Effects of COVID-19 pandemic on low birth weight in a nationwide study in India.

BACKGROUND: Among newborns, those born in India have the highest prevalence of low birth weight (LBW). The COVID-19 pandemic exacerbated the risk factors for LBW. This study examined whether birth outcomes deteriorated during the pandemic period compared to those during the pre-pandemic period. METHODS: This cross-sectional study included nationally representative data on 198,203 infants. Multivariate ordinary least square and logistic regression models with district fixed effects were fitted to compare the birth outcomes in the pandemic period (April 2020-April 2021) and the pre-pandemic period (July 2014-December 2019). Regression models were adjusted for covariates-gender and birth order of the child, mother's age and education, rural residence, religion, caste, and household wealth. RESULTS: The pandemic cohort includes 11,851 infants (5.8%), while the pre-pandemic cohort includes 192,764 infants (94.2%). The LBW prevalence rate is 20% in the pandemic cohort and 17% in the pre-pandemic cohort. The covariate-adjusted model shows significant differences in birth weight (11 grams) and LBW (aOR: 1.08; 95% CI: 1.03-1.14) between the pandemic and pre-pandemic cohorts. CONCLUSIONS: Our findings show that babies born during the COVID-19 pandemic are more likely to be LBW. The subgroup analyses indicate significant differences by religion but not by maternal education, caste, and wealth group.

Globally, approximately 20 million babies are born with low birth weight (weighing less than 2,500 grams) every year. These babies are at increased risk of physical and cognitive deficits and behavioral abnormalities in their later lives. In this research, we investigate the impact of the COVID-19 pandemic on the prevalence of low birth weight in India. Our findings reveal that babies born between April 2020 and April 2021 faced a higher risk of being born as low birth weight compared to those born before April 2020. This underscores the necessity for targeted policies aimed at mitigating the risk of low birth weight during periods of high COVID-19 infection, especially for vulnerable populations in low and middle-income countries.

The intergenerational transmission of mental and physical health in the United Kingdom.

As health is increasingly recognized as a key component of human welfare, a new line of research on intergenerational mobility has emerged that focuses on broad measures of health. We extend this research to consider two key components of health: physical health and mental health. We use rich survey data from the United Kingdom linking the health of adult children at around age 30 to their parents. We estimate that the rank-rank slope in health is 0.17 and the intergenerational health association is 0.19 suggesting relatively rapid mobility compared to other outcomes such as income. We find that while both mental and physical health have a similar degree of intergenerational persistence, parents' mental health is much more strongly associated with broad measures of adult children's health than parents' physical health. We also show that the primacy of parent mental health over physical health on children's health appears to emerge during early adolescence. Finally, we construct a comprehensive measure of welfare by combining income and health and estimate a rank-rank association of 0.27. This is considerably lower than the comparable estimate of 0.43 from the US suggesting that there is greater mobility in welfare in the UK than in the US.

Compact for care: how the Affordable Care Act marketplaces fell short for a vulnerable population in Hawaii.

The Patient Protection and Affordable Care Act (ACA) was passed in 2010 to expand access to health insurance in the USA and promote innovation in health care delivery. While the law significantly reduced the proportion of uninsured, the market-based protection it provides for poor and vulnerable US residents is an imperfect substitute for government programs such as Medicaid. In 2015, residents of Hawaii from three Compact of Free Association nations (the Federated States of Micronesia, Palau and Marshall Islands) lost their eligibility for the state's Medicaid program and were instructed to enrol in coverage via the ACA marketplace. This transition resulted in worsened access to health care and ultimately increased mortality in this group. We explain these changes via four mechanisms: difficulty communicating the policy change to affected individuals, administrative barriers to coverage under the ACA, increased out of pocket health care costs and short enrolment windows. To achieve universal health coverage in the USA, these challenges must be addressed by policy-makers.

Intergenerational Mobility in Self-Reported Health Status in the US.

We present estimates of intergenerational mobility in self-reported health status (SRHS) in the US using data from the PSID. We estimate that the rank-rank slope in SRHS is 0.26. We show that including both parent health and income in models of intergenerational mobility increases the explanatory power of child outcomes. We construct a monetary metric for health and then use this to combine income and health into a measure of welfare and estimate the rank-rank slope to be about 0.4 for this new measure. Finally, we document striking health mobility gaps by race, region and parent education.

The impact of Medicaid on medical utilization in a vulnerable population: Evidence from COFA migrants.

In March 2015, the State of Hawaii stopped covering the majority of migrants from countries belonging to the Compact of Free Association (COFA) in its Medicaid program. COFA migrants were required to obtain private insurance in the exchanges established under the Affordable Care Act. Using statewide hospital discharge data, we show that Medicaid-funded hospitalizations and emergency room visits declined in this population by 31% and 19%, respectively. Utilization funded by private insurance did increase but not enough to offset the declines in Medicaid-funded utilization. We show that the expiration of benefits increased uninsured ER visits. Finally, we exploit a feature of the policy change to provide evidence that the declines in utilization are due to higher rates of uninsured migrants rather than higher levels of cost sharing on private plans.

The Mortality Effects of Reduced Medicaid Coverage Among International Migrants in Hawaii: 2012-2018.

Objectives. To study the impact on mortality in Hawaii from the revoked state Medicaid program coverage in March 2015 for most Compact of Free Association (COFA) migrants who were nonblind, nondisabled, and nonpregnant.Methods. We computed quarterly crude mortality rates for COFA migrants, Whites, and Japanese Americans from March 2012 to November 2018. We employed a difference-in-difference research design to estimate the impact of the Medicaid expiration on log mortality rates.Results. We saw larger increases in COFA migrant mortality rates than White mortality rates after March 2015. By 2018, the increase was 43% larger for COFA migrants (P = .003). Mortality trends over this period were similar for Whites and Japanese Americans, who were not affected by the policy.Conclusions. Mortality rates of COFA migrants increased after Medicaid benefits expired despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change.

The intergenerational transmission of health in the United States: A latent variables analysis.

Social scientists have long documented that many components of socioeconomic status such as income and education have strong ties across generations. However, health status, arguably a more critical component of welfare, has largely been ignored. We fill this void by providing the first estimates of the Intergenerational Health Association (IHA) that are explicitly based on a nonlinear latent variable model. We develop an estimation procedure for a nonlinear model with categorical outcomes in which the latent index is a mixed linear model and contains covariates that might not vary within cross-sectional units. Adjusting for only age and gender, we estimate an IHA of 0.3 indicating that about one third of a parent's health status gets transmitted to their children. Once we add additional mediators to the model, we show that education, and particularly children's education, is an important transmission channel in that it reduces the IHA by one third. Finally, we show that estimates of the IHA from nonlinear models are only moderately higher than those from linear models, whereas rank-based mobility estimates are identical.

Impact of Financial Incentives on Health Outcomes and Costs of Care among Medicaid Beneficiaries with Diabetes in Hawai'i.

The Hawai'i Patient Reward And Incentives to Support Empowerment (HI-PRAISE) project, part of the Medicaid Incentives for Prevention of Chronic Diseases program of the Affordable Care Act, examined the impact of financial incentives on Medicaid beneficiaries with diabetes. It included an observational pre-post study which was conducted at nine Federally Qualified Health Centers (FQHCs) between 2013 to 2015. The observational study enrolled 2,003 participants. Participants could earn up to $320/year in financial incentives. Primary outcomes were change in hemoglobin A1c, blood pressure, and cholesterol; secondary outcomes included compliance with American Diabetes Association (ADA) standards of diabetes care and cost effectiveness. Generalized estimating equation models were used to assess differences in clinical outcomes and general linear models were utilized to estimate the medical costs per patient/day. Changes in clinical outcomes in the observational study were statistically significant: mean hemoglobin A1c decreased from 8.56% to 8.24% (P < .0001); mean systolic blood pressure decreased from 125.16 to 124.18 mm Hg (P = .0137); mean diastolic blood pressure decreased from 75.54 to 74.78 mm Hg (P = .0005); total cholesterol decreased from 180.77 to 174.21 mg/dl (P < .0001); and low-density lipoprotein decreased from 106.17 to 98.55 mg/dl (P < .0001). Improved ADA compliance was also observed. A key limitation was a reduced sample size due to participant's fluctuating Medicaid eligibility status. HI-PRAISE showed no reduction in total health cost during the project period.

Health and health inequality during the great recession: Evidence from the PSID.

We estimate the impact of the Great Recession of 2007-2009 on health outcomes in the United States. We show that a one percentage point increase in the unemployment rate resulted in a 7.8-8.8% increase in reports of poor health. In addition, mental health was adversely impacted. These effects were concentrated among those with strong labor force attachments. Whites, the less educated, and women were the most impacted demographic groups.

Financial Incentives for Medicaid Beneficiaries With Diabetes: Lessons Learned From HI-PRAISE, an Observational Study and Randomized Controlled Trial.

PURPOSE: The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes. DESIGN: Observational pre-post study and randomized controlled trial (RCT). SETTING: Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente. PARTICIPANTS: The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente. INTERVENTION: Participants could earn up to $320/year of financial incentives for a minimum of 1 year. MEASURES: (1) Clinical outcomes of change in hemoglobin A1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness. ANALYSIS: Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day. RESULTS: Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% ( P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL ( P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated. CONCLUSION: The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.

An Analysis of Sibling Correlations in Health using Latent Variable Models.

We investigate sibling correlations in youth health status using the Panel Study of Income Dynamics. We do so by estimating the covariance structure of a system of equations in latent variables using methods that have hitherto not been used in the literature on intergenerational transmissions of health. Across a battery of outcomes, we find that between 50 and 60% of health status can be attributed to shared familial or neighborhood characteristics. Taking the principal component across all outcomes, we obtain a sibling correlation of about 53%. These estimates, which are larger than previous estimates of sibling correlations in health that rely on linear models, are more in-line with sibling correlations in income and suggest that health status, like other measures of socioeconomic success, is strongly influenced by family background. Copyright © 2017 John Wiley & Sons, Ltd.

The impact of internal displacement on child mortality in post-earthquake Haiti: a difference-in-differences analysis.

BACKGROUND: The Haiti earthquake in 2010 resulted in 1.5 million internally displaced people (IDP), yet little is known about the impact of displacement on health. In this study, we estimate the impact of displacement on infant and child mortality and key health-behavior mechanisms. METHODS: We employ a difference-in-differences (DID) design with coarsened exact matching (CEM) to ensure comparability among groups with different displacement status using the 2012 Haiti Demographic and Health Survey (DHS). The participants are 21,417 births reported by a nationally representative sample of 14,287 women aged 15-49. The main independent variables are household displacement status which includes households living in camps, IDP households (not in camps), and households not displaced. The main outcomes are infant and child mortality; health status (height-for-age, anemia); uptake of public health interventions (bed net use, spraying against mosquitoes, and vaccinations); and other conditions (hunger; cholera). RESULTS: Births from the camp households have higher infant mortality (OR = 2.34, 95 % CI 1.15 to 4.75) and child mortality (OR = 2.34, 95 % CI 1.10 to 5.00) than those in non-camp IDP households following the earthquake. These odds are higher despite better access to food, water, bed net use, mosquito spraying, and vaccines among camp households. CONCLUSIONS: IDP populations are heterogeneous and households that are displaced outside of camps may be self-selected or self-insured. Meanwhile, even households not displaced by a disaster may face challenges in access to basic necessities and health services. Efforts are needed to identify vulnerable populations to provide targeted assistance in post-disaster relief.

Unemployment and mortality: evidence from the PSID.

We use micro-data to investigate the relationship between unemployment and mortality in the United States using Logistic regression on a sample of over 16,000 individuals. We consider baselines from 1984 to 1993 and investigate mortality up to ten years from the baseline. We show that poor local labor market conditions are associated with higher mortality risk for working-aged men and, specifically, that a one percentage point increase in the unemployment rate increases their probability of dying within one year of baseline by 6%. There is little to no such relationship for people with weaker labor force attachments such as women or the elderly. Our results contribute to a growing body of work that suggests that poor economic conditions pose health risks and illustrate an important contrast with studies based on aggregate data.

Health status and the allocation of time.

We consider the relationship between health and time allocation in the American Time Use Survey. Better health is associated with large positive effects on home production and larger positive effects on market production, but less consumption of leisure. Theoretically, if market- and home-produced goods are perfect substitutes, the positive correlation between health and home production implies that health exerts larger effects on home than on market efficiency. Notably, these correlations are higher for single people than for married people, perhaps reflecting a lack of market substitutes for the time of married people.

Home-based preventative care in high-risk dialysis patients: a pilot study.

OBJECTIVE: Most dialysis patients have multiple comorbidities with complex healthcare needs and consume a disproportionate share of medical resources. We conducted a pilot study employing telehealth technology to determine whether home-based preventative care can improve healthcare outcomes, impact quality of life (QOL), and be cost effective by proactively managing underlying chronic conditions that place the patient at risk. MATERIALS AND METHODS: Forty-four patients (19 in the remote technology group [RT] and 25 in the usual care group [UC]) participated in this study. The mean age was 57 for those in the RT group (7 females and 12 males) and 62 for those receiving UC (11 females and 14 males). Health outcome measurements included hospitalizations, emergency room visits, and the number of days hospitalized. Economic analysis included total hospital and emergency room charges. QOL was measured using the medical outcomes survey instrument 36-Item Short Form Health Survey (SF-36). RESULTS: Hospitalizations (RT 0.0018 and UC 0.0056 per study day), hospital days (RT 0.008 and UC 0.036 per study day), emergency room visits (RT 0.0003 and UC 0.0019 per study day), and associated charges (RT $114 and UC $322 per study day) were significantly less in the RT group of the study compared with patients receiving UC. The perceived QOL remained the same in the UC group from outset to midpoint of the study (59.1, 59.5), whereas it decreased slightly in the RT group (63.9, 60.76). CONCLUSIONS: The results suggest that remote telehealth technology can play an important role in improving health outcomes and the cost of care of patients with end-stage renal disease who have complex healthcare needs.

Weight gain in adolescents and their peers.

Despite the urgent public health implications, relatively little is yet known about the effect of peers on adolescent weight gain. We describe trends and features of adolescent BMI in a nationally representative dataset and document correlations in weight gain among peers. We find strong correlations between own body mass index (BMI) and peers' BMI's. Though the correlations are especially strong in the upper ends of the BMI distribution, the relationship is smooth and holds over almost the entire range of adolescent BMI. Furthermore, the results are robust to the inclusion of school fixed effects and basic controls for other confounding factors such as race, sex, and age. Some recent research in this area considers whether or not adolescent weight gain is caused by peers. We discuss the econometric issues in plausibly estimating such effects while accounting for growth spurts and difficulties in defining adolescent obesity. While our work identifies correlations between adolescent BMI and peers' BMI, it is not intended to and cannot fully address the existence of endogenous peer effects.

Selective migration and health in the USA, 1984-93.

Using data from the Panel Study of Income Dynamics, we investigated the impact of health on domestic migration within the USA. We find that, for men below 60 years of age, a move from the middle to the bottom of the health distribution reduces mobility by 32-40 per cent. Non-random attrition from the panel implies that these are lower bounds. By contrast, we find evidence that, among older men, there is higher mobility at the top and bottom of the health distribution than there is in the middle. For women, we find no evidence of a relationship between their own health and mobility, although spouse's health does affect the mobility of married women.

Socioeconomic disparities in breast cancer screening in Hawaii.

INTRODUCTION: Despite evidence that breast cancer screening reduces morbidity and mortality, many women do not obtain mammograms. Our objective was to analyze the relationship between income and mammography screening for members enrolled in a large health plan in Hawaii. METHODS: We analyzed claims data for women (N = 46,328) aged 50 to 70 years during 2003 and 2004. We used parametric and nonparametric regression techniques. We used probit estimation to conduct multivariate analysis. RESULTS: At the 5th percentile of the earnings distribution, the probability of mammography is 57.1%, and at the 95th percentile, it is 67.7%. Movement from the 5th percentile to the 35th percentile of the earnings distribution increases the probability of mammography by 0.0378 percentage points. A similar movement from the 65th percentile to the 95th percentile increases the probability by 0.0394 percentage points. Also, we observed an income gradient within narrowly defined geographic regions where physical access to medical care providers is not an issue. CONCLUSION: We observed a steep income gradient in mammography screening in Hawaii. Because of the prevalence of measurement error, this gradient is probably far greater than our estimate. We cannot plausibly attribute our findings to disparities in coverage because 100% of our sample had health insurance coverage. The gradient also does not appear to result from poorer people residing in areas that are geographically isolated from providers of medical care.

Business cycles, migration and health.

We investigate the proposition that illness poses as an obstacle to one's ability to use migration to hedge the business cycle. We employ data on migration, regional unemployment rates and health status from 10 years (1984-1993) of the US Panel Study of Income Dynamics. Our results provide considerable for support this proposition. The evidence is the strongest for men, but we also find weaker evidence for married women. These results suggest that--ceterus paribus--aggregate health outcomes in an area should improve when the regional economy expands.