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Geographic Disparities in Alzheimer's Disease and Related Dementia Mortality in the US: Comparing Impacts of Place of Birth and Place of Residence
January 2025
Working Paper Number:
CES-25-11
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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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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Run Effects of Military Service: Evidence from the 911 Attacks
November 2021
Working Paper Number:
CES-21-36
We investigate the effect of military service on labor market, health and family formation outcomes, leveraging differential changes in enlistment rates brought about by the September 11th attacks (911). Using restricted microdata, we identify hundreds of 'high service" counties in which certain birth-county cohorts exhibit large enlistment responses to 911. We find that individuals born into high service counties between 1977 and 1983 (aged 18-24 at the time of the attack), enlisted at nearly twice the rate of earlier birth cohorts (older than 24 at the time of the attack). These high service birth-county cohorts experienced a 10% increase in wages, decreased unemployment and impacts on other labor market measures as well as key household formation measures including marriage and fertility. We also find increases in the hospitalization and mortality rates. Labor market benefits outweigh mortality costs at standard discount rates.
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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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The Impact of College Education on Old-Age Mortality: A Study of Marginal Treatment Effects
January 2017
Working Paper Number:
CES-17-30
Using a newly constructed dataset that links 2000 U.S. Census long-form records to Social Security Administration data files, I evaluate the effect of college education on mortality. In an OLS regression, women and men who have at least some college education have 20% lower mortality rates than those with a high school degree or less. I proceed with an empirical design intended to illuminate the extent to which this relationship is causal, estimating marginal treatment effects (MTEs) using the proximity of the nearest college to individuals' birthplace as an instrument. Results indicate positive selection into college education (in terms of longevity) for both women and men. Selection drives almost all of the mortality gap for women. For men, longevity gains from college attendance are concentrated among individuals with unobserved variables that make them unlikely attend college. This suggests that men who would benefit most from receiving college education in terms of mortality reductions are those who are not attending.
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Differences in Self-employment Duration by Year of Entry & Pre-entry
November 2016
Working Paper Number:
carra-2016-09
Self-employment is associated with entrepreneurship and a motivation to pursue an opportunity. Previous research indicates that people also become self-employed because of limited opportunities in the wage sector. Using a unique set of data that links the American Community Survey to Form 1040 and W-2 records, this paper extends the existing literature by examining self-employment duration for five consecutive entry cohorts, including two cohorts who entered self-employment during the Great Recession. Severely limited labor market opportunities may have driven many in the recession cohorts to enter self-employment, while those entering self-employment during the boom may have been pursuing opportunities under favorable market conditions. To more explicitly test the concept of "necessity" versus "opportunity" self-employment, we also examine the pre-entry wage labor attachment of entrants. Specifically, we ask whether an association exists between wage labor attachment and the duration of self-employment. We also explore whether the demographic/socio-economic characteristics and self-employment exit behavior of the cohorts are different, and if so, how. We find evidence consistent with the existence of "necessity" vs. "opportunity" self-employment types.
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The New Lifecycle of Women's Employment: Disappearing Humps, Sagging Middle, Expanding Tops
November 2016
Working Paper Number:
carra-2016-07
The new lifecycle of women's employment is initially high and flat, there is a dip in the middle and a phasing out that is more prolonged than for previous cohorts. The hump is gone, the middle is a bit sagging and the top has greatly expanded. We explore the increase in cumulative work experience for women from the 1930s to the 1970s birth cohorts using the SIPP and the HRS. We investigate the changing labor force impact of a birth event across cohorts and by education and also the impact of taking leave or quitting. We find greatly increased labor force experience across cohorts, far less time out after a birth and greater labor force recovery for those who take paid or unpaid leave. More work experience across the lifecycle is related to the increased employment of women in their older ages.
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Selection and Specialization in the Evolution of Marriage Earnings Gaps
October 2015
Working Paper Number:
CES-15-36
We examine changes in marriage and earnings patterns across four cohorts born between 1936 and 1975, using data from a series of Survey of Income and Program Participation panels linked to administrative data on earnings. We find that for both men and women, marriage has become increasingly positively associated with education and earnings potential. We compare ordinary least squares (OLS) and fixed effect (FE) estimates of the earnings differential associated with marriage. We find that the marriage earnings gap fell for women in fixed-effect estimates implying that the impact of specialization has diminished over time. We also find that increasingly positive selection into marriage means that OLS estimates overstate the reduction in the marriage earnings gap. While our findings imply that marriage is no longer associated with lower earnings among women without minor children in our most recent cohort, the motherhood gap remains large. Among men, we find that the marriage premium actually increases for more recent birth cohorts in fixed-effects regressions.
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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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Long-Run Earnings Volatility and Health Insurance Coverage: Evidence from the SIPP Gold Standard File
October 2011
Working Paper Number:
CES-11-35
Despite the notable increase in earnings volatility and the attention paid to the growing ranks of the uninsured, the relationship between career earnings and short- and mediumrun health insurance status has been ignored due to a lack of data. I use a new dataset, the SIPP Gold Standard File, that merges health insurance status and demographics from the Survey of Income and Program Participation with career earnings records from the Social Security Administration (SSA) and the Internal Revenue Service (IRS) to examine the relationship between long-run family earnings volatility and health insurance coverage. I find that more volatile career earnings are associated with an increased probability of experiencing an uninsured episode, with larger effects for men, young workers, and the unmarried. These findings are consistent with the 'scarring' literature, and suggest the importance of safety-net measures for job losses and health insurance coverage.
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