Full Population Data Research Articles

How are lifestyle factors associated with socioeconomic differences in health care costs? Evidence from full population data in the Netherlands

IntroductionThere is a strong socioeconomic gradient in health care costs. However, little is known about the role of lifestyle factors in the association between health care costs and socioeconomic status (SES). This study investigates variation in the association between lifestyle indicators and health care costs between and within neighborhoods with similar SES. MethodUsing 2016 whole-population data for all 790 neighborhoods of the Netherlands, we estimated the association between neighborhood average health care cost performance (i.e., health care costs adjusted for population age and gender) and neighborhood socioeconomic status (NSES) and four lifestyle indicators - smoking, alcohol consumption, exercise and sport club membership. Additionally, using regression analysis, we explored the multivariate relationship between average health care cost performance, NSES and lifestyle indicators. ResultsNeighborhoods with proportionally fewer smokers and more sport club members had significantly lower average health care costs. Remarkably, neighborhoods with more people who complied with the recommended maximum alcohol consumption had significantly higher health care costs. These findings were consistent within and between neighborhoods with different SES levels. Neighborhoods with more compliance with exercise guidelines had lower health care costs. However, this relationship was inconsistent across different NSES levels, with the largest cost reductions found in the most deprived neighborhoods. ConclusionOur findings suggest that prevention policies aimed at reducing the number of smokers and increasing sport club membership may reduce health care costs across all NSES groups, while increasing compliance with physical exercise norms may be effective mainly in low SES neighborhoods.

Prolonged periods of waiting for an asylum decision and the risk of psychiatric diagnoses: a 22-year longitudinal cohort study from Denmark.

The high prevalence of psychiatric disorders among resettled refugees necessitates identification of factors that reduce the risk of mental illness. In this 22-year longitudinal cohort study, we assessed whether the length of asylum-decision waiting periods is associated with resettled refugees' risk of being diagnosed with a psychiatric disorder. We used full-population data from the Danish Civil Registration System to establish a cohort of 46 104 refugees resettled in Denmark during 1995-2016. Hazard ratios (HRs) for first-time psychiatric hospital contact (ICD-10) after residence permit issuance across varying lengths of asylum-decision waiting periods were estimated by cross-linkage with the Danish National Patient Register. Long asylum-decision waiting periods were associated with an increased risk of psychiatric disorders. Compared with refugees who waited 0-6 months for their asylum decision, the HRs of any psychiatric diagnosis were 1.22 [95% confidence interval (CI): 1.12-1.33] for those who waited 13-24 months and 1.46 (95% CI: 1.27-1.69) for those who waited 25-71 months. Associations varied across diagnoses and length of follow-up: whereas the risk of nervous disorders increased with longer asylum-decision waiting periods in the follow-ups of 0-2.9, 3-5.9 and 6-11.9 years, the risk of psychotic disorders was associated with longer asylum-decision procedures only in the 0-2.9-year follow-up. Resettled refugees who waited longer than 1 year for an asylum decision face an increased risk of psychiatric disorders. Host countries should consider that long asylum-decision waiting periods could lead to mental illness among refugees.

Sick of retirement?

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.

Do village-level normative and network factors help explain spatial variability in adolescent childbearing in rural Honduras?

Adolescent childbearing rates are higher in Central America than almost anywhere else. However, in this research we discovered that adolescent childbearing exhibits variability from one village to another, and we might discover factors associated with this spatial variability that can help us understand key characteristics underlying the pattern of early childbearing. To do this, we assessed the village-level normative and network factors associated with adolescent birth (birth taking place before age 20 years) in rural Honduras and evaluated the geographic dispersion of these patterns. We used full population data from 24,937 people in 176 villages (81% of the eligible population) to assess prevalence and patterns of adolescent childbearing among women. We modeled the predictors of adolescent births among women younger than 21 years. After accounting for individual demographic characteristics, one of the strongest predictors of adolescent birth within the population was village-level collective norms about the acceptability of adolescent childbearing, based on aggregating normative measures from the entire population. The proportion of women in the village who had given birth as an adolescent was also strongly associated with an individual girl's likelihood of having given birth as an adolescent. We used full village-level network analyses to calculate social cohesion within the village. Normative pressure was strongly associated with the likelihood of an adolescent birth in villages with high cohesion (high network density) and was not associated or had a weak association in villages with low cohesion. On the other hand, the longer a girl had lived in the village, the stronger the association between the overall proportion of women in that village who gave birth as adolescents and the girl's own likelihood of having done so. Spatial analyses suggest that levels of adolescent births vary spatially across villages, as do the village-level normative factors associated with them.

Sick of Retirement?

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.

Economic Incentives, Disability Insurance and Labor Supply

Using a difference-in-difference model on full population data, I estimate the labor market responses following a 2015 Norwegian disability insurance (DI) reform. The reform introduced an incentive program to encourage DI beneficiaries to increase their labor supply, and I find that the program significantly increased the average working hours and modestly affected the labor market participation of DI beneficiaries. There is significant heterogeneity in the estimated effects; young DI beneficiaries increased both the intensive and the extensive labor market participation. The analysis accentuates the importance of analyzing the intensive labor market response when evaluating the effects of DI reforms.

Migration and occupational careers: The static and dynamic urban wage premium by education and city size

AbstractUsing matched employer‐employee full population data on regional migrants in Sweden, this paper addresses the question whether the urban wage premium, and ‘thick’ labour market matching effects, are to be found across all educational groups, and whether the population threshold for these types of effects varies by educational category. Estimating initial wages, average wage level and wage growth 2001‐2009, we find similar wage premiums for all workers in the three largest metropolitan areas, but that there are distinct population thresholds for these type of effects, regardless of educational background. However, job search behaviour as explaining dynamic effects over time seems to pertain mostly to those with higher education.

Children bereaved by fatal intimate partner violence: A population-based study into demographics, family characteristics and homicide exposure.

BackgroundIn the context of violence against women, intimate partner homicide increasingly receives research and policy attention. Although the impact of losing a parent due to intimate partner homicide is intuitively obvious, little is known about the children involved. We aimed to identify all children bereaved by parental intimate partner homicide in the Netherlands in the period 2003–2012, describe their demographics and family circumstances, and assess their exposure to prior violence at home and to the homicide itself.Methods and findingsWe cross-examined 8 national data sources and extracted data about children’s demographics and circumstances prior to, and during the homicide. Our primary outcomes were prior violence at home (child maltreatment, neglect or domestic violence) and homicide witness status (ranging from being at a different location altogether to being present at the scene). During the decade under study, 256 children lost a biological parent due to 137 cases of intimate partner homicide. On average, the children were 7.4 years old at the time of the homicide (51.1% were boys; 95% CI 47.3–54.7) and most lost their mother (87.1%; full population data). Immigrant children were overrepresented (59.4%; 95% CI 52.8–66.0). Of the children for whom information about previous violence at home was gathered, 67.7% (95% CI 59.7–73.7) were certainly exposed and 16.7% (95% CI 11.3–22.2) probably. Of the children who had certainly been exposed, 43.1% (95% CI 41.1–60.9) had not received social services or mental health care. The majority of the children (58.7%; 95% CI 52.1–65.3) were present at the location of the homicide when the killing took place, with varying levels of exposure. Homicide weapons mostly involved cutting weapons and firearms, leading to graphic crime scenes.ConclusionsCare providers need capacity not only to help children cope with the sudden loss of a parent but also with unaddressed histories of domestic violence and exposure to graphic homicide scenes, in a culture-sensitive way. Future directions include longitudinal monitoring of children’s mental health outcomes and replication in other countries.

Sensitivity to Shocks and Implicit Employment Protection in Family Firms

In this study I present empirical evidence that employment in family firms is less sensitive to performance and product market fluctuations, both at the industry and at the firm level. This supports the idea that family firms are able to offer their employees implicit employment protection. Family firms are believed to have longer time horizons, and are as owners more easily identified with their company and its actions. These are features that could make family firms more cautious in terms of adjusting their employment. I confirm previous findings that family firms are less sensitive to sales fluctuations at the industry level and I show that this also holds for fluctuations in value added. I extend the analysis to show that family firms are less sensitive to unanticipated industry shocks by filtering out the trend component. When investigating idiosyncratic shocks to the firm, I find that family firms are less anxious to translate temporary shocks in performance into changes in employment. By using full population data from tax registers, I am able to identify all family firms, both listed and non-listed. This has previously not been feasible.

Sensitivity to shocks and implicit employment protection in family firms

In this study I find that employment in family firms is less sensitive to performance and product market fluctuations. I show this by investigating aggregate fluctuations at the industry level as well as idiosyncratic firm level shocks. By differentiating between temporary and permanent shocks at the firm level, I find that family firms appear to be less anxious to translate temporary shocks into changes in employment. This supports the idea that family firms are able to offer their employees implicit employment protection. Family firms are believed to have longer time horizons, and are as owners more easily identified with their company and its actions. These are features that could make family firms more cautious in terms of adjusting their employment. Unlike previous contributions, I am able to identify all family firms, both private and public, by using full population data from tax registers.

Effect of Marriage and Spousal Criminality on Recidivism.

The authors analyzed whether the effect of marriage on recidivism varied by spousal criminality. For this purpose, they used propensity score matching and full population data from Statistics Denmark on all unmarried and previously convicted men from birth cohorts 1965–1985 (N = 102,839). The results showed that marriage reduced recidivism compared to nonmarriage only when the spouse had no criminal record. Similarly, marriage to a nonconvicted spouse reduced recidivism significantly more than marriage to a convicted spouse. These findings not only underline how important marriage is for social integration but also stress the heterogeneous nature of the protective effects of marriage.

Safe storage and thefts of firearms in Sweden: An empirical study

Strict safe storage regulations are a cornerstone of the Swedish gun control legislation. The rationale is that, by limiting the number of guns a licensed gun owner may own and requiring them to have their guns locked up in gun safes when not in use, legal guns may be prevented from ending up in the hands of criminals through theft. This study, the first full population data study of gun thefts in Sweden, investigated all reported gun thefts in Sweden from 2003 and 2010 and in the county of Stockholm from 1995 to 2010. The analysis revealed that actual thefts from legal gun owners are very rare both in absolute terms and when compared with the number of gun owners, with legal guns and with burglaries. Most firearms that were stolen were properly stored in gun safes, a proportion that also increased to almost 100 percent during the period. The most common method of theft is to steal the entire gun safe. Further, the analysis revealed that official reports on gun thefts have serious errors; 16 percent of police reports on gun thefts referred to cases in which no modern firearm requiring a licence had been stolen.

Does size of local labour markets affect wage inequality? a rank-size rule of income distribution

The questions addressed in this paper are: (i) does wage inequality increase with local population size, and if so, (ii) what are possible factors behind this increase? In a cross-section analysis of Swedish local labour markets using unique full population data, the article shows that urban scale, i.e. size of local population, has significant positive effects on wage inequality. Testing for potential explanations, labour market diversification, human capital, migration, age structure and employment are shown to be significantly associated with inequality. Given these effects, the article raises the question of how to understand and incorporate scale effects into models of long-term change in wage inequality.

Population Control Charts for Population Data

Healthcare managers are beginning to collect full population data, rather than sample data, on some patient and performance measures. For example, hospitals and healthcare systems already gather and store comprehensive data on admissions, ambulatory encounters, and other procedures. And as the electronic medical record is more widely used, complete population data will be collected on an even wider range of clinical measures, such as blood pressure and Laboratory values, in both inpatient and outpatient settings. To correctly monitor process quality when working with full population data, rather than sample data, healthcare managers will need appropriate statistical tools. Traditional control charts, which are used for tracking processes over time, are not suitable for such population data because they are based on the assumption that sample data are being collected. The author proposes a new type of control chart specifically for use with such population data: population control charts. These control charts can be used for monitoring processes that have output measures with continuous, binomial, or nonbinomial rate variables.

A Statistical Study of the Occurrence of Spontaneous Tumors in a Large Colony of Rats

In a recent publication 1 the writers described 521 spontaneous tumors borne by 489 members of a colony of rats used in the study of induced Cysticercus sarcoma of the liver, coming to autopsy from September 30, 1920, to May 4, 1929. The experiments on Cysticercus sarcoma, which have been in progress since October, 1919, and of which several reports have been published in this and other journals 1 started with 548 purchased animals, to which 1,819 unpedigreed descendants were soon added. Breeders were selected both from the purchased stock and their unpedigreed descendants and a pedigreed colony was established. This gradually increased in size, but for the last four or five years the population has fluctuated between 7,000 and 10,000. The purpose of this paper is to present a statistical analysis of the population data of this rat colony in respect to the occurrence of spontaneous neoplasms. For the most part these spontaneous tumors are the ones described in the paper referred to above, but the two sets do not entirely coincide since the former contains three groups of animals on which full population data are not available and in the latter are included spontaneous tumor bearers which came to autopsy at a somewhat later date.