Objective: Building on the hypothesis that early-life exposures might influence the onset of Alzheimer's Disease and Related Dementia (ADRD), this study delves into geographic variations in ADRD mortality in the US. By considering both state of residence and state of birth, we aim to discern the comparative significance of these geospatial factors.
Methods: We conducted a secondary data analysis of the National Longitudinal Mortality Study (NLMS), that has 3.5 million records from 1973-2011 and over 0.5 million deaths. We focused on individuals born in or before 1930, tracked in NLMS cohorts from 1979-2000. Employing multi-level logistic regression, with individuals nested within states of residence and/or states of birth, we assessed the role of geographical factors in ADRD mortality variation.
Results: We found that both state of birth and state of residence account for a modest portion of ADRD mortality variation. Specifically, state of residence explains 1.19% of the total variation in ADRD mortality, whereas state of birth explains only 0.6%. When combined, both state of residence and state of birth account for only 1.05% of the variation, suggesting state of residence could matter more in ADRD mortality outcomes.
Conclusion: Findings of this study suggest that state of residence explains more variation in ADRD mortality than state of birth. These results indicate that factors in later life may present more impactful intervention points for curbing ADRD mortality. While early-life environmental exposures remain relevant, their role as primary determinants of ADRD in later life appears to be less pronounced in this study.
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EXAMINING THE LONG TERM MORTALITY EFFECTS OF EARLY HEALTH SHOCKS
March 2014
Working Paper Number:
CES-14-19
A growing literature in economics and other disciplines has tied exposure to early health shocks, particularly in utero influenza, to reductions in a variety of socioeconomic and health outcomes over the life course. However, no current evidence exists that examines this health shock on mortality because of lack of available data. This paper uses newly released files from the large, representative National Longitudinal Mortality Study to explore the mortality effects of the 1918 influenza pandemic for those in utero. While the results on socioeconomic outcomes mimic those in the literature, showing reductions in completed schooling and income fifty years following influenza exposure, the findings also suggest no effect on overall mortality or by categories of cause-of-death. These results are counter-intuitive in their contrast with the many reported effects on cardiovascular health as well as the literature linking education with later mortality
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New Evidence on the Impacts of Early Exposure to the 1918 Influenza Pandemic on Old-Age Mortality
January 2018
Working Paper Number:
CES-18-06
This paper provides new evidence of the impacts of early life exposure to the 1918 pandemic with old-age mortality by analyzing data from the National Longitudinal Mortality Study (n ~ 220,000). The specifications used year and quarter of birth indicators to assess the effects of timing of pandemic exposure and used Cox proportional hazard models for all-cause mortality outcomes. The findings suggest evidence of excess all-cause mortality for cohorts born during 1918 and mixed evidence for cohorts born in 1917 and 1919. Therefore, contrary to some existing research, the results suggest no consistent evidence of the importance of specific windows of exposure by gestation period.
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Mortality in a Multi-State Cohort of Former State Prisoners, 2010-2015
February 2022
Working Paper Number:
CES-22-06
Previous studies report that individuals who have been imprisoned have higher mortality rates than their demographic counterparts in the general population, particularly non-Hispanic white former prisoners. Most of these studies have been based on a single state's prison system, and the extent to which their findings can be generalized has not been established. In this study we explore the role that race/Hispanic origin, other demographic characteristics, and custodial/ criminal history factors have on post-release mortality, including on the timing of deaths. We also assess whether conditional release to community supervision or reimprisonment may explain the higher post-release mortality found among non-Hispanic whites. In the second part of the analysis, we estimate standardized mortality ratios (SMRs) by sex, age group, and race/Hispanic origin using as reference the U.S. general population. The data come from state prison releases from the Bureau of Justice Statistics' (BJS) National Corrections Reporting Program (NCRP). The NCRP records were linked to the Census Numident to identify deaths occurring within five years from prison release. We also linked NCRP records to previous decennial censuses and survey responses to obtain self-reported race and Hispanic origin if available. We found that non-Hispanic white former prisoners were more likely to die within five years after prison release and more likely to die in the initial weeks after release compared to racial minorities and Hispanics. Reimprisonment, age at release, and a history of multiple prison terms had a similar influence on the odds of dying across all race/Hispanic origin groups. Other factors, such as the type of release and the duration of the last term in prison, were associated with higher risks of mortality for some groups but not for others.
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Age, Sex, and Racial/Ethnic Disparities and Temporal-Spatial Variation in
Excess All-Cause Mortality During the COVID-19 Pandemic: Evidence from Linked Administrative and Census Bureau Data
May 2022
Working Paper Number:
CES-22-18
Research on the impact of the COVID-19 pandemic in the United States has highlighted substantial racial/ethnic disparities in excess mortality, but reports often differ in the details with respect to the size of these disparities. We suggest that these inconsistencies stem from differences in the temporal scope and measurement of race/ethnicity in existing data. We address these issues using death records for 2010 through 2021 from the Social Security Administration, covering the universe of individuals ever issued a Social Security Number, linked to race/ethnicity responses from the decennial census and American Community Survey. We use these data to (1) estimate excess all-cause mortality at the national level and for age-, sex-, and race/ethnicity-specific subgroups, (2) examine racial/ethnic variation in excess mortality over the course of the pandemic, and (3) explore whether and how racial/ethnic mortality disparities vary across states.
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Estimating the Impact of the Age of Criminal Majority: Decomposing Multiple Treatments in a Regression Discontinuity Framework
January 2023
Working Paper Number:
CES-23-01
This paper studies the impact of adult prosecution on recidivism and employment trajectories for adolescent, first-time felony defendants. We use extensive linked Criminal Justice Administrative Record System and socio-economic data from Wayne County, Michigan (Detroit). Using the discrete age of majority rule and a regression discontinuity design, we find that adult prosecution reduces future criminal charges over 5 years by 0.48 felony cases (? 20%) while also worsening labor market outcomes: 0.76 fewer employers (? 19%) and $674 fewer earnings (? 21%) per year. We develop a novel econometric framework that combines standard regression discontinuity methods with predictive machine learning models to identify mechanism-specific treatment effects that underpin the overall impact of adult prosecution. We leverage these estimates to consider four policy counterfactuals: (1) raising the age of majority, (2) increasing adult dismissals to match the juvenile disposition rates, (3) eliminating adult incarceration, and (4) expanding juvenile record sealing opportunities to teenage adult defendants. All four scenarios generate positive returns for government budgets. When accounting for impacts to defendants as well as victim costs borne by society stemming from increases in recidivism, we find positive social returns for juvenile record sealing expansions and dismissing marginal adult charges; raising the age of majority breaks even. Eliminating prison for first-time adult felony defendants, however, increases net social costs. Policymakers may still find this attractive if they are willing to value beneficiaries (taxpayers and defendants) slightly higher (124%) than potential victims.
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The Long-Term Effects of Income for At-Risk Infants: Evidence from Supplemental Security Income
March 2024
Working Paper Number:
CES-24-10
This paper examines whether a generous cash intervention early in life can "undo" some of the long-term disadvantage associated with poor health at birth. We use new linkages between several large-scale administrative datasets to examine the short-, medium-, and long-term effects of providing low-income families with low birthweight infants support through the Supplemental Security Income (SSI) program. This program uses a birthweight cutoff at 1200 grams to determine eligibility. We find that families of infants born just below this cutoff experience a large increase in cash benefits totaling about 27%of family income in the first three years of the infant's life. These cash benefits persist at lower amounts through age 10. Eligible infants also experience a small but statistically significant increase in Medicaid enrollment during childhood. We examine whether this support affects health care use and mortality in infancy, educational performance in high school, post-secondary school attendance and college degree attainment, and earnings, public assistance use, and mortality in young adulthood for all infants born in California to low-income families whose birthweight puts them near the cutoff. We also examine whether these payments had spillover effects onto the older siblings of these infants who may have also benefited from the increase in family resources. Despite the comprehensive nature of this early life intervention, we detect no improvements in any of the study outcomes, nor do we find improvements among the older siblings of these infants. These null effects persist across several subgroups and alternative model specifications, and, for some outcomes, our estimates are precise enough to rule out published estimates of the effect of early life cash transfers in other settings.
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RESIDENTIAL MOBILITY ACROSS LOCAL AREAS IN THE UNITED STATES AND THE GEOGRAPHIC DISTRIBUTION OF THE HEALTHY POPULATION
February 2014
Working Paper Number:
CES-14-14
Determining whether population dynamics provide competing explanations to place effects for observed geographic patterns of population health is critical for understanding health inequality. We focus on the working-age population where health disparities are greatest and analyze detailed data on residential mobility collected for the first time in the 2000 US census. Residential mobility over a 5-year period is frequent and selective, with some variation by race and gender. Even so, we find little evidence that mobility biases cross-sectional snapshots of local population health. Areas undergoing large or rapid population growth or decline may be exceptions. Overall, place of residence is an important health indicator; yet, the frequency of residential mobility raises questions of interpretation from etiological or policy perspectives, complicating simple understandings that residential exposures alone explain the association between place and health. Psychosocial stressors related to contingencies of social identity associated with being black, urban, or poor in the U.S. may also have adverse health impacts that track with structural location even with movement across residential areas.
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School Discipline and Racial Disparities in Early Adulthood
June 2021
Working Paper Number:
CES-21-14
Despite interest in the role of school discipline in the creation of racial inequality, previous research has been unable to identify how students who receive suspensions in school differ from unsuspended classmates on key young adult outcomes. We utilize novel data to document the links between high school discipline and important young adult outcomes related to criminal justice contact, social safety net program participation, post-secondary education, and the labor market. We show that the link between school discipline and young adult outcomes tends to be stronger for Black students than for White students, and that inequality in exposure to school discipline accounts for approximately 30 percent of the Black-White disparities in young adult criminal justice outcomes and SNAP receipt.
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DOES PARENTS' ACCESS TO FAMILY PLANNING INCREASE CHILDREN'S OPPORTUNITIES? EVIDENCE FROM THE WAR ON POVERTY AND THE EARLY YEARS OF TITLE X
January 2017
Working Paper Number:
CES-17-67
This paper examines the relationship between parents' access to family planning and the economic resources of their children. Using the county-level introduction of U.S. family planning programs between 1964 and 1973, we find that children born after programs began had 2.8% higher household incomes. They were also 7% less likely to live in poverty and 12% less likely to live in households receiving public assistance. After accounting for selection, the direct effects of family planning programs on parents' incomes account for roughly two thirds of these gains.
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Fighting Fire with Fire(fighting Foam): The Long Run Effects of PFAS Use at U.S. Military Installations
December 2024
Working Paper Number:
CES-24-72
Tens of millions of people in the U.S. may be exposed to drinking water contaminated with perand poly-fluoroalkyl chemicals (PFAS). We provide the first estimates of long-run economic costs from a major, early PFAS source: fire-fighting foam. We combine the timing of its adoption with variation in the presence of fire training areas at U.S. military installations in the 1970s to estimate exposure effects for millions of individuals using natality records and restricted administrative data. We document diminished birthweights, college attendance, and earnings, illustrating a pollution externality from military training and unregulated chemicals as a determinant of economic opportunity.
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