Long-term exposure to ambient fine particulate matter constituents and mortality from total and site-specific gastrointestinal cancer.

BACKGROUND: Ambient fine particulate matter (PM2.5) exposure has been associated with an increased risk of gastrointestinal cancer mortality, but the attributable constituents remain unclear. OBJECTIVES: To investigate the association of long-term exposure to PM2.5 constituents with total and site-specific gastrointestinal cancer mortality using a difference-in-differences approach in Jiangsu province, China during 2015-2020. METHODS: We split Jiangsu into 53 spatial units and computed their yearly death number of total gastrointestinal, esophagus, stomach, colorectum, liver, and pancreas cancer. Utilizing a high-quality grid dataset on PM2.5 constituents, we estimated 10-year population-weighted exposure to black carbon (BC), organic carbon (OC), sulfate, nitrate, ammonium, and chloride in each spatial unit. The effect of constituents on gastrointestinal cancer mortality was assessed by controlling time trends, spatial differences, gross domestic product (GDP), and seasonal temperatures. RESULTS: Overall, 524,019 gastrointestinal cancer deaths were ascertained in 84.77 million population. Each interquartile range increment of BC (0.46 µg/m3), OC (4.56 µg/m3), and nitrate (1.41 µg/m3) was significantly associated with a 27%, 26%, and 34% increased risk of total gastrointestinal cancer mortality, respectively, and these associations remained significant in PM2.5-adjusted models and constituent-residual models. We also identified robust associations of BC, OC, and nitrate exposures with site-specific gastrointestinal cancer mortality. The mortality risk generally displayed increased trends across the total exposure range and rose steeper at higher levels. We did not identify robust associations for sulfate, ammonium, or chlorine exposure. Higher mortality risk ascribed to constituent exposures was identified in total gastrointestinal and liver cancer among women, stomach cancer among men, and total gastrointestinal and stomach cancer among low-GDP regions. CONCLUSIONS: This study offers consistent evidence that long-term exposure to PM2.5-bound BC, OC, and nitrate is associated with total and site-specific gastrointestinal cancer mortality, indicating that these constituents need to be controlled to mitigate the adverse effect of PM2.5 on gastrointestinal cancer mortality.

How does early-life famine experience influence household energy transition?

The transition of households towards cleaner energy is crucial for achieving sustainable development goals. However, the impacts and associated mechanisms of early-life experiences on household energy transition have not been considered. Based on data from the 2015 Chinese General Social Survey, this study aimed to investigate whether people experiencing China's Great Famine (1959-1961) in their early life promoted household energy transition in adulthood. The varying severity of the Great Famine in different provinces was characterised as a quasi-natural experiment and was used to perform difference-in-differences (DID) estimation analysis for birth cohorts. The results showed that the transitions from firewood, agricultural waste, and animal waste to liquefied petroleum gas and electricity were significant in households with the Great Famine experiences. Specifically, the long-term energy transition effect of the famine was exhibited mostly in those who experienced the famine during childhood (4-11 years old) and adolescence (12-17 years old). Besides, early-life famine experiences led to poor physical health, and more modern forms of energy, such as electricity, were consumed to avoid further deteriorating health. Early-life famine experience also brought psychological trauma to people at that time, which led them to increase Internet use to gain emotional support, and the increased Internet use provided better access to information about the energy transition. Moreover, the household energy transition influenced by early-life famine experience occurred more in female-headed, rural, more educated, and low-income households. Our results illustrated the role of early-life famine experience in household energy transition and provided new insights into developing effective energy policies.

Spatial spillover effects of a carbon trading policy on green technology innovation in China.

A carbon market is a widely used policy tool worldwide. This study employs a difference-in-differences (DID) model to estimate the impact of a carbon trading policy on green technology innovation and applies a spatial DID (SDID) model to investigate its spatial spillover effects. The findings suggest that China's carbon market effectively promotes green technology innovation, as green invention patent applications for listed enterprises increase by 28.8% when implementing the carbon trading policy. Moreover, implementing a carbon trading policy promotes local green technology innovation and has spatial spillover effects on neighboring cities. Furthermore, heterogeneity test results show that the spatial spillover effects differ by geographical region, economic development levels, ownership type (state-owned and non-state-owned enterprises), and degree of government intervention. Therefore, we suggest enhancing enterprises' technological innovation by providing policy support and prioritizing the development of carbon markets in regions with high economic development levels.

Long-term exposure to ambient fine particulate matter-bound polycyclic aromatic hydrocarbons and cancer mortality: A difference-in-differences approach.

The association of ambient fine particulate matter (PM2.5) exposure with cancer mortality was controversial, which may ascribe to the difference in PM2.5 constituents. Polycyclic aromatic hydrocarbons (PAHs) are carcinogenic constituents in PM2.5, which are suspected to account for PM2.5-induced cancer mortality but are yet to be investigated. We aimed to assess the association between long-term exposure to PM2.5-bound PAHs and cancer mortality and estimate the attributable mortality. A difference-in-differences approach was used to investigate the causal effect of long-term exposure to PM2.5-bound PAHs on cancer mortality. We divided Jiangsu province, China into 53 spatial units and summarized the annual number of cancer deaths in each spatial unit during 2016-2020. Annual population-weighted exposure to PM2.5-bound PAHs of each spatial unit was assessed by an inverse distance weighting method. The association between PM2.5-bound PAHs exposures and cancer mortality was evaluated by controlling spatial differences, temporal trends, PM2.5 mass exposures, temperatures, and socioeconomic status. Records of 793,269 cancer deaths were identified among 84.7 million population. Each ln-unit increase of exposure to total benzo[a]pyrene equivalents (∑BaPeq), total carcinogenic PAHs (∑PAH7c), and total PAHs (∑PAHs) was significantly associated with a 3.21%, 3.48%, and 2.64% increased risk of cancer mortality, respectively; the risk increased monotonically at low-level exposures but attenuated or flattened afterward (all p for nonlinearity <0.05). Similar exposure-response associations were identified for specific PAHs except that the associations for both fluoranthene and benzo[a]anthracene were linear. We estimated that exposure to ∑BaPeq, ∑PAH7c, and ∑PAHs contributed to 5.73%, 8.73%, and 7.33% of cancer deaths, respectively. In conclusion, long-term exposure to PM2.5-bound PAHs was associated with an increased risk of cancer mortality and contributed to substantial cancer deaths. Our findings highlight the importance to prevent deaths from cancer by reducing PM2.5-bound PAHs exposures and the necessity to take into consideration specific constituents in particulate pollution management in future.

Does the integration of urban and rural health insurance influence the functional limitations of the middle-aged and elderly in rural China?

In January 2016, the Chinese government integrated the two systems of urban resident basic medical insurance and new rural cooperative medical system to establish a unified Urban and Rural Resident Medical Insurance. The integration of medical insurance is purported to enhance access for the rural population; however, a dearth of literature exists regarding its effect on functional impairment among middle-aged and elderly residing in rural areas. This study aims to evaluate the impact of urban-rural health insurance integration on functional limitation among middle-aged and elderly individuals in rural China. A longitudinal survey was conducted among 7855 middle-aged and elderly individuals in rural China. Using a nonequivalent control group pretest-posttest design, we exploit these policy changes to evaluate their impact on middle-aged and elderly individuals' functional limitation. The results showed that the integration of urban and rural health insurance systems was significantly associated with reduced functional limitation (Odds ratio .742; 95%CI 0.603, 0.914) among middle-aged and elderly individuals in rural China. Our findings also indicate that prevalent behaviors such as tobacco use, and alcohol consumption may exacerbate functional limitation among middle-aged and elderly individuals. These findings suggest that the integration of urban and rural health insurance systems can have a positive impact on the functional limitation of middle-aged and elderly individuals in rural China and could be an important factor in improving the health and well-being of middle-aged and elderly individuals in rural areas.

The effect of low-carbon transportation pilot policy on carbon performance: evidence from China.

In 2011, aiming to achieve sustainable development in the transportation sector, the Chinese government started a pilot policy of low-carbon transportation system (LCTS). Based on the panel data for 280 prefecture-level cities in China from 2006 to 2017, we first measure carbon efficiency by using the SBM-DEA model, and identify the direct and spatial spillover effects of LCTS on carbon efficiency and carbon intensity by adopting a spatial difference-in-differences approach (SDID). The results indicate that LCTS construction not only enhances local carbon performance but also has a significant spatial spillover effect in neighboring cities. The results are still valid after a series of robustness tests. The mechanism analysis reveals that LCTS can elevate carbon performance by improving energy efficiency, green innovation, and developing public transit. The direct and indirect effects of LCTS on carbon performance show more pronounced effects in megalopolis and eastern region. This paper provides reliable empirical evidence for the effect of LCTS on carbon performance, which is conducive to deepening the understanding of carbon emissions and has a high reference value for the rational formulation of carbon reduction policies.

The effect of PM2.5 levels on continuum functional capability among older adults: Potential cause-effect or statistical associations.

BACKGROUND: Since there is limited knowledge about health effects of the clean air policy (CAP, i.e., a series of emission-control actions) on continuum functional capacity (CFC) among the older adults on a large representative data, our research was to fill this gap. METHODS: We used a continuous variable of airborne fine particulate matter (PM2.5) particles as a proxy for the CAP to evaluate the linear and non-linear effect of PM2.5 exposure on CFC of older adults, under the quasi-experimental framework of the temporal contrast between 2011 (before the CAP) and 2015 (after the CAP). Multiple environmental factors were considered and spline function was utilized to fit the spatial autocorrelations. A competing risk model was constructed to qualify the impact of PM2.5 on multidimensional disability. RESULTS: After adjusting for potential confounders, a J-shaped association was found between PM2.5 concentration increase on CFC, with a threshold 2µg/m3. We also demonstrated that a 10-µg/m3 increase in PM2.5 concentration was related to a 14.0% (95% CI:0.00, 19.00%) increment risk in the functional decline. Similarly, the competing risk model presented a hazard ratio of multidimensional disability ranging from 1.707(0.928-4.141) at 40µg/m3 concentration of PM2.5 to 4.384 (1.970-9.755) over 80µg/m3. Stratified analyses showed that married men less than 80 years old in rural areas are more likely to be affected by PM2.5 exposure, where the influencing mechanism of air pollutant to outdoor and indoor activities might be the potential cause. CONCLUSION: Implementing CAP might improve CFC, prevent the occurrence of disability, and update the air policy.

Can environmental protection policies promote regional innovation efficiency: a difference-in-differences approach with continuous treatment.

Environmental regulation and innovative development are essential means to solve the negative externalities of environmental pollution. However, developing countries often face the dual pressures of environmental pollution and innovative development. This paper focuses on whether environmental protection policies (EPP) can achieve a win-win situation between green development and innovative development. Based on the panel data of 277 cities in China from 2006 to 2016, this paper studies the impact of China's EPP on urban innovation efficiency by using a time-varying difference-in-differences approach. Combined with the geographical features of Chinese cities, we further take urban form into the mediating effect analysis. The results show that (1) EPP has a significant positive impact on innovation efficiency, and the result satisfies the parallel trend test; (2) the robustness test shows that EPP has technological innovation and diffusion effects; and (3) the mediating effect test show that urban form has a significant mediating effect on the impact of EPP on innovation efficiency. Therefore, environmental policies should be formulated considering the differences of urban form to achieve the optimal implementation effect.

Effects of cost sharing on long-term care service utilization among home-dwelling older adults in Japan.

OBJECTIVES: This study aimed to examine the effect of increased cost sharing on long-term care (LTC) service utilization among home-dwelling older adults, using nationwide long-term care insurance (LTCI) claims data in Japan. METHODS: In August 2015, the coinsurance rate for Japanese LTCI increased from 10% to 20% for higher-income beneficiaries. We analyzed 27,911,076 person-month observations between April 2015 and July 2016 from 1,983,163 home-dwelling older adults (aged ≥ 65 years). We employed a difference-in-differences approach to estimate the effect of the increased coinsurance rate on overall LTC service utilization and for each of the four main service subcategories. The control group comprised those whose coinsurance rates remained at 10%. RESULTS: The treatment group, whose coinsurance rate increased, accounted for 9.6% of all participants. The raised coinsurance rate caused statistically significant reductions of 0.46% (95% confidence interval [CI]: 0.36%, 0.56%) and $25.7 (95% CI: $23.7, $27.8) in the percentage of utilization of LTC services and total monthly LTC expenditures per person, respectively. Service utilization decreased in each of the four service subcategories. CONCLUSIONS: The increased coinsurance rate resulted in statistically significant but small reductions in LTC service utilization overall and in each service type among higher-income home-dwelling beneficiaries. Requiring more cost sharing from higher-income individuals may alleviate the fiscal burden on LTC systems without serious reductions in service utilization.

An Estimation of the Effect of Green Financial Policies and Constraints on Agriculture Investment: Evidences of Sustainable Development Achievement in Northwest China.

Farming' community actively participating as micro-actors in green finance schemes is critical for regional planning and development. On the basis of the extent to which financial progress and sustainable development are coordinated, in a difference-in-differences approach, this article employed 2350 small investigations to estimate the influence of green-finance strategies on peasants' agriculture investment and developed a mediation effect method. It investigates the role of peasant managerial variability in mediating the influence of financial constraints. The results indicate that the introduction of a financial restriction variable reduces the positive impacts of green-finance regulations on peasants' agricultural investment. Moreover, peasants who participate in non-agricultural management exercises are more inclined to take advantage of green financing regulations and are affected via financial restrictions in mediate means. The building of a green-finance sector in remote regions should accomplish unique positioning and rapid growth.

Effect of cleaner residential heating policy on air pollution: A case study in Shandong Province, China.

Coal-fired heating in winter is a primary source of air pollution in many countries. In northern China, the use of scattered coal for winter heating has led to severe environmental issues. In this study, we use a quasi-natural experiment in Shandong Province, China, to investigate the effectiveness of a cleaner heating transition policy. Specifically, we use a difference-in-differences approach to identify the effects of the cleaner heating transition policy on air pollution using high-resolution hourly data. Our findings indicate that implementation of the policy could effectively reduce air pollution by decreasing a PM2.5 by 7.32%, PM10 by 2.62%, SO2 by 3.98%, and NO2 by 4.67%. In addition, we used event study and a series of robustness checks to further support our findings. Notably, our findings indicate that implementation of the policy includes a spatial spillover effect, which differs according to the level of compulsory implementation and the distance to a city centre. Overall, our findings can help promote the application of a cleaner transitioning policy for the entire country and offer guidance for further policy development regarding the effective reduction of winter air pollution in the developing world.

Alleviating water scarcity and poverty through water rights trading pilot policy: A quasi-natural experiment based approach.

Water poverty is among the most significant global challenges and severely restricts the sustainable development of societies and economies, especially in the world's arid regions. Many countries have attempted to address this challenge. Market-based trading mechanisms represent an essential method of resolving the problem of water shortages and alleviating water poverty. Based on a quasi-natural experiment of water rights trading pilots in China, this study uses panel data from 31 provinces (municipalities) from 2009 to 2019 to explore the impact of water rights trading pilot policy on water poverty through a difference-in-differences (DID) model. The research results show that such policies can effectively alleviate water poverty by improving water-saving irrigation technology, promoting industrial and agricultural water trading, and optimizing the industrial structure. Additionally, dynamic effect and spatial heterogeneity analyses show that the water rights trading pilot policy have long-term effects and have a stronger mitigation effect on the western region of China compared with the central and eastern regions. Therefore, the Chinese government should not only further expand the implementation scope of these policies but also adjust measures according to local conditions to accurately and effectively implement such policies in different regions. Our study provides insights into water policies in China that can better manage natural resources and reduce water poverty in the arid areas around the world.

Effects of ecological protection and restoration on phytoplankton diversity in impounded lakes along the eastern route of China's South-to-North Water Diversion Project.

Traditional lake phytoplankton diversity studies do not take into account the impact of ecological protection and restoration project policies. Here, a difference-in-differences (DID) model, which is commonly used to analyze the relative importance of economic factors, was used to evaluate the impact of such policies on phytoplankton diversity in lakes. Dongping Lake was used as the experimental group, and the upstream Nansi Lake was used as the control group. The phytoplankton diversity index of the experimental group and the control group was used as the explanatory variable of the DID model. Six environmental and socioeconomic factors, temperature and precipitation, were used as control variables in the DID model. The effects of ecological protection and restoration project policy on phytoplankton diversity in lakes were analyzed. Under the influence of policy implementation, the phytoplankton diversity in the experimental lake was improved by 2.79% compared with that in the control lake. Temperature and precipitation were the main factors affecting phytoplankton diversity in the two connected shallow lakes in the Shandong Peninsula. This study verified that DID models can be used to quantitatively analyze the impact of ecological protection and restoration project policies on phytoplankton diversity in lakes.

A Reduction in Health Care Expenditures Linked to Mental Health Service Use Among Adults With Chronic Physical Conditions.

OBJECTIVE: The aim was to examine the impact of receipt of mental health services on health care expenditures for U.S. adults with major chronic physical conditions. METHODS: Medical Expenditure Panel Survey data for 2004-2014 were analyzed for adults ages ≥18 with at least one of six chronic physical conditions (cardiovascular diseases, cancer, diabetes, emphysema, asthma, and arthritis) who were followed up for 2 years (N=33,419). Outcomes included overall health care spending and expenditure by service type (inpatient services, outpatient services, emergency department visits, office-based physician visits, and prescribed medication). A difference-in-differences model compared a change in health care costs in the subsequent year for those who did and did not receive mental health services in the preceding year. RESULTS: On average, the increase in overall health care expenditure in the subsequent year among adults receiving mental health services in the preceding year was smaller by 12.6 percentage points (p<0.05) than for those who did not receive such services. The difference was equivalent to $1,146 in 2014 constant U.S. dollars (p=0.05). Medication treatment alone did not have a meaningful effect on overall costs. The combination of psychotherapy and medication was associated with a per-capita reduction in overall health care expenditure of 21.7 percentage points, or $2,690 (p<0.01). The combination was also associated with reduced costs for office-based visits (p<0.05) and medication (p<0.05). CONCLUSIONS: Receipt of mental health services was associated with a reduction in overall health care costs, particularly for office-based visits and prescribed medication, among adults with chronic physical conditions.

Impacts of anticancer drug parity laws on mortality rates.

This study investigates the impacts of anticancer drug parity laws on mortality rates in the United States using a difference-in-differences approach. Using data from 2004 to 2017 Compressed Mortality Files, we show that the anticancer drug parity laws reduce the mortality rate for head/neck malignant cancers but have no impact on malignant cancers of other types. We also rule out an insurance expansion channel that may influence the relationship between anticancer drug parity laws and malignant cancer mortality. Our results are robust to various specifications and falsification tests. Our findings imply that providing equal access to oral anticancer drugs is an effective tool for the prevention of premature mortality.

Does green industrial policy promote the sustainable growth of polluting firms? Evidences from China.

In this research, the impact of municipal green industry policies in 15 cities on the economic and environmental performance of local companies was evaluated, and the policy coordination mechanism was studied. As a dual-goal policy mix, the green industrial policy has been used by Chinese municipal governments to solve the dilemma between the economic growth and environmental mitigation. However, the quantitative evaluation of these green industrial policy trials remains limited. To address this issue, the policy evaluation in this research applied sewage discharge data and operation data of 22,670 Chinese textile firms from 1998 to 2013 from Chinese Environmental Statistics Database. Fixed-effect regression analysis and dynamic difference-in-differences (DID) approach were used to assess the dual-faceted impacts of green industrial policies and their subtypes, as well as the continuity of these impacts. The findings suggest that adopting a dual-objective green industrial policy is an effective approach to encourage heavy-polluting firms to develop in a more balanced and sustainable way. From dynamic DID analysis, these green industrial policies have continuity effects on both chemical oxygen demand discharge intensity and annual revenue of firms after implementation and the general impacts can last for at least 4 years. The study also reveals the heterogeneity in the impacts of three different subtypes of green industrial policy. The technology-push policy subtype can quickly reduce environmental discharge without compromising economic development, while demand-pull policy subtype has a slow effect on the improvement of environmental performance. The balanced policy subtype can promote enterprises to achieve both optimal performance of economy and environment, although the efficiency of balanced policy subtype is between two subtypes. Generally, this research provides reliable basis for the implementation of green industrial policies in developing countries and provides certain inspiration for the enriching of green industry policy theory.

Impact of medical subsidy disqualification on children's healthcare utilization: A difference-in-differences analysis from Japan.

Financial support for children's medical expenses has been introduced in many countries. Limited work has been done on price elasticity in children's healthcare demand, especially in countries other than the United States. Moreover, it remains unclear how the effects of a change in the cost sharing rate on healthcare demand would differ by medical condition. We investigated the impact of an increase in the cost sharing rate on medical service utilization among school children as a whole and for each of nine common conditions, applying a difference-in-differences approach. The study period ranged from April 1, 2012, to March 30, 2014. Participants were elementary school children in an urban area who were eligible for National Health Insurance (a community-based public insurance) during the study period and who were enrolled in the 2nd, 3rd, or 4th grade in April 2013. We collected observations from 2896 persons and 69,504 (2896 × 24 months) person-months. When elementary school children were promoted to the 4th grade, they became disqualified for a municipal medical subsidy. The control group was the children promoted to the 2nd or the 3rd grade, who remained eligible for the subsidy. All data were obtained from health insurance claims. We identified the nine most common medical conditions among the subject children, and stratified the analyses by the condition diagnosed. We found that an increase in the cost sharing rate reduced outpatient service utilization as a whole. Also, we observed an increase in inpatient service utilization, not because of worsened health conditions, but rather due to substitution of inpatient service for outpatient service. The reductions in outpatient service were heterogeneous across medical conditions; declines were sharper for mild or chronic conditions. These findings may help to characterize how a change in cost sharing rate affects health outcomes in children.