Eligibility Age Research Articles

Enrollment of adolescent and young adult patients newly diagnosed with cancer in NCI CTEP-sponsored clinical trials before and after launch of the NCI National Clinical Trials Network.

Participation of adolescents and young adults (AYAs) in oncology clinical trials is important to ensure adequate opportunities for AYA patients to contribute to, and benefit from, advances in cancer treatment. Accrual data for National Cancer Institute (NCI) Cancer Therapy Evaluation Program (CTEP) cooperative group-led treatment trials were examined to assess enrollment of newly diagnosed AYA patients (15-39 years) during the period 2004-2019, with particular interest in comparing enrollment before launch of the NCI National Clinical Trials Network (NCTN) to after. All phase 2, 2/3, and 3 trials activated during the period between January 1, 2004, and December 31, 2019, were identified (n=1568) and reduced to a set of 304 that met predetermined criteria to focus on cooperative group-led trials that involved therapy for newly diagnosed cancer and had age eligibility overlapping the AYA range. The proportion of AYA patients relative to total accrual, along with 95% bootstrapped CI was calculated for patients enrolled pre-NCTN and post-NCTN. AYA accrual comprised 9.5% (95% CI, 7.6-11.8) pre-NCTN compared with 14.0% (95% CI, 9.9-18.3) post-NCTN. The mean difference in proportions post-NCTN compared with pre-NCTN was 4.4% (0.7%-8.3%). These results indicate an increase in AYA participation in trials conducted within the NCTN relative to the pre-NCTN period. This suggests an awareness and utilization of NCTN trials for AYAs with cancer.

The Retirement-Health Puzzle: A Sigh of Relief at Retirement?

While the health effects of retirement have been well studied, existing findings remain inconclusive, and the mechanisms underlying the linkage between retirement and health are unclear. Thus, this study aimed to evaluate the effects of retirement on health and its potential mediators. Using a national household survey conducted annually from 2004 to 2019 in Japan (the Japan Household Panel Survey), we evaluated the effects of retirement among Japanese men aged 50 or older on their health, in addition to other outcomes that could be attributed to health changes associated with retirement (i.e., health behaviors, psychological well-being, time use for unpaid activities, and leisure activities). As outcomes are not measured every year, we analyzed 5,794-10,682 person-year observations for 975-1,469 unique individuals. To address the potential endogeneity of retirement, we adopted an instrumental variable fixed-effects approach based on policy changes in eligibility ages for employee pensions. We found that retirement improved psychological well-being, exercise habits, and time spent on unpaid work. The psychological benefits of retirement were no longer observed for longer durations after retirement, whereas healthy habits and unpaid activities continued. Moreover, health-related improvements after retirement occurred mostly in the higher-income group. Enhancement in personal quality of life owing to increased leisure time and stress reduction from work in addition to lifestyle changes may be key to understanding the health benefits of retirement. Considering the mechanisms behind retirement-health relationships and potential heterogeneous effects is essential for healthy postretirement lives when increasing the retirement age.

Does free healthcare improve children's healthcare use and outcomes? Evidence from Japan's healthcare subsidy for young children

We investigate the extent to which the subsidy for children's healthcare in Japan affects children's healthcare use and outcomes. The subsidy, which made children's healthcare services essentially free for patients, was introduced and expanded to preschool-age children in the 1990s. We use a difference-in-differences framework by exploiting variations in subsidy status, as the introduction timing and eligibility age differ across municipalities. We find that the subsidy significantly increased the use of outpatient care, as measured by the number of patients, visit intervals, and monthly spending. We also find evidence on the increase of inpatient use only for infants under 12 months of age (i.e., aged zero). Furthermore, the subsidy significantly improved children's subjective health symptoms reported by parents and contributed to reducing the mortality rate for infants by 0.79/1,000 individuals. In summary, our results suggest that free healthcare for children improves their access to healthcare as well as health outcomes, thus prioritizing this investment as part of national healthcare plans.

No “honeymoon phase”: whose health benefits from retirement and when

Does retirement lead to a short, transitory health boost, followed by a stable longer-run effect? The short-run effect has been hypothesized to be a kind of honeymoon effect, that is followed by a longer-run effect that may be either positive or negative. We examine the time path of the health effect of retirement and study effect heterogeneities between individuals along several dimensions. Moreover, we study a broad range of health outcomes, all in order to come to an understanding of the effect patterns that lie behind the diverse findings reported in previous research. For identification we use a fixed effects instrumental variable approach in which the normal and early retirement age thresholds serve as instruments. Using data for 10 countries from the Survey of Health, Retirement and Ageing in Europe (SHARE), we find that retiring both at the normal and early retirement eligibility ages significantly improves all the health aspects we consider. Other than hypothesized, results do not show a honeymoon phase-like transitory health boost. Instead, especially blue-collar workers go through an adjustment period after retiring, in which their health worsens. Afterwards, health stabilizes and improves, so that retirement has a health preserving effect in the longer run. This beneficial health effect of retirement occurs across all occupational groups, across a range of health outcomes, and for both sexes, though there are a number of heterogeneities between groups regarding which health outcomes are particularly affected.

Preschool Availability and Women’s Employment: Evidence from Indonesia

While a large body of literature has documented positive impacts of childcare on maternal labor supply, thinner evidence is available on whether childcare can also nudge women into better jobs in developing countries. We evaluate the impact of public preschool expansion in Indonesia on women’s labor supply and characteristics linked to the quality of their employment, including employment types, earnings, and hours. We rely on a triple-differences approach exploiting variations in preschool availability over time and across districts, as well as preschool age eligibility cutoffs, in a panel data set spanning over 20 years. We find strong positive impacts on employment—an additional public preschool per 1,000 children in the district increases women’s work participation by 9.1%. However, it is driven primarily by an increase in unpaid family work, typically in household farms or businesses. We do not find impacts on earnings or hours of work. These findings are likely explained by the modality of preschools in Indonesia—operating for only 3 hours per day, they are unlikely to enable women to secure a paid job outside the home with longer time commitments.

Age as a yardstick for political citizenship Voting age and eligibility age in Sweden during the twentieth century

AbstractIn this article we analyse the changes in the age of voting and eligibility for office in Sweden during the twentieth century. We scrutinise arguments, actors, and contexts. Age proved to be an important yardstick for political citizenship and a source of political conflicts of importance for the development of democratic institutions which is largely neglected in earlier research on universal suffrage. Democratisation processes not only have led to the inclusion of new groups of citizens, but also exclusions. Our study demonstrates the importance of shifting understanding of young people, family formation, demographic shifts, intergenerational power balances and constitutional dilemmas.

The Effects of Increasing the Eligibility Age for Public Pension on Individual Labor Supply: Evidence from Japan

The Effects of Increasing the Eligibility Age for Public Pension on Individual Labor Supply: Evidence from Japan

The effects of universal child allowance on maternal health: Evidence from South Korea

BackgroundChild allowance (CA) in South Korea was first introduced in September 2018. CA provides a monthly allowance to children from birth to age 5. To date, existing studies on the effects of CA in Korea have focused mainly on household economic outcomes. The current study is the first to examine the effect of CA on maternal physical and mental health, measured by self-reported health status, depression, and life satisfaction. MethodsWe use nationally representative data from the Korea Welfare Panel Study (KOWEPS) from 2017 to 2018. The analytic sample consists of 772 Korean mothers whose youngest child is between age 2 and age 7. Taking advantage of an exogenous policy change and the age eligibility of the policy, we employ a difference-in-regression-discontinuities (DRD) strategy to identify the effects of CA on self-reported health status, depression, and life satisfaction. ResultsOverall, we find suggestive evidence that the introduction of CA contributed to reducing depression while improving self-reported health and life satisfaction. In particular, the policy reform had a significant effect on life satisfaction, showing that CA improves life satisfaction by 0.497 points. ConclusionsResults suggest that CA can improve both physical and mental health for eligible mothers. Such findings are indicative of a causal link between income and health. There has been a recent political movement to raise the age threshold of CA to up to age 18 to cover older children and increase benefit levels. Our findings provide important policy implications for the political discussion on CA expansion.

Studying the mixed transmission in a community with age heterogeneity: COVID-19 as a case study.

COVID-19 has been prevalent worldwide for about 2 years now and has brought unprecedented challenges to our society. Before vaccines were available, the main disease intervention strategies were non-pharmaceutical. Starting December 2020, in Ontario, Canada, vaccines were approved for administering to vulnerable individuals and gradually expanded to all individuals above the age of 12. As the vaccine coverage reached a satisfactory level among the eligible population, normal social activities resumed and schools reopened starting September 2021. However, when schools reopen for in-person learning, children under the age of 12 are unvaccinated and are at higher risks of contracting the virus. We propose an age-stratified model based on the age and vaccine eligibility of the individuals. We fit our model to the data in Ontario, Canada and obtain a good fitting result. The results show that a relaxed between-group contact rate may trigger future epidemic waves more easily than an increased within-group contact rate. An increasing mixed contact rate of the older group quickly amplifies the daily incidence numbers for both groups whereas an increasing mixed contact rate of the younger group mainly leads to future waves in the younger group alone. The results indicate the importance of accelerating vaccine rollout for younger individuals in mitigating disease spread.

Does retirement affect voluntary work provision? Evidence from Europe and the U.S.

We examine whether retirement has a causal effect on the frequency of voluntary work provision in Europe and the U.S. We draw on data from the English Longitudinal Study of Ageing, The Irish Longitudinal Study on Ageing, the Survey of Health, Ageing and Retirement in Europe and the Health Retirement Study for the period 2009–2017 and use eligibility ages for old age pensions in an instrumental variable estimation to address endogeneity. We find that retirement increases the frequency of voluntary work provision in all countries.

An investigation into human papillomavirus (HPV) vaccination for patients undergoing surgery for high-grade cervical or vulvar dysplasia

IntroductionEligibility for the human papillomavirus (HPV) vaccine now includes adults 27 through 45 years. It has not been reported how providers are addressing HPV vaccination in patients with existing preinvasive disease. Our objectives were to determine the rates at which vaccination is offered to and received by patients undergoing surgery for high-grade cervical or vulvar dysplasia. Materials and MethodsThis was a single-institution retrospective cohort study including patients ages 18 through 45 years undergoing surgery for high-grade cervical or vulvar dysplasia from 10/2018 to 2/2020. Our primary outcome was the rate at which HPV vaccination was discussed at the pre- and/or post-operative visits. The secondary outcome was the rate of vaccine uptake in these individuals. Characteristics of those offered HPV vaccination were compared to those not offered vaccination. ResultsOf the 115 patients included, 36 (31.3%) had HPV vaccination addressed in the perioperative setting. Thirty-two of these patients had never been vaccinated, and 21 of these (65.6%) went on to receive partial or complete HPV vaccination. Those in whom HPV vaccination was addressed were more likely to be under 27 years (RR 3.2; 95% CI 2.1–4.8) and less likely to be smokers (RR 0.5; 95% CI 0.2–0.9) or have prior excisional procedures (RR 0.3; 95% CI 0.1–0.9). The absolute rate of discussing HPV vaccination with patients improved from 26.0% within six months of vaccine age eligibility expansion, to 35.4% after six months (P = 0.32). ConclusionsProviders did not consistently address HPV vaccination among patients being treated for high-grade cervical or vulvar dysplasia despite the potential benefits. However, a high proportion of these patients are amenable to vaccination. Quality improvement initiatives are warranted to increase the rate of HPV vaccine counseling in this context.

Informality and Pension Reforms in Bolivia: The Case of Renta Dignidad

How social protection programmes affect work choices is a question that has been at the centre of labour economics research for decades. More recently, a scant literature has focused on the effects of social protection on work choices and informal employment in the context of low and middle-income countries. This paper contributes to this scant literature by examining the effect of Bolivia’s Renta Dignidad, a universal non-contributory old age pension that covers all Bolivians aged 60 years and older. We exploit the discontinuity introduced by the age eligibility criteria of the programme and the timing of the announcement of the programme, to implement a difference-in-differences approach. Overall, we find that Renta Dignidad has no detrimental effects on labour force participation and the intensity of labor of adult members of beneficiary households. Instead, we find that the pension reduces the intensity of work for girls aged 12–18 living with a pensioner, which indicates a positive effect on intra-household time allocation. In terms of work choices, Renta Dignidad reduces the probability of holding a salaried job in rural areas by about 8 percentage points, which denotes a shift from formal to informal employment.

Does the actuarial adjustment for pension delay affect retirement and claiming decisions?

AbstractWe investigate the impact of a 2005 policy that provided more generous terms for delaying state pensions in the United Kingdom. First, we find that the policy reduced the fraction of males and possibly females receiving pensions at the earliest eligibility age and shortly thereafter. This shift affected cohorts who became eligible for state pensions at or after the policy change. Second, the policy is associated with increases in male and female labor supply around the earliest pension eligibility age, consistent with some individuals working longer to finance pension delay. However, further analysis suggests that these labor supply changes are more likely to reflect longer-term trends across birth cohorts rather than a causal effect of the policy.

Child-to-Parent Intergenerational Transfers, Social Security, and Child Wealth Building

I study the relationship among child-to-parent transfers, parents' social security eligibility, and child wealth building. Using data from the Panel Study of Income Dynamics and a regression discontinuity approach, I find that the wealth of adult children increases discontinuously at the parents' Social Security eligibility age for Black, female, and low-income groups. Additionally, the probability that a parent receives monetary transfers decreases discontinuously at the Social Security age for these groups. The effects were not statistically significant for counterpart groups. These findings suggest that by reducing the reliance of parents on their adult children, Social Security may contribute to wealth building among economically disadvantaged households.

Lung Cancer Screening Knowledge and Perceived Barriers Among Physicians in the United States

IntroductionLung cancer remains the leading cause of cancer death in the United States and has historically been detected late in its course. Low-dose computed tomography scan (LDCT) reduces lung cancer mortality by 20% and is currently recommended by clinical practice guidelines. However, compared with other cancer screening modalities, LDCT utilization remains low. This study surveyed office-based primary care physicians across the United States to better understand LDCT utilization. MethodsA total of 1500 family and internal medicine physicians selected from the American Medical Association’s physician master file were surveyed between April and July 2019 regarding LDCT practices, eligibility, clinical scenarios, and perceived barriers. ResultsThe American Association for Public Opinion Research response rate 3 was 59% (652 respondents); 599 completed supplemental questions regarding lung cancer screening. A total of 88% of respondents discussed LDCT in the previous year, and 78% had ordered at least one LDCT. Most (59%) knew the tobacco exposure criteria for LDCT and correctly identified appropriate clinical scenarios (49%–86% responded correctly). Less than half of respondents correctly identified the age eligibility criteria (44%–45% responded correctly). In general, male physicians, those who graduated after 1990, and family medicine physicians were more likely to report accurate knowledge regarding LDCT eligibility. The top perceived barriers to LDCT were cost to the patient (48% identified as a major barrier), insurance not covering screening (46% major), and patients being unaware of lung cancer screening (40% major). ConclusionKnowledge and practices about lung cancer screening are improving, though remain suboptimal. The most common barriers remain cost or insurance-based and suggest the need for a systems-based response to increase awareness and reduce the underutilization of LDCT.

Differences in career longevity before and after implementation of the Women’s Tennis Association Tour Age Eligibility Rule and Player Development Programmes: a 25-year study

ObjectivesTo assess differences in career longevity, as a potential marker of athlete well-being, before and after the 1995 implementation of the Women’s Tennis Association (WTA) Age Eligibility Rule (AER) and...

Enhancing the Utility of the Health and Retirement Study (HRS) to Identify Drivers of Rising Mortality Rates in the United States.

A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) highlights rising rates of working-age mortality in the United States, portending troubling population health trends for this group as they age. The Health and Retirement Study (HRS) is an invaluable resource for researchers studying health and aging dynamics among Americans ages 50 and above and has strong potential to be used by researchers to provide insights about the drivers of rising U.S. mortality rates. This paper assesses the strengths and limitations of HRS data for identifying drivers of rising mortality rates in theU.S. and provides recommendations to enhance the utility of the HRS in thisregard. Among our many recommendations, we encourage the HRS to prioritize the following: link cause of death information to respondents; reduce the age of eligibility for inclusion in the sample; increase the rural sample size;enhance the existing HRS Contextual Data Resource by incorporating longitudinal measures of structural determinants of health; develop additional data linkages to capture residential settings and characteristics across the life course; and add measures that capture drug use, gun ownership, and social media use.

Waiting to get a pension: The impact of pension eligibility on psychological distress.

In this paper, we examine how pension eligibility affects the psychological distress levels of older women in Australia by exploiting the exogenous changes in the eligibility ages of the old Age Pension (AP). The unique features of the Australian AP allow us to study the impact of the reform on the non-working, as well as on the working population. The empirical results show that pension eligibility has a modest but consistently beneficial effect on psychological stress levels. Reaching pension eligibility significantly reduces the stress levels of women who were out of the labor force, indicating the positive role of the AP for disadvantaged groups. At the same time, women with strenuous jobs experience a significant improvement in their stress levels when they transit into retirement. We show that an improvement in stress levels accompanies an increase in financial security and improvements in social participation and health behaviors. Our results highlight the potentially overlooked consequences of pension reforms for the well-being of vulnerable populations and for health inequalities across socio-economic groups.

What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study.

Using test, trace and isolate systems can help reduce the spread of COVID-19. Parents have the additional responsibility of using these systems for themselves and acting on behalf of their children to help control COVID-19. We explored factors associated with the use of England's NHS Test and Trace service among parents of school-aged children. One-to-one telephone interviews with parents (n = 18) of school-aged (4 to 18 years) children living in England between 30 November to 11 December 2020. Data were explored using thematic analysis. Three themes and eight sub-themes emerged. In terms of recognising symptoms of COVID-19, parents needed prompting before recalling the main symptoms described by the NHS. Parents suggested several factors relating to the nature of the symptom(s) and contextual information that might lead to or prevent them from seeking a test. Although parents supported symptomatic testing and described trusting official sources of information (e.g., Government and NHS websites). However, some concerns were raised regarding the accuracy of test results, safety at testing centres and logistics of testing but none of the concerns appeared to prevent engagement with testing. Parents perceived adherence to testing and self-isolation as pro-social behaviour, although family resources and circumstances impacted their ability to adhere fully. Our study identified several barriers to parents using NHS Test and Trace as needed. Information about the eligibility of testing (main symptoms of COVID-19 and the age of eligibility) needs to be more precise and resources provided to enable families to adhere to self-isolation if the efficiency of test, trace and isolate systems is to be optimised.

Practice, Perceptions, and Prospects of Mammography Screening in Nigeria: Insights From a National Survey of Female Health Workers

BackgroundMammography, the most preferred tool for breast cancer screening, has very poor uptake in Nigeria, even among health workers. No nationwide study has been done to ascertain this. This study sought to determine the current perceptions and practices of Nigerian female health care practitioners on mammography screening across different types and levels of health care institutions in the country's 6 geopolitical zones. MethodsThis cross-sectional online survey was conducted using Google Forms distributed among Nigerian female health workers via online professional associations and networks. Descriptive and inferential statistics were done using SPSS version 20. ResultsA total of 562 respondents, with mean age of 41.30 ± 9.8 years, were surveyed. About half (50.3%) were doctors, with majority practicing in southern Nigeria. A mammography screening utilization rate of 15.4% was found, with majority having their first mammography long after attaining the age of eligibility. As of the time of the survey, only 24.8% of tertiary health workers had access to functional mammography machines at their place of work. Majority of female doctors (78%) never refer eligible patients for mammography, although nearly all (98.6%) were willing to do so. About 54% of those who have had a previous mammography screening vs. 17% who have not had 1 would recommend it to others. Majority of respondents recommended annual mammography from the age of forty at a subsidized cost. ConclusionNigerian female health workers have limited access to mammography and consequently do not screen often. Efforts must be made to make ‘charity begin at home’.