Behavioural Responses to Health Innovations and the Consequences for Socioeconomic Outcomes

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Abstract

Several US states have recently restricted the access to abortions. We study fertility intentions and how family planning and abortions are used as mechanisms to control fertility among couples facing income risk. We formulate and estimate a life‐cycle consumption‐saving model with uninsurable income risk and imperfect contraceptive control that matches fertility behavior in the British Household Panel Survey (BHPS) well. We use the estimated model to investigate how family planning and abortions are used to control fertility in our model. Our simulations suggest that income risk affects family planning and that abortion is used to control fertility due to the presence of income risk. This indicates that the availability of abortions might play a role as an insurance mechanism.

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Abstract

We study how health behaviors are shaped through family spillovers. We leverage administrative data to identify the effects of health shocks on family members’ consumption of preventive care and health-related behaviors, constructing counterfactuals for affected households using households that experience the same shock but a few years in the future. Spouses and adult children immediately improve their health behaviors and their responses are both significant and persistent. These spillovers are far-reaching as they cascade even to coworkers. While some responses are consistent with learning information about one’s own health, the evidence points to salience as a major operative explanation.

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We provide new evidence on households’ labor supply responses to fatal and severe non-fatal health shocks in the short- and medium-run. To identify causal effects, we leverage administrative data on Danish families and construct counterfactuals using households that experience the same event a few years apart. Fatal events lead to considerable increases in surviving spouses’ labor supply, which the evidence suggests is driven by families who experience significant income losses. Non-fatal shocks have no meaningful effects on spousal labor supply, consistent with their adequate insurance coverage. The results support self-insurance as a driving mechanism for the family labor supply responses.

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We describe gender and socioeconomic inequalities in the Big Five personality traits over the life cycle, using a facet-level inventory linked to administrative data. We estimate life-cycle profiles non-parametrically and test for cohort and sample-selection effects. We discuss the economic implications of the following findings: Women of all ages score more highly than men on all personality traits, including three that are positively associated with wages; Individuals with high own or parental education have more favorable traits except Conscientiousness; Over the life cycle, gender and socioeconomic gaps widen in Openness and shrink in Neuroticism, a trait associated with worse outcomes.

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This paper examines the long-term effects of childhood disability on individuals’ educational and occupational choices, late-career labor market participation, and mortality. We merge medical records on children hospitalized with poliomyelitis during the 1952 Danish epidemic to census and administrative data, and exploit quasi-random variation in paralysis incidence in this population. While childhood disability increases the likelihood of early retirement and disability pension receipt at age 50, paralytic polio survivors are more likely to obtain a university degree and to go on to work in white-collar and computer-demanding jobs than their non-paralytic counterparts. Our results are consistent with individuals making educational and occupational choices that reflect a shift in the comparative advantage of cognitive versus physical skills. We also find that paralytic polio patients from low socioeconomic status backgrounds are more likely to die prematurely than their non-paralytic counterparts, whereas there is no effect on mortality among polio survivors from more advantaged backgrounds.

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Abstract

Background
Human papillomavirus (HPV) vaccine coverage was high in Denmark until it plunged following negative media coverage. We examined whether the decline in HPV vaccination undermined uptake of another adolescent vaccine, measles, mumps and rubella (MMR).

Methods
The Danish national health register provided data on uptake of MMR vaccine dose 2 (at age 13) for children born from 1991 to 2003 (n = 827,716). The primary exposure variable comprised three time periods: before HPV vaccine introduction, during high HPV vaccine coverage, and after the drop in HPV vaccine coverage. To examine the effect of HPV vaccination on MMR2 uptake, we estimated MMR2 uptake by age 13 using logistic regression, controlling for gender, birth month, birth year, and maternal education.

Findings
MMR2 vaccination coverage was high for both girls and boys (86% and 85%) in 2009. Following the introduction of HPV vaccine for girls in 2009, MMR2 coverage increased for girls even as it decreased for boys (gender gap 4·6 percentage points, 95% CI 4·3 to 4·8). Coverage with MMR2 for girls continued to be high over the following four years, and almost all girls (91%) who received MMR2 vaccination also received HPV1 vaccination within the same week. When negative media coverage led to a decline in HPV vaccination, MMR2 uptake for girls also declined. By 2015, MMR2 coverage for girls and boys had become similar again (80% and 79%). Families with the highest level of maternal education showed the strongest decline in MMR2 coverage for girls.

Interpretation
Concomitant vaccine provision can increase overall vaccine uptake. However, reduced demand for one vaccine may reduce concomitant vaccination and undermine resiliency of a country’s vaccination program.

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Abstract

It is well-established that neonatal health is a strong predictor of socioeconomic outcomes later in life, but does neonatal health also predict key outcomes of the next generation? This paper documents a surprisingly strong relationship between birth weight of parents and school test scores of their children. The association between maternal birth weight and child test scores corresponds to 50–80 percent of the association between the child’s own birth weight and test scores across various empirical specifications, for example including grandmother fixed effects that isolate within-family differences between mothers. Paternal and maternal birth weights are equally important in predicting child test scores. Our intergenerational results suggest that inequality in neonatal health is important for inequality in key outcomes of the next generation.

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This work proposes a method to compute the income gradient in period life expectancy that accounts for income mobility. Using income and mortality records of the Danish population over the period 1980–2013, we validate the method and provide estimates of the income gradient. The period life expectancy of individuals at a certain age, and belonging to a certain income class, is normally computed by using the mortality of older cohorts in the same income class. This approach does not take into account that a substantial fraction of the population moves away from their original income class, which leads to an upward bias in the estimation of the income gradient in life expectancy. For 40-y-olds in the bottom 5% of the income distribution, the risk of dying before age 60 is overestimated by 25%. For the top 5% income class, the risk of dying is underestimated by 20%. By incorporating a classic approach from the social mobility literature, we provide a method that predicts income mobility and future mortality simultaneously. With this method, the association between income and life expectancy is lower throughout the income distribution. Without accounting for income mobility, the estimated difference in life expectancy between persons in percentiles 20 and 80 in the income distribution is 4.6 y for males and 4.1 y for females, while it is only half as big when accounting for mobility. The estimated rise in life-expectancy inequality over time is also halved when accounting for income mobility.

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This paper examines the causal effect of retirement on health and healthcare utilization using two identification strategies on Danish full population data. First, I use a reform of the statutory retirement age in an IV design. Second, I use a large discontinuity in retirement take-up at the earliest age of retirement (60) in a regression discontinuity design. The results show that early retirement leads to decreases in GP visits and hospitalizations of 8–10% in the short run. The reduction in GP visits is driven by a drop in female GP utilization, while both genders contribute equally to the decline in hospitalizations. Early retirement has no effect on health measured by comorbidities or mortality. Statutory retirement has no effect on health or healthcare utilization. The results suggest that gender, age at retirement and complier composition are important sources of heterogeneity.

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Abstract

Importance Type 1 diabetes has been associated with cardiovascular disease and late complications such as retinopathy and nephropathy. However, it is unclear whether there is an association between type 1 diabetes and school performance in children.

Objective To compare standardized reading and mathematics test scores of schoolchildren with type 1 diabetes vs those without diabetes.

Design, Setting, and Participants Population-based retrospective cohort study from January 1, 2011, to December 31, 2015 (end date of follow-up), including Danish public schoolchildren attending grades 2, 3, 4, 6, and 8. Test scores were obtained in math (n = 524 764) and reading (n = 1 037 006). Linear regression models compared outcomes with and without adjustment for socioeconomic characteristics.

Exposures Type 1 diabetes.

Main Outcomes and Measures Primary outcomes were pooled test scores in math and reading (range, 1-100).

Results Among 631 620 included public schoolchildren, the mean (SD) age was 10.31 (SD, 2.42) years, and 51% were male; 2031 had a confirmed diagnosis of type 1 diabetes. Overall, the mean combined score in math and reading was 56.11 (SD, 24.93). There were no significant differences in test scores found between children with type 1 diabetes (mean, 56.56) and children without diabetes (mean, 56.11; difference, 0.45 [95% CI, −0.31 to 1.22]). The estimated difference in test scores between children with and without type 1 diabetes from a linear regression model with adjustment for grade, test topic, and year was 0.24 (95% CI, −0.90 to 1.39) and 0.45 (95% CI, −0.58 to 1.49) with additional adjustment for socioeconomic status.

Conclusions and Relevance Among Danish public schoolchildren, there was no significant difference in standardized reading and mathematics test scores of children with type 1 diabetes compared with test scores of children without diabetes.

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