Socioeconomic deprivation, health and healthcare utilisation among millennials.

This study estimates and decomposes components of different measures of inequality in health and healthcare use among millennial adolescents, a sizeable cohort of individuals at a critical stage of life. Administrative data from the UK Hospital Episode Statistics are linked to Next Steps, a survey collecting information about millennials born between 1989 and 1990, providing a uniquely comprehensive source of health and socioeconomic variables. Socioeconomic inequalities in psychological distress, long-term illness and the use of emergency and outpatient hospital care are measured using a corrected concentration index. Shapley-Shorrocks decomposition techniques are employed to measure the relative contributions of childhood socioeconomic circumstances to adolescents' health and healthcare inequality of opportunity. Results show that income-related deprivation contributes to significant inequalities in mental and physical health among adolescents aged between 15 and 17 years old. There are also pro-rich inequalities in the use of specific outpatient hospital services (e.g., orthodontic and mental healthcare), while pro-poor disparities are found in the use of emergency care services. Regional and parental circumstances are leading factors in influencing inequality of opportunity in the use of hospital care among adolescents. These findings shed light on the main drivers of health inequalities during an important stage of human development and have potentially important implications on human capital formation across the life-cycle.

A systematic review and meta-analysis on the effects of ill health and health shocks on labour supply.

BACKGROUND: Several studies have explored the effects of ill health and health shocks on labour supply. However, there are very few systematic reviews and meta-analyses in this area. The current work aims to fill this gap by undertaking a systematic review and meta-analysis on the effects of ill health and health shocks on labour supply. METHODS: We searched using EconLit and MEDLINE databases along with grey literature to identify relevant papers for the analysis. Necessary information was extracted from the papers using an extraction tool. We calculated partial correlations to determine effect sizes and estimated the overall effect sizes by using the random effects model. Sub-group analyses were conducted based on geography, publication year and model type to assess the sources of heterogeneity. Model type entailed distinguishing articles that used the standard ordinary least squares (OLS) technique from those that used other estimation techniques such as quasi-experimental methods, including propensity score matching and difference-in-differences methodologies. Multivariate and univariate meta-regressions were employed to further examine the sources of heterogeneity. Moreover, we tested for publication bias by using a funnel plot, Begg's test and the trim and fill methodology. RESULTS: We found a negative and statistically significant pooled estimate of the effect of ill health and health shocks on labour supply (partial r = -0.05, p < .001). The studies exhibited substantial heterogeneity. Sample size, geography, model type and publication year were found to be significant sources of heterogeneity. The funnel plot, and the trim and fill methodology, when imputed on the left showed some level of publication bias, but this was contrasted by both the Begg's test, and the trim and fill methodology when imputed on the right. CONCLUSION: The study examined the effects of ill health and health shocks on labour supply. We found negative statistically significant pooled estimates pertaining to the overall effect of ill health and health shocks on labour supply including in sub-groups. Empirical studies on the effects of ill- health and health shocks on labour supply have oftentimes found a negative relationship. Our meta-analysis results, which used a large, combined sample size, seem to reliably confirm the finding.

Sick and depressed? The causal impact of a diabetes diagnosis on depression.

BACKGROUND: There is sparse evidence on the impact of health information on mental health as well as on the mechanisms governing this relationship. We estimate the causal impact of health information on mental health via the effect of a diabetes diagnosis on depression. METHODS: We employ a fuzzy regression discontinuity design (RDD) exploiting the exogenous cut-off value of a biomarker used to diagnose type-2 diabetes (glycated haemoglobin, HbA1c) and information on psycometrically validated measures of diagnosed clinical depression drawn from rich administrative longitudinal individual-level data from a large municipality in Spain. This approach allows estimating the causal impact of a type-2 diabetes diagnosis on clinica ldepression. RESULTS: We find that overall a type-2 diabetes diagnosis increases the probability of becoming depressed, however this effect appears to be driven mostly by women, and in particular those who are relatively younger and obese. Results also appear to differ by changes in lifestyle induced by the diabetes diagnosis: while women who did not lose weight are more likely to develop depression, men who did lose weight present a reduced probability of being depressed. Results are robust to alternative parametric and non-parametric specifications and placebo tests. CONCLUSIONS: The study provides novel empirical evidence on the causal impact of health information on mental health, shedding light on gender-based differences in such effects and potential mechanisms through changes in lifestyle behaviours.

Does caring for others affect our mental health? Evidence from the COVID-19 pandemic.

Despite a growing literature about the mental health effects of COVID-19, less is known about the psychological costs of providing informal care during the pandemic. We examined longitudinal data from the UK's Understanding Society Survey, including eight COVID surveys, to estimate fixed effects difference-in-differences models combined with matching, to explore the causal effects of COVID-19 among informal carers. While matching accounts for selection on observables into caregiving, multiple period difference-in-differences specifications allow investigation of heterogeneous mental health effects of COVID-19 by timing and duration of informal care. The estimates suggest that while mental health fluctuated following the imposition of social restrictions, informal carers who started caregiving during the pandemic show the largest mental health deterioration, especially during lockdowns. Policies to mitigate the psychological burden of caregiving might be more effective if targeted at those starting to provide care for the first time.

Does health information affect lifestyle behaviours? The impact of a diabetes diagnosis.

Despite an increasing interest in the effect of health information on health-behaviours, evidence on the causal impact of a diagnosis on lifestyle factors is still mixed and does not often account for long-term effects. We explore the role of health information in individual health-related decisions by identifying the causal impact of a type-2 diabetes diagnosis on body mass index (BMI) and lifestyle behaviours. We employ a fuzzy regression discontinuity design (RDD) exploiting the exogenous cut-off value in the diagnosis of type-2 diabetes provided by a biomarker (glycated haemoglobin) drawn from unique administrative longitudinal data from Spain. We find that following a type-2 diabetes diagnosis individuals appear to reduce their weight in the short-term. Differently from previous studies, we also provide evidence of statistically significant long-term impacts of a type-2 diabetes diagnosis on BMI up to three years from the diagnosis. We do not find perceivable effects of a type-2 diabetes diagnosis on quitting smoking or drinking. Overall, health information appears to have a sustained causal impact on weight reduction, a key lifestyle and risk factor among individuals with type-2 diabetes.

Public preferences for safe consumption sites for opioid use: A discrete choice experiment.

BACKGROUND: Safe consumption sites provide people who use drugs with medical supervision and sterile paraphernalia for drug use. Although the presence of sites in neighborhoods can be controversial, few studies have assessed the preferences of individuals for attributes of safe consumption sites. METHODS: A discrete choice experiment was conducted to assess public preferences for safe consumption sites. Logit and mixed logit models were used to analyze data. Participants were recruited from Conjointly.com using a sample of the general population in Canada. The sample included adults only, was split approximately evenly by gender, and reflects census data for household income and geographic area. Attributes included: cost of the site to the healthcare system; effectiveness of the site in reducing overdose death; financial compensation to residents if a site opens in their neighborhood; if the site is located in the respondent's neighborhood; and if the site reduces improperly discarded needles. RESULTS: The sample consisted of 203 respondents. Respondents had negative preferences for sites that increased cost to the healthcare system. Conversely, they had positive preferences for sites that would reduce fatal overdoses, that could reduce improperly discarded needles, and sites that provided compensation to those impacted by the establishment of sites. CONCLUSIONS: Findings suggest that there exist a set of attributes that influence respondents' preferences for safe consumption sites. By considering these attributes when designing sites and developing messaging for sites, decision-makers may develop sites that are potentially less controversial.

Uncontrolled diabetes and health care utilisation: A bivariate latent Markov model approach.

Although uncontrolled diabetes (UD) or poor glycaemic control is a widespread condition with potentially life-threatening consequences, there is sparse evidence of its effects on health care utilisation. We jointly model the propensities to consume health care and UD by employing an innovative bivariate latent Markov model that allows for dynamic unobserved heterogeneity, movements between latent states and the endogeneity of UD. We estimate the effects of UD on primary and secondary health care consumption using a panel dataset of rich administrative records from Spain and measure UD using a biomarker. We find that, conditional on time-varying unobservables, UD does not have a statistically significant direct effect on health care use. Furthermore, individuals appear to move across latent classes and increase their propensities to poor glycaemic control and health care use over time. Our results suggest that by ignoring time-varying unobserved heterogeneity and the endogeneity of UD, the effects of UD on health care utilisation might be overestimated and this could lead to biased findings. Our approach reveals heterogeneity in behaviour beyond standard groupings of frequent versus infrequent users of health care services. We argue that this dynamic latent Markov approach could be used more widely to model the determinants of health care use.

Determinants of systemic hypertension in older adults in Africa: a systematic review.

BACKGROUND: An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. We, therefore, undertook a systematic review to identify these risk factors. METHODS: We searched for population-based studies of adults aged ≥50 years living in Africa and reporting an estimate of hypertension and associated risk factors. We included articles published in any language between January 1980 and May 2018 using a comprehensive search strategy. We extracted data including the sample characteristics, prevalence of hypertension and risk factors with their effect sizes. RESULTS: From an initial 10,719 records, we retained 63 eligible full text articles for review out of which we analyzed 23 studies made up of 19 primary and four multiple publications which had data on risk factors from bivariate or multivariable analysis. The primary studies, published from 2010 to 2018, involved a total of 30,500 participants in 12 different countries with mean ages ranging from 62.7 ± 9 years to 76.9 ± 8.4 years. Through narrative synthesis, we found consistent determinants of hypertension (overweight/obesity and history of stroke), less consistent but frequent determinants (including older age group, female sex and urban residence), inconsistent determinants (including education, wealth index, alcohol intake and physical activity) and nonsignificant covariates (marital status and having health insurance). Overall, the highest adjusted odds ratios were those associated with obesity and history of stroke. CONCLUSION: The key determinants of systemic hypertension in older adults in Africa are older age group, overweight/obesity, history of stroke and female sex. Health programmes should promote weight reduction throughout the life course, including during the middle and older age of African adults.

Hypertension in older adults in Africa: A systematic review and meta-analysis.

BACKGROUND: Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa. METHODS: We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies. FINDINGS: We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results. CONCLUSION: The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities.

Uncontrolled diabetes and health care utilisation: panel data evidence from Spain.

Despite size and relevance of uncontrolled diabetes, robust evidence on its effects on health care utilisation is very limited, especially among European countries. We employed longitudinal administrative data from Spain (2004-2010) to explore the relationship between uncontrolled type 2 diabetes and health care utilisation. We used a biomarker (glycated haemoglobin, HbA1c) to detect the presence of uncontrolled diabetes and explore its effects on both primary and secondary health care. We estimated a range of panel count data models, including negative binomials with random effects, dynamic and hurdle specifications to account for unobserved heterogeneity, previous utilisation and selection. We found uncontrolled diabetes in between 27 and 30% of patients of both genders. Our estimates suggested that although women appeared to systematically consume more health care compared to men, their consumption levels did not seem to be influenced by uncontrolled diabetes. Conversely, among men uncontrolled diabetes increased the average number of GP visits per year by between 3 and 3.4%, specialist visits by 5.3-6.1%, depending on specifications, and also extended annual hospital length of stay by 15%. We also found some evidence of heterogeneity in utilisation based on the level of uncontrolled diabetes among male individuals. Overall, our results suggested the need for different diabetes management plans depending on gender and levels of glycaemic control.

Prevalence, awareness, and associated risk factors of hypertension in older adults in Africa: a systematic review and meta-analysis protocol.

BACKGROUND: The health of older persons has not been a major priority in many African countries. Hypertension is one of the common health problems of older persons. However, there is little information on the prevalence of hypertension in older adults in Africa. This is in spite of the fact that Africa has the highest age-standardized prevalence of hypertension in the world. We therefore present this protocol to conduct a systematic review and meta-analysis on the prevalence of hypertension and the level of its awareness among older persons living in Africa. METHODS: Major databases (EMBASE, MEDLINE, Academic Search Complete, CINAHL, PsycINFO) and unpublished literature will be searched to identify population-based studies on hypertension in adults aged 50 years and older living in Africa. Eligible articles are those which use the 140/90-mmHg cutoff to diagnose hypertension and were published from 1980 to present. We will exclude subjects in restricted environments such as patients and refugees. Articles will be independently evaluated by two reviewers to determine if they meet the inclusion criteria. They will also evaluate the quality of included studies using a validated tool by Hoy and colleagues for prevalence studies. The main outcome is the prevalence of hypertension while the explanatory variables include demographic, socio-economic, dietary, lifestyle and behavioural factors. Effect sizes in bivariate and multivariate analyses will be presented as odds or prevalence ratios. We will explore for heterogeneity of the standard errors across the studies, and if appropriate, we will perform a meta-analysis using a random-effects model to present a summary estimate of the prevalence of hypertension in this population. DISCUSSION: The estimates of the prevalence, the risk factors and the level of awareness of hypertension could help in galvanizing efforts at prioritizing the cardiovascular health of older persons in Africa. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017056474.

The impact of the UK National Minimum Wage on mental health.

Despite an emerging literature, there is still sparse and mixed evidence on the wider societal benefits of Minimum Wage policies, including their effects on mental health. Furthermore, causal evidence on the relationship between earnings and mental health is limited. We focus on low-wage earners, who are at higher risk of psychological distress, and exploit the quasi-experiment provided by the introduction of the UK National Minimum Wage (NMW) to identify the causal impact of wage increases on mental health. We employ difference-in-differences models and find that the introduction of the UK NMW had no effect on mental health. Our estimates do not appear to support earlier findings which indicate that minimum wages affect mental health of low-wage earners. A series of robustness checks accounting for measurement error, as well as treatment and control group composition, confirm our main results. Overall, our findings suggest that policies aimed at improving the mental health of low-wage earners should either consider the non-wage characteristics of employment or potentially larger wage increases.

Do public smoking bans have an impact on active smoking? Evidence from the UK.

The literature on the effects of public smoking bans on smoking behaviour presents conflicting results and there is limited evidence on their impact on active smoking. This paper evaluates the impact of smoking bans on active smoking using data from the British Household Panel Survey and exploiting the policy experiment provided by the differential timing of the introduction of the bans in Scotland and England. We assess the short-term impact of the smoking bans by employing a series of flexible difference-in-differences fixed effects panel data models. We find that the introduction of the public smoking bans in England and Scotland had limited short-run effects on both smoking prevalence and the total level of smoking. Although we identify significant differences in trends in smoking consumption across the survey period by population sub-groups, we find insufficient evidence to conclude that these were affected by the introduction of the smoking bans. These results challenge those found in the public health literature but are in line with the most recent strand of economic literature indicating that there is no firm evidence on the effects of smoking bans on smoking.