Padmaja Ayyagari

Job loss and depression: The role of subjective expectations

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individuals subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

The Longevity Gap Between Black and White Men in the United States at the Beginning and End of the 20th Century

OBJECTIVES We sought to assess whether the disparity in mortality rates between Black and White men decreased from the beginning to the end of the 20th century. METHODS We used Cox proportional hazard models for mortality to estimate differences in longevity between Black and White Civil War veterans from 1900 to 1914 (using data from a pension program) and a later cohort of male participants (using data from the 1992 to 2006 Health and Retirement Study). In sensitivity analysis, we compared relative survival of veterans for alternative baseline years through 1914. RESULTS In our survival analysis, the Black-White male difference in mortality, both unadjusted and adjusted for other influences, did not decrease from the beginning to the end of the 20th century. A 17% difference in Black-White mortality remained for the later cohort even after we controlled for other influences. Although we could control for fewer other influences on longevity, the Black-White differences in mortality for the earlier cohort was 18%. CONCLUSIONS In spite of overall improvements in longevity, a major difference in Black-White male mortality persists.

Understanding Heterogeneity in Price Elasticities in the Demand for Alcohol for Older Individuals

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

The Impact of Job Stress on Smoking and Quitting: Evidence from the Hrs

Abstract Job-related stress might affect smoking behavior because smoking may relieve stress and stress can make individuals more present-focused. Alternatively, individuals may both self-select into stressful jobs and choose to smoke based on unobserved factors. We use data from the Health and Retirement Study to examine how job stress affects the probability that smokers quit and the number of cigarettes smoked for current smokers. To address the potential endogeneity of job stress based on time invariant factors, we include individual fixed effects, which control for factors such as ability to handle stress. Occupational fixed effects are also included to control for occupational characteristics other than stress; time dummies control for the secular decline in smoking rates. Using a sample of people who smoked in the previous wave, we find that job stress is positively related to continuing to smoke among recent smokers. The results indicate that the key impact of stress is on the extensive margin of smoking, as opposed to the number of cigarettes smoked.

Will health care reform reduce disparities in insurance coverage?: Evidence from the dependent coverage mandate.

Objectives:We used data from the Medical Expenditure Panel Survey to assess the impact of the Affordable Care Act’s dependent coverage mandate on disparities in health insurance coverage rates and evaluated whether non-Hispanic blacks and Hispanics gained coverage at the same rates as non-Hispanic whites. Methods:To estimate changes in insurance rates, we employed a difference-in-difference regression approach comparing 7962 young adults aged 19–25 to 9321 adults aged 27–34. Separate regressions were estimated for non-Hispanic blacks, Hispanics, and non-Hispanic whites to understand whether the mandate had differential effects by race/ethnicity. Separate regressions by income level and race/ethnicity were also estimated. Results:Insurance rates increased by 9.3 percentage points among non-Hispanic whites, 7.2 percentage points among Hispanics, and 9.4 percentage points among non-Hispanic blacks. These changes were not significantly different from each other. Among individuals with income of <133% of the Federal Poverty Level, non-Hispanic whites experienced significantly larger gains, whereas at higher-income levels, non-Hispanic blacks experienced significantly larger gains than other racial/ethnic groups. Conclusions:The dependent coverage mandate of the Affordable Care Act increased insurance rates among all racial and ethnic groups but did not change overall disparities. Disparities may have widened among low-income populations which highlights the importance of Medicaid expansions in reducing disparities. Among higher-income populations, disparities between non-Hispanic blacks and non-Hispanic whites were reduced.

Self-rated health trajectories in the African American health cohort.

Background Self-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans. Materials/Methods Data on 998 African American men and women aged 50–64 years old were taken from a probability-based community sample that was first assessed in 2000–2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later. Using an innovative approach for including decedents in the analysis, semi-parametric group-based mixture models were used to identify person-centered group trajectories of self-rated health over time. Multivariable multinomial logistic regression analysis was then used to differentiate the characteristics of AAH participants classified into the different group trajectories. Results Four self-rated health group trajectories were identified: persistently good health, good but declining health, persistently fair health, and fair but declining health. The main characteristics that differentiated the self-rated health trajectory groups from each other were age, education, smoking, morbidity (angina, congestive heart failure, diabetes, and kidney disease), having been hospitalized in the year prior to baseline, depressive symptoms, mobility limitations, and initial self-rated health. Conclusions This is the first study to examine self-rated health trajectories separately among African Americans. Four qualitatively distinct self-rated health group trajectories were identified that call into question the accuracy of prior reports that a single, average self-rated health trajectory for African Americans adequately captures their within-group heterogeneity.

Education and health: evidence on adults with diabetes

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003–2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

Does prescription drug coverage improve mental health? Evidence from Medicare Part D.

The introduction of the Medicare Prescription Drug program (Part D) in 2006 resulted in a significant increase in access to coverage for older adults in the U.S. Several studies have documented the impact of this program on prescription drug utilization, expenditures and medication adherence among older adults. However, few studies have evaluated the extent to which these changes have affected the health of seniors. In this study we use data from the Health and Retirement Study to identify the impact of the Medicare Part D program on mental health. Using a difference-in-difference approach, we find that the program significantly reduced depressive symptoms among older adults. We explore the mechanisms through which this effect operates and evaluate heterogeneity in impact.

Continued Gains in Health Insurance but Few Signs of Increased Utilization An Update on the ACA’s Dependent Coverage Mandate

Objectives: To evaluate the Affordable Care Act’s dependent coverage mandate impact on insurance take-up and health services use through the second full year of implementation. Data: Medical Expenditure Panel Survey from 2006 to 2012. Study Design: Difference-in-difference regressions comparing pre-/postpolicy-outcome changes between 19- to 25-year-olds and 27- to 34-year-olds. Principal Findings: Following significant increases in 2011, insurance take-up among 19- to 25-year-olds leveled off overall in 2012. However, increases in coverage for Black young adults were higher in 2012 compared to 2011. Despite increased coverage, there is little evidence of an overall effect on health services use postmandate. Evidence points to increased doctor visits and emergency department visits among Hispanics in the first year postmandate. Conclusions: The Affordable Care Act young adult mandate led to significant gains in insurance take-up, though evidence suggests that the bulk of the gains occurred in the first year after the mandate. Gains for Black young adults appear to have picked up in 2012.

Spillover Effects of the Affordable Care Act? Exploring the Impact on Young Adult Dental Insurance Coverage

OBJECTIVES To assess whether the Affordable Care Acts (ACA) dependent coverage health insurance mandate had a spillover impact on young adult dental insurance coverage and whether any observed effects varied by household income. DATA Medical Expenditure Panel Surveys from 2006 through 2011. STUDY DESIGN We employed a difference-in-difference regression approach comparing changes in insurance rates for young adults ages 19-25 years to changes in insurance rates for adults ages 27-30 years. Separate regressions were estimated by categories of household income as a percentage of the Federal Poverty Level (FPL) to understand whether the mandate had heterogeneous spillover effects. RESULTS Private dental insurance increased by 6.7 percentage points among young adults compared to a control group of 27-30-year olds. Increases were concentrated at middle-income levels (125-400 percent FPL). CONCLUSIONS The dependent coverage mandate provision of the Affordable Care Act has not only increased health insurance rates among young adults but also dental insurance coverage rates.