Troy Quast

Mortality and business cycles by level of development: evidence from Mexico.

We investigate the relationship between mortality and business cycles within Mexico, where development varies significantly. We exploit this variation by separately analyzing the top ten and bottom ten developed states for the period 1993-2004. We find that while overall mortality is procyclical nationally and in the top ten states, it is countercyclical in the bottom ten. Further, we show that in the top ten states mortality due to non communicable conditions is procyclical, while in the bottom ten mortality due to non communicable conditions and infectious and parasitic diseases are countercyclical. Our results suggest that the relationship between mortality and business cycles may vary by level of development.

Sex Work Regulation and Sexually Transmitted Infections in Tijuana, Mexico

While reducing the transmission of sexually transmitted infections is a common argument for regulating sex work, relatively little empirical evidence is available regarding the effectiveness of these policies. We investigate the effects of highly publicized sex work regulations introduced in 2005 in Tijuana, Mexico on the incidence of trichomoniasis. State-level, annual data for the 1995-2012 period are employed that include the incidence rates of trichomoniasis by age group and predictor variables. We find that the regulations led to a decrease in the incidence rate of trichomoniasis. Specifically, while our estimates are somewhat noisy, the all-ages incidence rate in the 2005-2012 period is roughly 37% lower than what is predicted by our synthetic control estimates and corresponds to approximately 800 fewer reported cases of trichomoniasis per year. We find that the decreases are especially pronounced for 15-24 and 25-44 age cohorts. Copyright

Economic cycles and heart disease in Mexico

While a considerable literature has emerged regarding the relationship between the business cycles and mortality rates, relatively little is known regarding how economic fluctuations are related to morbidity. We investigate the relationship between business cycles and heart disease in Mexico using a unique state-level dataset of 512 observations consisting of real GDP and heart disease incidence rates (overall and by age group) from 1995 to 2010. Our study is one of the first to use a state-level panel approach to analyze the relationship between the business cycle and morbidity. Further, the state and year fixed effects employed in our econometric specification reduce possible omitted variable bias. We find a general procyclical, although largely statistically insignificant, contemporaneous relationship. However, an increase in GDP per capita sustained over five years is associated with considerable increases in the incidence rates of ischemic heart disease and hypertension. This procyclical relationship appears strongest in the states with the lowest levels of development and for the oldest age groups. Our results suggest that economic fluctuations may have important lagged effects on heart disease in developing countries.

Abortion Facility Closings and Abortion Rates in Texas

From 2004 to 2014, the overall abortion rate in Texas fell by almost a third from 10.7 to 7.2 abortions per 1000 women aged 10 to 49 years. During this same period, the number of abortion clinics operating at least 6 months in the year fell from 40 to 27. We examined the relationship between the abortion rate and the proximity of abortion facilities. We matched annual, county-level data on abortion rates in Texas from 2004 through 2014 with the distance from the county centroids to the nearest abortion facility in operation. Linear regressions were used to estimate the association between abortion rates and proximity to abortion facilities. The regressions controlled for county-level and state-level characteristics as well as the availability of abortion services in neighboring US states and Mexico. We found that a 100-mile increase in distance to the nearest abortion facility was associated with a 10% decrease in the overall abortion rate. The relationship appeared to be driven largely by distances of 200 miles or more. The overall relationship was generally present for whites and blacks, whereas the pattern was less clear for Hispanics. The analysis indicated that the overall association was driven largely by women aged 20 to 34 years. Decreased access to abortion facilities was associated with decreases in the abortion rate, yet the relationship varied by race/ethnicity and age. As such, regulations that affect the operational status of abortion facilities likely have differential effects on women.

Macroeconomic fluctuations and sexually transmitted infections in Mexico by level of state development

Sexually transmitted infections (STIs) are a major public health burden globally and especially in developing countries. The relationship between macroeconomic fluctuations and STIs rates has received scant attention in the literature. In this paper we examine the relationship between economic fluctuations and the incidence rates of STIs in Mexico. Mexico offers an exceptional setting because there is a wide range of development across states and the availability of good quality data that covers a lengthy period. We assemble a unique panel of state-level annual data for the 1993-2012 period, for each of the 32 Mexican states. The data include incidence rates by STI type and age group. Economic activity is measured using GDP per capita and explanatory variables are employed to control for the supply of health care and relevant demographic characteristics. We use the human development index for each state to generate three indicator variables that reflect the level of development: top ten, middle twelve, and bottom ten. Our empirical estimation employs the data at the state-year level and includes time and state fixed effects as well as state time trends. The dependent variables in our econometric specifications are the all-ages and age-specific incidence rates of each STI. The real GDP per capital is our control variables of interest. We include interaction terms to reflect the potential for differing effects depending on whether the state in question is in the top, middle, or bottom level of development. Our estimates indicate that there are important differences along a number of dimensions in how economic fluctuations affect STI incidence rates. In terms of economic development, there is generally no relationship in the top states, a procyclical relationship in the middle states, and a mixed relationship in the bottom states. The associations also vary by type of STI, where the trichomoniasis incidence rate is largely countercylical (especially in the bottom states) and the other types (gonorrhea, herpes and syphilis) are generally procyclical. Finally, the largest relationships are mostly found in the 45-64 age group, whereas there is less of a relationship for the oldest age group. Our findings suggest that during economic expansions, public health officials may want to devote additional resources to efforts to reduce risky sexual behaviors in the middle and bottom states. These efforts could include public awareness advertising, greater efforts at STI testing, and attempts at reducing prostitution.

Hormonal Contraception, depression, and Academic Performance among females attending college in the United States

Associations between Hormonal Contraception (HC) and Depression have been previously reported, and indicate increased risk to younger women. These relationships need be explored and expanded to include measures of impact on Academic Performance (AP). Data was acquired from the National College Health Assessment (NCHA), administered from Fall 2008 to Spring 2015 across 370 schools nationwide. The most popular HC method was oral, followed by an IUD, and vaginal ring. HC use increased across all ages groups 18-29, and then decreased in the 30-34 age group. HC use significantly increased the odds of ever being diagnosed with depression in all age groups. HC use was found to have significantly increased odds of reporting AP issues in the 18-19 age group and to have significantly decreased odds of reporting AP issues in the 25-29 age group. Adding depression as a moderator, HC use continued to significantly increase the odds of AP issues. Women and their providers should balance the risks and benefits of initiating HC. Specifically, younger women, and be advised of the risks that HC presents in terms of a potential association with depression. Efforts to develop standardized protocols for discussing the risk-benefits for HC therapy should be pursued.

Healthcare utilization by children with asthma displaced by Hurricane Katrina

ABSTRACT Objective: To assess the performance of TexKat, the largest Hurricane Katrina Medicaid Emergency Waiver, in providing care to asthmatic children. Methods: Medicaid enrollment and encounter data for 2004 and 2006 from Louisiana and Texas were analyzed in a pre–post comparison. Changes in utilization by children in the waiver were compared to changes in utilization by children in Medicaid in three control groups: children in Louisiana counties that were designated as a disaster assistance area but who were not displaced; children in Louisiana counties that were not designated as a disaster assistance area, and children in Texas. The analysis included prescriptions for controller and quick-relief medications as well as encounters in inpatient, emergency, outpatient, and office settings. Results: The sample proportion of TexKat enrollees who had a prescription filled for controller medications fell from 0.37 to 0.28 between 2004 and 2006. By contrast, the sample proportions for the three control groups were relatively unchanged or increased. The inferential analysis indicated that the 2004–2006 change in proportions for the TexKat group differed from the changes for each of the three control groups (p-value < 0.001). For office and emergency department visits, the 2004–2006 decreases in both the proportion of subjects with a visit and the average number of visits for the TexKat group were greater than the changes for the control groups (p-value < 0.001). Conclusions: While TexKat appears to have largely been successful in preventing extreme utilization disruptions, the analysis suggests that children in the program may have received inadequate care.

Psychopharmacology Utilization Among Children with Anxiety and Obsessive–Compulsive and Related Disorders Following Hurricane Katrina

This study aimed to examine the impact of Hurricane Katrina exposure on medication utilization among children with pre-existing anxiety and obsessive–compulsive and related disorders (OCRDs). Medicaid claims data from 2004 to 2006 were analyzed. Children with pre-existing anxiety/OCRDs were compared as a function of those living in a Louisiana disaster area, Louisiana non-disaster area, or Texas in terms of filled prescriptions and average days medication supply. This was further examined as a function of disorder/medication type. Prescriptions filled and average days medication supply were lower for those who resided in the disaster area of Louisiana relative to non-disaster zones in Texas (but not Louisiana). Children with OCD who lived in a disaster zone in Louisiana had 16.6 fewer days supply of antidepressants relative to youth in Texas. Similarly, children with PTSD who lived in a disaster zone in Louisiana had approximately 7 fewer days supply of stimulant medication relative to those who lived in Texas. Medication utilization was reduced for those youth directly exposed to Katrina relative to children in Texas, suggesting potential service disruption. Children with OCD and PTSD may be more likely to experience treatment disruption. Following disasters, particular attention should be given to ensuring continued treatment access for youth with pre-existing anxiety and OCRDs (as well as other conditions).

Is There a Relationship between HMO Quality of Care and Financial Performance? Evidence from Texas HMOs

The profits earned by health insurance companies have been under intense scrutiny by policymakers and the general public. However, attempts to reduce insurance company profits could affect the quality of care that they provide to their enrollees. This study investigates whether there is a relationship between the profitability of an HMO and the quality of care that its enrollees receive. The sample is comprised of health maintenance organizations in Texas from 2000 to 2008. Quality of care is proxied by HEDIS compliance rates for selected child and female health measures, while profits are measured both on a dollar and percentage basis. Annual data are used that are disaggregated by market area. The results suggest that there is a statistically significant relationship between profits and some measures of quality. Specifically, the child health measures used here are positively related to profits, in that increases (decreases) in profits are associated with increases (decreases) in quality. By contrast, there is not a statistically significant relationship between the available female health measures and profits. Further, for the child health measures, instrumental variable models that attempt to address to the potential endogeneity of quality and profits are consistent with the possibility that changes in profits have a causal effect on quality of care.