of PM2.5 and outpatient visits as well as hospitalizations in Guangdong Province, China, where 127 million residents live in a severe PM2.5 pollution environment. An approach that integrates the generalized weighted quantile sum (gWQS) regression with the difference-in-differences (DID) approach was used to assess the overall mixture effects and relative contributions of each constituent. We observed significant associations between long-term exposure to the mixture of PM2.5 constituents (WQS index) and outpatient visits (IR%, percentage increases in risk per unit WQS index increase:1.73, 95%CI: 1.72, 1.74) as well as hospitalizations (IR%:5.15, 95%CI: 5.11, 5.20). Black carbon (weight: 0.34) and nitrate (weight: 0.60) respectively exhibited the highest contributions to outpatient visits and hospitalizations. The overall mixture effects on outpatient visits and hospitalizations were higher with increased summer air temperatures (IR%: 7.54, 95%CI: 7.33, 7.74 and IR%: 9.55, 95%CI: 8.36, 10.75, respectively) or decreased winter air temperatures (IR%: 1.88, 95%CI: 1.68, 2.08 and IR%: 4.87, 95%CI: 3.73, 6.02, respectively). Furthermore, the overall mixture effects on outpatient visits and hospitalizations were significantly higher in populations with higher socioeconomic status (P < 0.01). It's crucial to address the primary sources of nitrate precursor substances and black carbon (mainly traffic-related and industrial-related air pollutants) and consider the complex interaction effects between air temperature and PM2.5 in the context of climate change. Of particular concern is the need to prioritize healthcare demands in economically disadvantaged regions and to address the health inequalities stemming from the uneven distribution of healthcare resources and PM2.5 pollution.

The impact of the energy-consuming right trading system on corporate environmental performance: Based on empirical evidence from panel data of industrial enterprises listed in pilot regions

The energy-consuming right trading system (ECRTS) is a significant institutional innovation in China to address the increasingly severe energy crisis and environmental issues. Identifying the policy effects of energy consumption rights on corporate environmental performance (CEP) is conducive to achieving a win-win situation for China's economic growth and carbon neutrality. This study aims to analyze the impact of energy-consuming right trading system on corporate environmental performance and provide empirical evidence and policy implications for the full implementation of future policies. Using data from Chinese listed industrial enterprises from 2012 to 2019 and adopting the difference-in-differences method and mediation analysis, we empirically analyze the policy effects of energy-consuming right trading system. We find that the energy-consuming right trading system significantly promotes the improvement of corporate environmental performance, and the conclusion remains valid after a series of robustness tests. Further mechanism examinations indicate that the system mainly enhances environmental performance by affecting corporate green technological innovation. Heterogeneity tests suggest that the energy-consuming right trading system has a stronger impact on companies in economically developed regions, non-state-owned enterprises, and those with higher asset flexibility. Our research results can aid in the green transformation of enterprises and provide practical evidence for China to accelerate the comprehensive construction of the energy consumption rights trading market.

Post-traumatic growth in later-life cognitive function? Evidence from the 1976 Great Tangshan Earthquake

OBJECTIVES

This study aimed to explore the long-term impacts of exposure to earthquake in adolescence on later-life cognitive function in China.

METHODS

Data were from the 2015 China Health and Retirement Longitudinal Study (CHARLS). Our analytical sample comprised 4394 participants aged 49 to 78 from two birth cohorts born between 1937 and 1966: exposed cohort during adolescence (born between 1952 and 1966), and non-exposed cohort during adolescence (born between 1937 and 1951). We defined earthquake exposure as the exposure severity of the 1976 Great Tangshan Earthquake (GTE). We selected community environmental characteristics as our key moderators. A difference-in-differences (DID) method was employed to estimate the long-term impact of the GTE on later-life cognitive function.

RESULTS

We found that exposure to the earthquake during adolescence resulted in higher scores of later-life cognitive function (for males: β = 2.18; 95% CI: 0.70-3.66; for females: β = 1.22; 95% CI: 0.11-2.33). For males, this impact was moderated by community environmental characteristics including the old-age allowance program (β = 3.07; 95% CI: 1.94-4.19) and the condition of basic community infrastructures (β = 1.52; 95% CI: 0.84-2.19).

CONCLUSIONS

Our study supports the post-traumatic growth theory. This finding suggest that individuals with early-life traumatic exposure need to be focused on. Additionally, improving the conditions of community infrastructures and establishing a community environment with comfort and security may be pretty important for promoting cognitive function and post-traumatic growth.

Effect of extreme high temperature on cognitive function at different time scales: A national difference-in-differences analysis

BACKGROUND

Mounting evidence has demonstrated that high temperature was associated with adverse health outcomes, especially morbidity and mortality. Nonetheless, the impact of extreme high temperature on cognitive performance, which is the fundamental capacity for interpreting one's surroundings, decision-making, and acquiring new abilities, has not been thoroughly investigated.

METHODS

We aimed to assess associations between extreme high temperature at different time scales and poor cognitive function. We used longitudinal survey data from the three waves of data from China Family Panel Study, providing an 8-year follow-up of 53,008 participants from China. We assessed temperature and extreme high temperature exposure for each participant based on the residential area and date of cognitive test. We defined the proportion of days/hours above 32 °C as the metric of the exposure to extreme high temperature. Then we used generalized additive model and difference-in-differences approach to explore the associations between extreme high temperature and cognitive function.

RESULTS

Our results demonstrated that either acute exposure or long-term exposure to extreme high temperature was associated with cognitive decline. At hourly level, 0-1 hour acute exposure to extreme high temperature would induce -0.93 % (95 % CI: -1.46 %, -0.39 %) cognitive change. At annual level, 10 percentage point increase in the hours proportion exceeding 32 °C in the past two years induced -9.87 % (95 % CI: -13.99 %, -5.75 %) cognitive change. Furthermore, subgroup analyses indicated adaptation effect: for the same 10 percentage increase in hours proportion exceeding 32 °C, people in warmer areas had cognitive change of -6.41 % (-11.22 %, -1.61 %), compared with -15.30 % (-21.07 %, -9.53 %) for people in cool areas.

CONCLUSION

Our results demonstrated that extreme high temperature was associated with reduced cognitive function at hourly, daily and annual levels, warning that people should take better measures to protect the cognitive function in the context of climate change.

Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study

BACKGROUND

Family doctors, serving as gatekeepers, are the core of primary health care to meet basic health needs, provide accessible care, and improve attainable health. The study objective was to evaluate the impact of the family doctor system on health service utilization among patients with hypertension and diabetes in China.

METHODS

Difference-in-Differences (DID) models are constructed to estimate the net effect of the family doctor system, based on the official health management records and medical insurance claim data of patients with hypertension and diabetes in an eastern city of China.

RESULTS

The family doctor system significantly increases follow-up visits (hypertension patients coef. = 0.13, diabetes patients coef. = 0.08, both p < 0.001) and outpatient visits (hypertension patients coef. = 0.08, diabetes patients coef. = 0.05, both p < 0.001) among the contracted compared to the non-contracted. The proportion of outpatient visits in community health centers among the contracted significantly rose (hypertension patients coef. = 0.02, diabetes patients coef. = 0.04, both p < 0.001) due to significantly more outpatient visits in community health centers and fewer in secondary and tertiary hospitals. It also significantly mitigates the increase in inpatient admissions among hypertension patients but not among diabetes patients.

CONCLUSIONS

The examined family doctor system strengthens primary care, both by increasing follow-up visits and outpatient visits and promoting a rationalized structure of outpatient utilization in China.

Has environmental protection tax reform promoted green transformation of enterprises? Evidence from China

Facing the increasingly stringent constraints of resources and the environment, the green transformation of enterprises is imperative. This study selects A-share listed companies in Shanghai and Shenzhen from 2014 to 2021 as samples, using the difference-in-differences method to examine the impact of the environmental protection tax reform (EPTR) on the green transformation of enterprises. The results indicate that the EPTR can promote the green transformation of enterprises, achieving this through three channels: raising the cost of pollution, strengthening the rigidity of law enforcement, and breaking the collusion between the government and enterprises. Notably, this promotional effect is more significant in non-state-owned enterprises, companies in the eastern and western regions, firms with low financing constraints, and those with high media attention. Further analysis shows that the EPTR has a positive impact on the green total factor productivity (GTFP) of enterprises, which implies that enterprises are not only proactively pushing for a green transformation at the strategic level but also taking practical actions. This study responds to the problem of the greening of tax system to promote the green development of enterprises from two aspects of enterprise strategic implementation and productivity and explores the impact mechanism from the perspective of institutional logic. It enriches the research on the effectiveness of the EPTR at the micro-level and broadens the research perspective on the impact mechanisms of environmental regulation. The findings of this study provide references for further optimising relevant policies and regulations and also offer insights for other countries and regions seeking sustainable development.

Farmland protection and fertilization intensity: Empirical evidence from preservation policy of Heilongjiang's black soil

The preservation of cultivated land quality stands as a vital prerequisite for ensuring food security and sustainability. In the black soil area of northeast China, a large amount of fertilizer was used to stabilize grain production in its early stages, which damaged soil structure and polluted the ecological environment. Based on the panel data of fertilization intensity of 48 districts and counties in Heilongjiang Province from 2010 to 2020, this study takes the implementation of the "Three-Year Action Plan for the Protection of Black Soil Farmland in Heilongjiang Province for the (2018-2020)" (TYAP) policy as a natural experiment, and uses the difference-in-differences (DiD) method to identify the causal effect of the policy on the local fertilization intensity. The results of the empirical study showed that the implementation of the TYAP policy significantly reduced the fertilization intensity of the black soil cultivated land implemented by the policy during the implementation period, which resulted in a decrease of 11.97% on average compared with the areas without the policy implementation. Several robustness tests provided additional confirmation of the aforementioned findings. This study further revealed that the policy mitigated fertilization intensity by fostering advancements in agricultural mechanization.

Unlocking the double-dividend: Evaluating the impact of SO₂ emissions trading scheme on firm's environmental and economic performance

The optimal design of environmental instruments demands a balance between environmental enhancement and economic growth. Utilizing microdata from the China Environmental Statistics Database and the China Industrial Firm Database, this study employs the difference-in-differences (DD) methodology to explore the dual effects of the SO₂ Emissions Trading Scheme (ETS) on the environmental and economic performance of micro-firms. The findings suggest that: (1) The SO₂ ETS not only induces emission reduction effects among firms in pilot areas but also improves their industrial added value. (2) The SO₂ ETS exhibits heterogeneous impacts across firms of diverse ownership, export status, and size. (3) While the SO₂ ETS prompts firms to advance technologically, boosting desulfurization capacities and subsequently enhancing total factor productivity, it also inadvertently results in companies offsetting some environmental compliance costs by curtailing employee wages.

Quasi-experimental methods for pharmacoepidemiology: difference-in-differences and synthetic control methods with case studies for vaccine evaluation

Difference-in-differences and synthetic control methods have become common study designs for evaluating the effects of policy changes, including health policies. They also have potential for providing real-world effectiveness and safety evidence in pharmacoepidemiology. To effectively add to the toolkit of the field, however, designs-including both their benefits and drawbacks-must be well understood. Quasi-experimental designs provide an opportunity to estimate the average treatment effect on the treated without requiring the measurement of all possible confounding factors, and to assess population-level effects. This requires, however, other key assumptions, including the parallel trends or stable weighting assumptions, a lack of other concurrent events that could alter time trends, and an absence of contamination between exposed and unexposed units. The targeted estimands are also highly specific to the settings of the study, and combining across units or time periods can be challenging. Case studies are presented for three vaccine evaluation studies, showcasing some of these challenges and opportunities in a specific field of pharmacoepidemiology. These methods provide feasible and valuable sources of evidence in various pharmacoepidemiologic settings and can be improved through research to identify and weigh the advantages and disadvantages in those settings.

The health and welfare effects of environmental governance: Evidence from China

Environmental regulations aim to reduce pollution and improve air quality and the health of residents. However, there is a lack of research focusing on the health and welfare effects of low-carbon city pilot policies. In this context, this study takes China's low-carbon city pilot policy as an entry point, focuses on the health effects of public environmental governance, and systematically investigates the effects and mechanisms of low-carbon city development on the health of middle-aged and elderly people by applying the difference-in-differences method. The study finds that low-carbon city (LCC) policy significantly improves the physical and mental health of middle-aged and elderly people, and the main transmission mechanism is the reduction in air pollution and improvement in social capital. These results hold following a series of robustness tests. Furthermore, low-carbon city construction can reduce hospitalization and outpatient costs for people over 45 years old by up to 3 % and 15.5 %, respectively. The findings of this study provide useful policy insights for ensuring sustainable improvement in environmental quality and public health.

Effects of nurse visit copayment on primary care use: Do low-income households pay the price?

Nurses are increasingly providing primary care, yet the literature on cost-sharing has paid little attention to nurse visits. We employ a staggered difference-in-differences design to examine the effects of adopting a 10-euro copayment for nurse visits on the use of public primary care among Finnish adults. We find that the copayment reduced nurse visits by 9%-10% during a one-year follow-up. There is heterogeneity by income in absolute terms, but not in relative terms. The spillover effects on general practitioner (GP) use are negative but small, with varying statistical significance. We also analyze the subsequent nationwide abolition of the copayment. However, we refrain from drawing causal conclusions from this due to the lack of credibility in the parallel trends assumption. Overall, our analysis suggests that moderate copayments can create a greater barrier to access for low-income individuals. We also provide an example of using a pre-analysis plan for retrospective observational data.

The human health effects of harmful algal blooms in Florida: The importance of high resolution data

Harmful algal blooms (HABs) have been found to cause increases in healthcare visits for a variety of illnesses to humans if exposure and contact is sufficient. We use a more comprehensive dataset than previously implemented in prior literature to better isolate visits by healthcare facility type and proximity to bloom. Using a difference-in-differences model, our results suggest HABs cause an increase of 23.67 healthcare admissions per zip code per month across four HAB-related diagnoses. This impact is a 3,000% increase over baseline non-bloom times and an increase in monthly healthcare costs of about $250,000 for the entire impacted area. Our data include inpatient non-emergency and outpatient healthcare visits, which account for over 60% of all HAB-related healthcare visits, meaning that prior literature that has not measured those facilities has greatly underestimated HAB health impacts.

The Impacts of New York State's Paid Family Leave Policy on Parents' Sleep and Exercise

OBJECTIVES

To assess changes in young parents' health behaviors following implementation of New York State's Paid Family Leave Program (NYSPFL).

METHODS

We used synthetic control (N = 117,552) and difference-in-differences (N = 18,973) models with data from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2019 to provide individual-level estimates of the effects of NYSPFL on self-reported exercise in the past month and average daily sleep of adults aged 21-30 years living with one or more children under 18 years of age in New York and comparison states.

RESULTS

Synthetic control model results indicate that the NYSPFL increased the likelihood of exercise in the past month among mothers, single parents, and low-income parents by 6.3-10.3% points (pp), whereas fathers showed a decrease in exercise (7.8 pp). Fathers, single parents, and those with two or more children showed increases in daily sleep between 14 and 21 min per day.

CONCLUSIONS FOR PRACTICE

State paid family and medical leave laws may provide benefits for health behaviors among young parents with children under 18, particularly those in low-income and single-parent households.

SARS-CoV-2 trends in Italy, Germany and Portugal and school opening during the period of Omicron variant dominance: A quasi experimental study in the EuCARE project

OBJECTIVES

We investigated the impact of school reopening on SARS-CoV-2 transmission in Italy, Germany, and Portugal in autumn 2022 when the Omicron variant was prevalent.

METHODS

A prospective international study was conducted using the case reproduction number (Rc) calculated with the time parametrization of Omicron. For Germany and Italy, staggered difference-in-differences analysis was employed to explore the causal relationship between school reopening and Rc changes, accounting for varying reopening dates. In Portugal, interrupted time series analysis was used due to simultaneous school reopenings. Multivariable models were adopted to adjust for confounders.

RESULTS

In Italy and Germany, post-reopening Rc estimates were significantly lower compared to those from regions/states that had not yet reopened at the same time points, both in the student population (overall average treatment effect for the treated subpopulation [O-ATT]: -0.80 [95% CI: -0.94;-0.66] for Italy; O-ATT-0.30 [95% CI: -0.36;-0.23] for Germany) and the adult population (O-ATT: -0.04 [95% CI: -0.07;-0.01] for Italy; O-ATT: -0.07 [95% CI: -0.11;-0.03] for Germany). In Portugal, there was a significant decreasing trend in Rc following school reopenings compared to the pre-reopening period (sustained effect: -0.03 [95% CI: -0.04; -0.03] in students; -0.02 [95% CI: -0.03; -0.02] in adults).

CONCLUSIONS

We found no evidence of a causal relationship between school reopenings in autumn 2022 and Omicron SARS-CoV-2 transmission.

People inflows as a pandemic trigger: Evidence from a quasi-experimental study

Although it has been established that population density can contribute to the outbreak of the COVID-19 virus, there is no evidence to suggest that economic activities, which imply a significant change in mobility, played a causal role in the unfolding of the pandemic. In this paper, we exploit the particular situation of Sardinia (Italy) in 2020 to examine how changes in mobility due to tourism inflows (a proxy of economic activities) influenced the development of the COVID-19 pandemic. Using a difference-in-differences approach, we identify a strong causal relationship between tourism flows and the emergence of COVID-19 cases in Sardinia. We estimate the elasticity of COVID-19 cases in relation to the share of tourists to be 4.1%, which increases to 5.1% when excluding local residents. Our analysis suggests that, in the absence of tools preventing the spread of infection, changes in population density due to economic activities trigger the pandemic spreading in previously unaffected locations. This work contributes to the debate on the complex relationship between COVID-19 and the characteristics of locations by providing helpful evidence for risk-prevention policies.

From unequal injuries to unequal learning? Socioeconomic gradients in childhood concussions and the impact on children's academic performance

Previous research identifies stark socioeconomic disparities in child injuries, yet research on the repercussions hereof on other aspects of children's lives remains sparse. This paper tests whether social gradients in minor traumatic brain injuries (mTBIs or concussions) contribute to corresponding inequalities in children's academic performance. Previous research on this topic is mostly based on small samples and confounded by non-random selection into experiencing mTBIs. We improve on prior research by using high quality, large N, administrative registry data. Further, we control for selection into having an mTBI via comparing the test score progression of children having an mTBI with children who experience an mTBI in later years (staggered difference-in-differences). Based on Danish ER/hospital records and national test score data, we find that children from families with lower earnings and less education are more likely to experience an mTBI and that having an mTBI negatively correlates with reading test scores. However, comparing present with future mTBI cases, we show that having an mTBI within a year before a test does not negatively affect children's reading scores. Our findings suggest that negative correlations between mTBIs and academic performance more likely reflect socioeconomic gradients in mTBI incidents rather than a direct causal effect. Further, socioeconomic gradients in mTBI incidents do not significantly contribute to corresponding disparities in academic performance.

Using machine learning and remote sensing to track land use/land cover changes due to armed conflict

Armed conflicts have detrimental impacts on the environment, including land systems. The prevailing understanding of the relation between Land Use/Land Cover (LULC) and armed conflict fails to fully recognize the complexity of their dynamics - a shortcoming that could undermine food security and sustainable land/water resources management in conflict settings. The Syrian portion of the transboundary Orontes River Basin (ORB) has been a site of violent conflict since 2013. Correspondingly, the Lebanese and Turkish portions of the ORB have seen large influxes of refugees. A major challenge in any geoscientific investigation in this region, specifically the Syrian portion, is the unavailability of directly-measured "ground truth" data. To circumvent this problem, we develop a novel methodology that combines remote sensing products, machine learning techniques and quasi-experimental statistical analysis to better understand LULC changes in the ORB between 2004 and 2022. Through analysis of the resulting annual LULC maps, we can draw several quantitative conclusions. Cropland areas decreased by 21-24 % in Syria's conflict hotspot zones after 2013, whereas a 3.4-fold increase was detected in Lebanon. The development of refugee settlements was also tracked in Lebanon and on the Syrian/Turkish borders, revealing different LULC patterns that depend on settlement dynamics. The results highlight the importance of understanding the heterogenous spatio-temporal LULC changes in conflict-affected and refugee-hosting countries. The developed methodology is a flexible, cloud-based approach that can be applied to wide variety of LULC investigations related to conflict, policy and climate.

New evidence of high-speed rail promoting green economic growth in the Yangtze River Economic Belt: empirical analysis based on difference-in-differences

The Yangtze River Economic Belt (YREB) is an important ecological barrier in China. From new perspectives, this paper explores the mechanism of high-speed rail (HSR) for green economic growth (GEG) in the YREB. This paper constructs 108 city panel data at the prefecture level and above in the YREB from 2003 to 2020. Difference-in-differences (DID) is adopted to research the impact of high-speed rail on GEG in the YREB. (1) HSR has significantly improved the GEG of the YREB. The effect value is 4.88%. The parallel trend test suggests that DID is valid. A time-varying instrumental variable combining average altitude and historical railway network is constructed for the endogeneity test. (2) Propensity score matching (PSM) and DID (PSM-DID) were employed to test the sample selection bias. (3) A battery of robustness tests, including the placebo test, variable replacement, and policy interference exclusion, is carried out. The conclusions are still valid. (4) HSR can promote the GEG of the YREB by encouraging technological innovation, industrial upgrading, and increasing ecological efficiency. The contribution rate from the largest to the smallest is ecological efficiency, industrial upgrading, and technological innovation. (5) Heterogeneity analysis shows that HSR has played an important role in encouraging GEG in the eastern, peripheral cities, and the downstream cities of the YREB. Finally, this paper puts forward policy suggestions for promoting GEG in the YREB.

Estimating the impact of the outbreak of wars on financial assets: Evidence from Russia-Ukraine conflict

This study analyzes the performance of the Shanghai Composite Index, S&P 500 index, WTI oil price, and LBMA gold price when wars took place, especially the Russia-Ukraine conflict. We employ empirical methods to explore the stability, instantaneous shock, and short-term shock regarding the abovementioned financial assets. We first adopt the event study method to ascertain whether the cumulative abnormal returns of the selected assets are significant when wars break out. Then, we use the permutation test to examine the significance of price level changes. Results show that only the Shanghai Composite Index is relatively stable. Second, the difference-in-differences model indicates that the 3 unstable assets all suffered positive shocks in their price levels within several days after the Russia-Ukraine conflict broke out. The parallel trend test confirms the validity of establishing the difference-in-differences model. Third, regression discontinuity is designed to measure the impact in a longer event window, suggesting the robustness of conclusions of the difference-in-differences model and revealing an upward trend before the conflict and a downward trend after the conflict of the financial assets. The study suggests that investors consider adjustments to investment strategies and governments take precautions to diminish the risk of the outbreak of wars.

Hospital response to Activity-Based Funding and price incentives: Evidence from Ireland

Activity-Based Funding (ABF) is a funding policy incentivising hospitals to deliver more efficient care. ABF can be complemented by additional price incentives to further drive hospital efficiency. In 2016, ABF was introduced for public patients admitted to Irish public hospitals. Additionally, a price incentive to perform laparoscopic cholecystectomy as day-case surgery was introduced in 2018. Private patient activity in public hospitals was subject to neither ABF nor price incentive. Using national Hospital In-Patient-Enquiry activity data 2013-2019, we evaluated the impact of ABF and the price incentive for laparoscopic cholecystectomy surgery in Ireland. We exploit variation in hospital payment for public and private patients treated in public acute Irish hospitals and employ a Propensity Score Matching Difference-in-Differences approach. We estimate the funding change impacts across outcomes measuring the proportion of day-case admissions and length of stay. We found no significant impact for either outcomes linked to ABF introduction. Similarly, no impacts linked to the price incentive were observed. It appears providers of laparoscopic cholecystectomy in Irish public hospitals did not react to the new funding mechanisms. The implementation of the funding policies did not improve hospital efficiency. Further strengthening of these new funding mechanisms are required to deliver more efficient care.

General Practitioners activity patterns: the medium-term impacts of Primary Care Teams in France

Faced with the fragmentation of the French primary care system, public policies aim to promote multiprofessional teamwork to improve both delivery efficiency and health professionals' working conditions. Thus, a practice-level add-on payment backed by cooperation commitments is implemented to foster and sustain the development of multiprofessional primary care groups (MPCGs). We study the impact of practising in MPCGs for general practitioners (GPs) in terms of the supply of care, practice patterns and income. Based on this quasiexperimental framework with a panel dataset covering the period 2005-2017, we account for the selection into MPCGs by combining a difference-in-differences design with propensity score matching to prebalance samples. We show that GPs in MPCGs increased their patient list more rapidly than control GPs (+10% increase of encountered patients) without increasing their provision of services (number of visits and drug prescriptions) more rapidly. Instead, compared to control GPs, MPCG GPs had a significantly faster reduction in the average number of visits (+5.5% reduction) and the euro-amounts of drug prescriptions per patient (+7.2% reduction) and other prescriptions. The growth of these effects between the short and medium term moreover suggests that the properties of multi-professional coordination and cooperation need time to develop.

Impact of the minimum wage increase on smoking behaviour: A quasi-experimental study in South Korea

BACKGROUND

While there's a growing body of research studying the health effects of minimum wage increases, evidence of its impact on smoking is inconsistent. Using nationally representative statistics, our quasi-experimental study examines the impacts of South Korea's 2018 minimum wage increase on smoking patterns, offering a distinctive context due to the significant wage growth and the country's permissive smoking culture.

METHODS

Using the Korean Welfare Panel Study (KOWEPS), we conducted a difference-in-differences analysis using two-way fixed effect (TWFE) and Callaway and Sant'Anna Difference-in-differences (CSDID) methods. The study sample (n = 3494) included individuals aged 19-64 at baseline in 2016, and employed in the entire study period (2016-2019).

RESULTS

The model results suggest a roughly 2% increase in the probability of current smoking with an insignificant impact on average daily cigarette consumption following the 2018 minimum wage increase in Korea. These effects were most pronounced among men and age groups (45-64). We also found policy effects on those earning up to 150% of the minimum wage.

CONCLUSION

In a culture with widespread acceptance of smoking, an exogenous increase in disposable income due to elevated minimum wage might enhance vulnerability to societal pressure to smoke. Although TWFE and CSDID both suggest the same overall trend, the latter approach allows a more detailed examination by acknowledging heterogeneous treatment effects. These results could guide policymakers to contemplate the potential for increased smoking resulting from minimum wage hikes in societies where tobacco use is common, and accordingly strategize anti-smoking public health initiatives.

How does the quality of care for type 2 diabetic patients benefit from GPs-nurses' teamwork? A staggered difference-in-differences design based on a French pilot program

In many countries, policies have explicitly encouraged primary care teams and inter-professional cooperation and skill mix, as a way to improve both productive efficiency gains and quality improvement. France faces barriers to developing team working as well as new and more advanced roles for health care professionals including nurses. We aim to estimate the impact of a national pilot experiment of teamwork between general practitioners (GPs) and advance practitioners nurses (APN)-who substitute and complement GPs-on yearly quality of care process indicators for type two diabetes patients (T2DP). Implemented by a not-for-profit meso-tier organisation and supported by the Ministry of Health, the pilot relied on the voluntary enrolment of newly GPs from 2012 to 2015; the staffing and training of APNs; skill mixing and new remuneration schemes. We use latent-response formulation models, control for endogeneity and selection bias by using controlled before-after and quasi-experimental design combining coarsened exact matching-prior to the treatment, at both GPs (435 treated vs 973 control) and T2DP levels -, with intention to treat (ITT; 18,310 in each group) and per protocol (PP, 2943 in each group) perspectives, as well as difference-in-differences estimates on balanced panel claims data from the National Health Insurance Fund linked to clinical data over the period 2010-2017. We show evidence of a positive and significant positive impact for T2DP followed-up by newly enrolled GPs in the pilot compared to the pretreatment period and the control group. The effect magnitudes were larger for PP than for ITT subsamples.

The morning after: Prescription-free access to emergency contraceptive pills

We analyze the introduction of prescription-free access to morning-after pills-emergency contraceptives that aim to prevent unintended pregnancy and subsequent abortion after unprotected sexual intercourse. Exploiting a staggered difference-in-differences setting for Europe combined with randomization inference, we find sharp increases in sales and manufacturers' revenues of more than 90%. However, whilst not reducing abortions significantly, the policy triggers an unexpected increase in fertility of 4%, particularly among women aged 25-34. We elaborate on mechanisms by looking at within-country evidence from several EU countries, which suggests that fertility is driven by decreasing use of birth control pills in response to easier access to morning-after pills.

Changes in public bike usage after the COVID-19 outbreak: A survey of Seoul public bike sharing users

When the COVID-19 pandemic swept across the world, people tended to seek more individualized and viable transportation modes, such as a bicycle. In this study, we examined the factors influencing changes in public bike sharing (PBS) in Seoul, to assess this trend post-pandemic. We conducted an online survey of 1,590 Seoul PBS users between July 30 and August 7, 2020. Using a difference-in-differences analysis, we found that participants who were affected by the pandemic used PBS 44.6 h more than unaffected individuals throughout the year. In addition, we used a multinomial logistic regression analysis to identify the factors affecting changes in PBS usage. In this analysis, the discrete dependent variables of increased, unchanged, and decreased were considered, representing the changes in PBS usage after the COVID-19 outbreak. Results revealed that PBS usage increased among female participants during weekday trips such as commuting to work and when there were perceived health benefits of using PBS. Conversely, PBS usage tended to decrease when the weekday trip purpose was for leisure or working out. Our findings offer insight into PBS user behaviors within the context of the COVID-19 pandemic and present policy implications to revitalize PBS usage.

The effects of an increase in the retirement age on health care costs: evidence from administrative data

In this paper, we use unique health record data that cover outpatient care and the associated costs to quantify the health care costs of a sizable increase in the retirement age in Germany. For the identification, we exploit a sizable cohort-specific pension reform which abolished an early retirement program for all women born after 1951. Our results show that health care costs significantly increase by about 2.9% in the age group directly affected by the increase in the retirement age (women aged 60-62). We further show that the cost increase is mainly driven by the following specialist groups: Ophthalmologists, general practitioners (GPs), neurology, orthopedics, and radiology. While the effects are significant and meaningful on the individual level, we show that the increase in health care costs is modest relative to the positive fiscal effects of the pension reform. Specifically, we estimate an aggregate increase in the health costs of about 7.7 million euro for women born in 1952 aged 60-62 which amounts to less than 2% of the overall positive fiscal effects of the pension reform.

Policy evaluation during a pandemic

National and local governments have implemented a large number of policies in response to the Covid-19 pandemic. Evaluating the effects of these policies, both on the number of Covid-19 cases as well as on other economic outcomes is a key ingredient for policymakers to be able to determine which policies are most effective as well as the relative costs and benefits of particular policies. In this paper, we consider the relative merits of common identification strategies that exploit variation in the timing of policies across different locations by checking whether the identification strategies are compatible with leading epidemic models in the epidemiology literature. We argue that unconfoundedness type approaches, that condition on the pre-treatment "state" of the pandemic, are likely to be more useful for evaluating policies than difference-in-differences type approaches due to the highly nonlinear spread of cases during a pandemic. For difference-in-differences, we further show that a version of this problem continues to exist even when one is interested in understanding the effect of a policy on other economic outcomes when those outcomes also depend on the number of Covid-19 cases. We propose alternative approaches that are able to circumvent these issues. We apply our proposed approach to study the effect of state level shelter-in-place orders early in the pandemic.

Health accidents and wealth decline in old age

This paper explores the impact of a health shock and changes in survival probability on the savings and portfolio choices of older individuals. Using a theoretical framework featuring a portfolio choice that incorporates imperfect annuity markets, we analyse how elderly individuals, whose survival probability has been altered by a health shock, allocate their resources. A difference-in-differences approach complements the theoretical approach by taking into account the effect of age and cohort, and controlling for selection bias related to health events at older ages. Our analysis utilizes a panel of 5570 observations from the Survey of Health, Aging, and Retirement in Europe (Shavelle et al., 2019;2017). Both theoretical and empirical findings converge, indicating that experiencing a health accident such as a stroke or heart attack leads to a decrease in safe savings. Consequently, investing in annuities becomes crucial in enabling individuals to mitigate the consequences of poor health in aging economies.

Smart city construction and green technology innovation: evidence at China's city level

In the context of China's economic and social transformation, smart cities are becoming increasingly important for green development. Based on pilot smart cities and panel data from 274 prefecture-level cities in China from 2006 to 2018, this paper mainly evaluates the impact of smart city construction (SCC) on green technology innovation (GTI). To analyze SCC mechanisms and heterogeneity, we used China's smart city pilots as a quasi-natural experiment. In terms of the influencing mechanism, SCC can promote GTI by enhancing the digital economy level. Meanwhile, the optimization allocation of resources, including labor, land, and capital, can effectively foster the promoting effect of SCC on GTI. Moreover, SCC has a spatial diffusion effect; it will not only promote local GTI, but also improve the level of GTI in neighboring cities. In terms of the heterogeneity analysis, smart cities, which present a large scales, rich human capital, and high-level infrastructure, have a strongly positive effect on GTI. This study provides important empirical evidence for the development of SCC and GTI.

The impact of devolution on experienced health and well-being

Devolution of health systems from national to local levels is a common focus of policymakers across the world. The overarching aim is to improve population health by better meeting the specific needs of local citizens. We examine the case of a coordinated devolution across several public service sectors in Greater Manchester, England, in 2016. We estimate the impact on experienced health and well-being using Short-Form 12 scores from 13,938 adult respondents to the UK Household Longitudinal Survey between 2012 and 2020. We use difference-in-differences and lagged-dependent variable regressions to compare Greater Manchester to the rest of England. We find no statistically significant changes in experienced health and well-being over the four years following the start of devolution. Our findings suggest that devolving population health management alone without budgetary powers and local accountability mechanisms may not be effective in improving experienced health and well-being in the relatively short-term.

School nutrition policy and diet quality of children and youth: a quasi-experimental study from Canada

OBJECTIVE

We investigated the impact of mandatory school nutrition policy on diet quality of Canadian school children using a quasi-experimental study design.

METHODS

Using 24-h dietary recall data from the 2004 Canadian Community Health Survey (CCHS) Cycle 2.2 and 2015 CCHS - Nutrition, we constructed the Diet Quality Index (DQI). We used multivariable difference-in-differences regressions to quantify the DQI scores associated with school nutrition policy. We conducted stratified analyses by sex, school grade, household income, and food security status to gain additional insights into the impact of nutrition policy.

RESULTS

We found that mandatory school nutrition policy was associated with an increased DQI score by 3.44 points (95% CI: 1.1, 5.8) during school-hours in intervention provinces relative to control provinces. DQI score was higher among males (3.8 points, 95% CI: 0.6, 7.1) than among females (2.9 points, 95% CI: -0.5, 6.3), and the score among students in elementary schools was higher (5.1 points, 95% CI: 2.3, 8.0) than that among high school students (0.4 points, 95% CI: -3.6, 4.5). We also found that DQI scores were higher for middle-high income and food secure households.

CONCLUSION

Provincial mandatory school nutrition policy was associated with better diet quality among children and youth in Canada. Our findings suggest that other jurisdictions may consider implementing mandatory school nutrition policy.

Does the low-carbon transition promote the ESG disclosure of renewable energy enterprises?

I use the low-carbon city pilot policy as a natural experiment to study how the low-carbon transition affects the ESG disclosure of renewable energy enterprises. The purpose of this research is to present new evidence for the effect of the low-carbon transition on renewable energy enterprises. I find that the low-carbon city pilot policy promotes the ESG disclosure of renewable energy enterprises. The channel test results show that the low-carbon city pilot policy promotes the ESG disclosure of renewable energy enterprises by improving their ESG performance, and ESG performance plays a mediator role. Further research reveals that the low-carbon city pilot policy has a greater positive impact on the ESG disclosure of renewable energy enterprises with higher levels of institutional investor shareholding ratio and internal control quality.

Synergistic effect of pollution reduction and carbon emission mitigation in the digital economy

Synergetic control of environmental pollution and carbon emissions (SCEPCE) is essential to green development. The emergence of the digital economy has become a significant component in regional economic growth. Investigating the digital driving mode for SCEPCE in developing countries is crucial. This paper empirically analyzes the effect of establishing big data comprehensive experimental areas (BDCEAs) on air pollutants and carbon emissions using panel data of prefecture-level cities from 2009 to 2020 and the time-varying difference-in-differences method. The research found that (1) BDCEA inhibits pollution and carbon emissions, and the policy effect is sustainable. (2) The synergistic effect is significant, particularly in small and medium-sized cities and old industrial-base cities. The benefit of reducing pollution is only significant in the east. The effect of reducing CO₂ emissions is only significant in the west. (3) The pollution reduction effect of digital economic development has the characteristics of an increasing marginal effect, and the marginal effect of its carbon reduction effect is not apparent. (4) The technological innovation and energy efficiency improvement effects are effective mechanisms. This paper enriches the studies on the factors influencing SCEPCE, which will help to realize SCEPCE and the harmonious coexistence of humans and nature in developing countries. However, policy incentives and green development strategies must be fine-tuned to achieve global SCEPCE.

Does the low-carbon city pilot policy work in China? A company-level analysis based on the PSM-DID model

To reduce carbon emissions and pursue sustainable economic development, China's central government formulated the low-carbon city pilot (LCCP) policy. Current studies focus primarily on the impact of the policy at the macro level (provinces and cities). So far, no study has looked at the impact of the LCCP policy on companies' environmental expenditures. Besides, as the LCCP policy is a weak-constraining central policy, it is interesting to see how it works at the company level. We employ company-level empirical data and the Propensity Score Matching - Difference in Differences (PSM-DID) method, which outperforms the traditional DID model in avoiding sample selection bias, to address the above issues. We concentrate on the second phase of the LCCP policy from 2010 to 2016, encompassing 197 listed companies in China's secondary and transportation industries. Our statistical results show that if the listed company's host city has piloted the LCCP policy, the company's environmental expenditures are reduced by 0.91 points at the 1% significance level. The above finding calls attention to the policy-implementation gap between the central and the local governments in China, which may make those weak-constraining central policies like the LCCP policy have purpose-defeating outcomes at the company level.

Does the low-carbon city pilot contribute to the blue sky defense? Evidence from China

China's goal of ecological civilization construction simultaneously faces the dual strategic tasks of pollution control and carbon reduction (PCCR). In addition to carbon reduction, does the low-carbon city pilot (LCCP) further contribute to the blue sky defense? This study investigates the impact of the LCCP on air pollution by employing a multiperiod difference-in-differences (DID) model based on data from 276 Chinese cities. The results show the following: (1) Compared with nonpilot areas, the LCCP reduces PM_2.5 levels in pilot areas by approximately 1.50% on average, which is achieved by "industrial restructuring", "government investment in science and technology (S&T)", and "green lifestyle". (2) The LCCP has heterogeneous effects on air quality across cities with different resource endowments and industrial attributes, showing a greater air quality improvement in nonresource-based cities (NREB cities) and old industrial base cities (OIB cities) than in other city types. (3) The positive impact of the LCCP on air improvement in the pilot areas is derived from "pollution control effects" rather than "pollution transfer effects". This study provides useful policy implications for the comprehensive green transition and exploration of synergistic governance for PCCR in China.

Impact of diabetes diagnosis on dental care utilization: evidence from Finland

BACKGROUND

Poor oral health is associated with many chronic diseases, including diabetes. As diabetes can worsen oral health and vice versa, care guidelines recommend that patients with diabetes maintain good oral health and have regular dental checkups. We analyzed the impact of receiving an initial type 2 diabetes diagnosis on dental care utilization.

METHODS

We used register data on residents aged over 25 in the city of Oulu, Finland, covering the years 2013-2018. We used the difference-in-differences method and individuals with no diabetes diagnosis as control group. As robustness checks, we used propensity score matching and constructed an alternative control group from patients that received the same diagnosis a few years apart.

RESULTS

Despite the guideline recommendations, we found that receiving a diabetes diagnosis did not increase the probability for dental care visits in a two-year follow-up. The findings remained similar for both high-income and low-income persons.

CONCLUSIONS

The finding is concerning in terms of diabetes management and oral health. Further research is needed on the reasons behind the lack of response to guidelines.

Can data center green reform facilitate urban green technology innovation? Evidence from China

With the expansion of the digital information industry, the size of global data centers is exploding. As part of a high-energy-consuming industry, data centers can support sustainable urban development through green transformation. This study uses a quasi-natural experiment of China's national green data center pilot policy implemented in 2015 to examine the impact of data center green transformation on green technology innovation in cities. Using a difference-in-difference (DID) analysis, this study finds that the national green data center pilot policy leads to higher levels of green technology innovation in cities, but the spillover effect of the policy on neighboring cities is insignificant. The mechanism test showed that the national green data center pilot policy could facilitate urban green technological innovation through capital deepening, market competition, and industrial agglomeration. In addition, the policy impact is more pronounced for cities with poorer environments, less civilization, high levels of network infrastructure, and more innovative endowments. The findings can provide new guidance for cleaner regional production from the standpoint of data center green development.

Short-term impacts of all-driver handheld cellphone bans on high-schoolers' texting while driving: quasi-experimental analyses of Illinois and Georgia

Teen drivers are more likely than their older counterparts to engage in distracted driving. Many states prohibit cellphone use for teen drivers, but only prohibit texting for all drivers. Evidence that these laws have been effective is mixed. We hypothesize that recent policy changes in Georgia and Illinois from teen cellphone bans with all-driver texting bans to all-driver handheld phone bans yielded short-term reductions in teen texting while driving. We analyzed Youth Risk Behavior Surveys in Georgia, Illinois, and control states North Carolina and Michigan. We estimated the reduction in texting while driving associated with policy changes via difference-in-differences models. In Illinois, 45.4 % of high school drivers texted while driving in 2013. After a 2014 policy change to an all-driver handheld ban, the percentage decreased in 2015 to 41.8 %, and decreased further in 2017 to 37.7 %. The adjusted DID estimate comparing Illinois to Michigan from 2013 to 2017 was -8.3 % (95 % CI: -15.5 % 1.1 %; p-value = 0.025). In Georgia, the percentage decreased from 37.5 % before the law to 30.8 % after, and the adjusted DID estimate comparing Georgia to North Carolina was -10.8 % (95 % CI: -19.0 %, -2.5 %; p-value = 0.011) than in North Carolina. Results support all-driver handheld phone bans to improve traffic safety for high school drivers.

Environmental regulatory pressures and the short-term debt for long-term investment of heavy-polluting enterprises: quasi-natural experiment from China

The behavior of short-term debt for long-term investment (SFLI) will probably worsen the business status of the enterprise and increase the financial risk of the enterprise. Will the credit term structure of heavily polluting enterprises improve or worsen as the environmental regulatory pressure increases? This study takes the implementation of China's new Environmental Protection Law (NEPL) as a quasi-natural experiment to evaluate the impact of environmental regulatory pressure on the short-term debt for long-term investment behavior of heavy-polluting enterprises by the approach of Difference-in-Differences (DID). The results reveals that the NEPL significantly helps heavy-polluting enterprises achieve a more sustainable development mode by alleviating their maturity mismatch problem between investment and financing of heavy-polluting enterprises, which is conducive to reducing business risks. The impact mechanisms test shows that environmental regulatory pressure is likely to inhibit their investment and financing behavior, and might generate a crowding-out effect of innovation. When considering the heterogeneity of enterprise, the impact of the NEPL is not significant in state-owned enterprises, key-monitoring enterprises, and large-scale enterprises. However, the non-consistent effect as well as the innovation crowding-out effect, need more collaborative governance countermeasures. This paper reveals the consequences of environmental regulation policies from the view of corporate's credit term structure and provides new evidence for supporting the Porter hypothesis through addressing the dilemma of SFLI in heavily polluting enterprises.

Spatial spillover effects of national-level eco-industrial park establishment on regional ecological efficiency: evidence from 271 cities in China

Using a panel dataset of 271 Chinese cities at the city level from 2004 to 2018, this study is the first to adopt a staggered spatial difference-in-differences (SDID) model to investigate the effect and mechanism of the national-level eco-industrial park (NEIP) policies on eco-efficiency. Moreover, this study deeply identifies the policy effect by using a spatial difference-in-difference-in-differences (SDDID) model, spatial attenuation boundary, and event study method. The results show that NEIP can significantly and consistently improve urban eco-efficiency. However, NEIP has a continuous negative effect on the eco-efficiency of the surrounding area. The siphoning effect of the NEIP on eco-efficiency is more pronounced in cities with more than one NEIP or in provincial capitals and municipalities with NEIPs. In addition, the spatial effect of the eco-efficiency of the NEIP can spread for approximately 100 km; i.e., there is a negative impact on the cities in the immediate vicinity of the NEIP (within 100 km). Moreover, the impact of the NEIP on urban and even regional eco-efficiency is mainly realized through the crowding out effect of heavily polluting enterprises and the technological innovation effect. Therefore, based on continuing to expand the NEIP pilot cities, the government should establish several regional eco-industrial city clusters centered on the pilot cities, adopt policies, and build the corresponding infrastructure. In addition, taking into account regional differences, the government should construct differentiated eco-industrial park goals and support policies to achieve regional economic development based on environmental protection.

Green location-oriented policies and carbon efficiency: a quasi-natural experiment from National Eco-industrial Demonstration Parks in China

This paper investigates how National Eco-industrial Demonstration Parks (NEDP) in China affects carbon emission efficiency. The difference-in-differences (DID) strategy is used for analysis. This paper finds that the construction of NEDP is conducive to the improvement of carbon emission efficiency, and the findings remain robust through placebo tests and propensity score matching. Heterogeneity analysis shows NEDP construction has greater utility on carbon efficiency in non-resource-based cities as well as in environmentally friendly cities. The mechanism analysis found that green technology innovation, industrial restructuring, and the relocation of industrial enterprises are effective ways to improve carbon efficiency in NEDP. Finally, this paper finds that the construction of NEDP has obvious spatial spillover effects on carbon efficiency, which can effectively heighten the carbon efficiency level of this locality and nearby areas.

Estimating the effect of increasing ambient temperature on antimicrobial resistance in China: A nationwide ecological study with the difference-in-differences approach

Antimicrobial resistance (AMR) and the possible consequences of rising ambient temperatures brought on by global warming have been extensively discussed. However, the epidemiological evidence on the effects of temperature on AMR is rare and little is known about the role of socioeconomic inequities. This ecological study obtained 31 provinces AMR data of Escherichia Coli (E. coli) from the China Antimicrobial Resistance Surveillance System (CARSS) over the period from 2014 to 2020, which were linked to the meteorological and socioeconomic data published in the China Statistical Yearbook. Modified difference-in-differences (DID) analyses were performed to estimate the effect of ambient temperature on AMR of E. coli to third-generation cephalosporins (ceftriaxone and cefotaxime), carbapenems, and quinolones, adjusting for variations in meteorological and socioeconomic factors. We estimated that every 1 °C increase in average ambient temperature was associated with 2.71 % (95 % confidence interval [CI]: 1.20-4.24), 32.92 % (95 % CI: 15.62-52.81), and 1.81 % (95 % CI: 0.47-3.16) increase in the prevalence of E. coli resistance to third-generation cephalosporins (ceftriaxone and cefotaxime), carbapenems and quinolones, respectively. The link was more profound in the regions with lower temperature and a median level of average humidity, and the regions with lower income, lower expenditure (in economics), lower health resources, and lower hospital admissions. Neither the replacement of the temperature variable nor the alternative approaches for confounding adjustment changed the positive association between ambient temperature and AMR. In general, there exists a positive association between ambient temperature and AMR, although the strength of such an association varies by socioeconomic and health services factors. The association is possibly nonlinear, especially for E. coli resistance to third-generation cephalosporins. The findings suggest that AMR control programs should explicitly incorporate weather patterns to increase their effectiveness.

Does urban agglomeration aggravate regional haze pollution? Empirical evidence from urban agglomerations in the middle reaches of the Yangtze River in China

Under China's "new normal," urban agglomeration (UA) has become a new direction for urbanization and regional coordinated development. The urban agglomeration in the middle reaches of the Yangtze River (MRYR-UA) is one of the locations where the haze concentration surpasses the Chinese standard. This study analyzes panel data from 284 Chinese prefecture-level cities from 2005 to 2018 to undertake an empirical investigation based on the MRYR-UA as a quasi-natural experiment for its development planning strategy. The results show that the establishment of the MRYR-UA greatly reduced regional haze pollution. In this paper, social, economic, and natural factors are considered: industrial structure, human capital, and population density can reduce haze pollution, while openness exacerbates urban pollution, confirming the pollution haven hypothesis. The increase in wind speed and rainfall can reduce the concentration of haze. The mediating effect test shows that economic, technological, and structural effects can alleviate haze pollution in the MRYR-UA. The heterogeneity analysis reveals that the number of enterprises decreased in core cities but significantly increased in edge cities, indicating that core cities transferred industrial enterprises to edge cities under the pressure of environmental regulation, resulting in the internal transfer of pollution.

Impact of dual control system of energy consumption and intensity on cost of debt financing: micro-evidence from Chinese listed companies

Capital providers have placed increasing importance on risks associated with transitioning to a low-carbon economy. This study investigates the causal link between energy regulation and cost of debt financing by exploiting regional variations in stringency of the dual control system of total energy consumption and energy intensity (dual controls) to construct a continuous difference-in-difference model. We use a sample of A-share listed firms in 2010-2020 and find that tighter energy regulation leads to higher cost of debt financing. We find that the underlying mechanism is risk premium brought by compliance cost and uncertainties. Further analysis indicates that the impact of dual controls is mainly driven by non-state-owned firms. Lastly, capital providers did not differentiate the interest rates they charge companies based on their level of green transition.

Long-term exposure to fine particulate matter and site-specific cancer mortality: A difference-in-differences analysis in Jiangsu province, China

BACKGROUND

Accumulating studies have reported that chronic exposure to ambient fine particulate matter (PM_2.5) can lead to adverse effects on lung cancer mortality; however, such chronic effects are less clear for mortality from other site-specific cancers.

OBJECTIVE

To explore the causal effect of long-term PM_2.5 exposure on mortality from all-site and a variety of site-specific cancers in Jiangsu province, China during 2015-2020 using a difference-in-differences analysis.

METHODS

For each of 53 county-based spatial units in Jiangsu province, we calculated annual death counts for all-site cancer and 23 site-specific cancers. Using a validated high-resolution PM_2.5 grid dataset, long-term PM_2.5 exposure of a spatial unit within a given year was evaluated as the average of population-weighted annual concentrations during recent 10 years. Conditional Poisson regression models were employed to evaluate exposure-response associations adjusting for spatial and temporal variables, seasonal temperatures, relative humidity, and gross domestic product (GDP).

RESULTS

During the study period, we identified 947,337 adult cancer deaths in Jiangsu province. Each 1 μg/m³ increment in PM_2.5 exposure was significantly associated with a 2.7% increase in the risk of all-site cancer mortality. PM_2.5-mortality associations were also observed in cancer of lip, oral cavity and pharynx, stomach, colorectum, pancreas, lung, bone and joints, ovary, prostate, and lymphoma (all adjusted P < 0.05), with the relative risks ranging from 1.028 (95% confidence interval [CI]: 1.011, 1.046) for stomach cancer to 1.201 (95% CI: 1.120, 1.308) for bone and joints cancers. Exposure-response curves showed that these associations were close to linearity, though most of them had increasing slopes at high exposure levels. Overall, women and subjects in low GDP regions were more vulnerable to PM_2.5 exposures.

CONCLUSIONS

Long-term exposure to ambient PM_2.5 contributes to a higher risk of mortality from multiple site-specific cancers.

Controlling time-varying confounding in difference-in-differences studies using the time-varying treatments framework

This article clarifies how the biostatistical literature on time-varying treatments (TVT) can provide tools for dealing with time-varying confounding in difference-in-differences (DiD) studies. I use a simulation study to compare the bias and standard error of inverse probability weighting estimators from the TVT framework, a DiD framework, and hybrid approaches that combine ideas from both frameworks. I simulated longitudinal data with treatment effect heterogeneity over multiple time points using linear and logistic models. Simulation settings looked at both time-invariant confounders and time-varying confounders affected by prior treatment. Estimators that combined ideas from both frameworks had lower bias than standard TVT and DiD estimators when assumptions were unmet. The TVT framework provides estimation tools that can complement DiD tools in a wide range of applied settings. It also provides alternate estimands for consideration in policy settings.

Can anti-corruption induce green technology innovation? Evidence from a quasi-natural experiment of China

Green technology innovation shoulders the dual task of green development and innovation leading. It is an inevitable choice for China to achieve the carbon peak and neutrality goal and promote high-quality economic development by effectively stimulating green innovation vitality and improving green innovation capacity. In this context, from the perspective of institutional quality, this study takes the anti-corruption campaign launched since the 18th National Congress of the Chinese Communist Party as a quasi-natural experiment, constructs an intensity difference-in-differences (DID) model, and tests the impact effect and mechanism of the anti-corruption campaign on regional green technology innovation. It is found that the anti-corruption campaign has significantly improved the level of regional green technology innovation. This conclusion still holds after a series of robustness tests such as parallel trend test, placebo test, and instrumental variable estimation. The results of mechanism analysis show that the anti-corruption campaign is helpful to increase foreign direct investment and change the government's fiscal expenditure bias, thus promoting the improvement of green technology innovation level. Heterogeneity analysis shows that the promotion effect of anti-corruption campaign on green technology innovation is more significant in eastern and southern regions. At the same time, the lower the degree of government intervention, the greater the protection of intellectual property rights, and the stronger the environmental governance, the greater the promoting effect of the anti-corruption campaign on green technology innovation. Further research shows that the improvement of the level of green technology innovation is conducive to the realization of the "dual control" goal of total and intensity of carbon emissions. This study proves the positive externality of anti-corruption campaign from the perspective of green technology innovation and provides new empirical evidence for the advantageous theory of anti-corruption.

Recreational cannabis legalization alters associations among cannabis use, perception of risk, and cannabis use disorder treatment for adolescents and young adults

OBJECTIVE

Understanding how recreational cannabis legalization may impact cannabis use disorder (CUD) among adolescents and young adults is key to developing an appropriate public health response. This research investigates whether associations among adolescent and young adult perception of risk of harm from cannabis use, prevalence of past-month cannabis use, and rate of CUD treatment admissions changed following recreational cannabis legalization in the US, 2008-2019.

METHODS

Data from the NSDUH and TEDS-A datasets are employed in difference-in-differences models of the effect of recreational legalization on perception of risk, cannabis use prevalence, and CUD treatment admissions. Moderated models test whether associations among variables changed following recreational legalization.

RESULTS

Following recreational legalization: 1) adolescent and young adult past-month cannabis use prevalence increased; 2) among both adolescents and young adults, the association of lower perception of risk of harm with higher cannabis use prevalence was strengthened; 3) among adolescents, the association of higher cannabis use prevalence with higher CUD treatment admissions was suppressed; and 4) among young adults, an association of higher cannabis use prevalence with lower CUD treatment admissions emerged.

CONCLUSIONS

Recreational legalization is likely to increase cannabis use among adolescents and young adults who perceive cannabis as less harmful, while at the same time reduce rates of CUD treatment utilization. These trends portend an increase in unmet need for CUD treatment for age groups particularly vulnerable to the development and negative consequences of CUD.