Interstate Variation Research Articles

Panel Data Analysis of Regional Differentials in the Registered Voter Turnout Rate and the Expected Benefits of Voting for Minorities

Voter participation rates vary widely across the 50 states. We seek to identify a source of this interstate variation, focusing upon the 2000, 2004, 2008, and 2012 general elections. Of note is that the latter two general elections featured a minority (i.e., African-American) nominee for president from one of the major political parties. Within the context of the rational voter model, we hypothesize that the presence of a minority candidate atop the ticket will boost minorities’ expected net benefits from voting, with the result that minority voter participation will be higher. Based on cross-sectional fixed-effects estimations, we find that states’ voter participation rates were unaffected by the percent of the population that was either African-American or Hispanic for the 2000 and 2004 election cycles, while states’ voter participation rates were positively related to the percent of the population that was either African-American or Hispanic for the 2008 and 2012 election cycles.

India's Looming Power Crisis and the Way Forward

The quantum jumps in the size of energy demand and acute power shortage in India means that it is high time to tap the non-conventional sources like wind, solar, biomass energy, etc. In this backdrop, the objective of the paper is to construct a Power Generation Deprivation Index (PGDI) to bring to the surface the issue of the looming power crisis. Given the inter-state variability among the focus variables considered coupled with the multicollinearity issue, made the author to use Principal Component Analysis (PCA). Also, a theoretical framework has been designed to show how the power usage over time can be derived but the empirical estimation of this framework is not a part of this article and has been left for further research. The findings validate the existence of a looming power crisis in India and finally the policy implications based on sustainable management of non-conventional sources of power have been discussed.

Direction of uneven health-care expenditure: Evidence from Northeast India.

Although the need for ensuring universal coverage in health has received the attention of policymakers under the Millennium Development Goals program, the skewed pattern of health-care expenditure has been increased globally. To find out the pattern of public health-care expenditure in northeastern states of India and also to identify the nature of inter-state variation in health-care expenditure among the states. The study was based on the secondary data collected from the State Finance Figures of Budgetary Statistics of Reserve Bank of India. The period of study was 13 years (2002-2003 to 2014-2015). The study used descriptive statistics and composite supply-side index separately for revenue and capital expenditure by randomizing through the population census figures of 2001 and 2011 for examining the pattern of interstate variation in health-care expenditure. It has been observed that the states having higher mean expenditure registered low compound annual growth rate in health expenditure and thereby causing low per capita value and lower value of the composite index. Thus, the largely populated state needs the due attention of policymaker in reducing the skewed pattern of health-care expenditure.

Is Alaska an Aberration or the Worst Case? A Robust Regression Approach to Understanding Inter-State Variations of Forcible Rape

ABSTRACTAlaska’s rape rate perennially exceeds that of all other states. This study considers Alaska’s socioeconomic extremes—its frontier demography, its externally dependent resource economy, and its military presence—as explanations for inter-state variations of sexual violence. Robust regression procedures that accommodate extreme values were used to account for the effects of measures capturing Alaska’s unique socioeconomic qualities on state-level rape rates. The results showing that other economically dependent states with frontier demographic structures also report elevated rape rates indicate that despite its endemic levels of sexual violence, Alaska is not an aberration but is instead the worst case possible.

National and Northern New England Opioid Prescribing Patterns, 2013-2014.

To evaluate current opioid prescribing patterns nationally and regionally across several northern New England states and compare with prescription data on an institutional level over a two-year period, between 2013 and 2014. The IMS Health National Prescription Audit (NPA) database was used to obtain prescription data from US retail pharmacies between 2013 and 2014. Our study compared noninjectable opioid dispensing between two time periods: January-June 2013 and July-December 2014. Opioid prescription data were obtained nationally and in New Hampshire, Vermont, Maine, and Massachusetts. Institutional prescription data were supplied by Dartmouth Hitchcock Medical Center (DHMC) and University of Vermont Medical Center (UVMC) pharmacies. There was a 3.4% ( P = 0.81) decrease in opioid prescriptions filled nationally. Among New England states, opioid prescribing decreased in Maine (-5.20%, P = 0.72), Massachusetts (-4.4%, P = 0.78), and Vermont (-2.2%, P = 0.89) but increased in New Hampshire by 1.3% ( P = 0.94). Examination of local institutional opioid utilization revealed a 13.6% decline in prescriptions filled at UVMC, and only a 0.4% decrease at DHMC. The review of opioid prescriptions filled in 2013-14 suggests that national opioid utilization may be reaching a plateau. Initiatives such as prescription monitoring programs, prescriber opioid education, addiction treatment programs, public addiction awareness, and availability of medical cannabis may play a role in interstate variability of opioid use. National and regional data served as a benchmark for local institutional comparison, laying groundwork for efforts to explore areas where opioids can be prescribed more judiciously.

Biotic and abiotic controls on co-occurring nitrogen cycling processes in shallow Arctic shelf sediments.

The processes that convert bioavailable inorganic nitrogen to inert nitrogen gas are prominent in continental shelf sediments and represent a critical global sink, yet little is known of these pathways in the Arctic where 18% of the world's continental shelves are located. Moreover, few data from the Arctic exist that separate loss processes like denitrification and anaerobic ammonium oxidation (anammox) from recycling pathways like dissimilatory nitrate reduction to ammonium (DNRA) or source pathways like nitrogen fixation. Here we present measurements of these co-occurring processes using 15N tracers. Denitrification was heterogeneous among stations and an order of magnitude greater than anammox and DNRA, while nitrogen fixation was undetectable. No abiotic factors correlated with interstation variability in biogeochemical rates; however, bioturbation potential explained most of the variation. Fauna-enhanced denitrification is a potentially important but overlooked process on Arctic shelves and highlights the role of the Arctic as a significant global nitrogen sink.

Millennium development goals achievement in different states of India (2003-2004 to 2013-2014)

Purpose According to the Government of India 2015 report on millennium development goal (MDG), India is yet to achieve almost 50 per cent of the goals set by UN. Characterized by its diversity, India’s progress in terms of the indicators of MDGs for the country as a whole averages out the prevailing state level variations. The purpose of this paper is to explore the status of these goals during 1993-1994-2013-2014 at state level using 12 targets and 35 indicators relevant for India along with an attempt to explain inter-state variations in this regard. Design/methodology/approach Using the technique for order preference by similarity to ideal solution method, a multiple criteria decision making method, the states have been ranked in terms of all the indicators of MDGs. These ranks were then analysed using socio-economic and political factors to understand the root cause of variation. Findings Ranking of the states considering all the indicators reveals the actual scenario in an effective way. The factors like state domestic product, state-wise standard of education level, social backwardness and political leadership help in finding the link between the derived ranks and these socio-economic and political factors. Originality/value Previous studies in this area have been carried out taking the indicators separately. However, without a comprehensive idea with all the indicators, the overall impact cannot be understood effectively. This study is novel since it takes into account each state with respect to all the indicators taken together thereby providing a comprehensive view on the variation in the achievement of MDG goals.

Are Daughters Like Mothers: Evidence on Intergenerational Educational Mobility Among Young Females in India

Taking data from the ‘India Youth Survey: Situation and Needs’ the paper examines intergenerational educational mobility for young females (vis-a-vis their mothers) in India. The paper uses transition/mobility matrices and mobility measures widely used in the literature on intergenerational mobility for the examination. The overall intergenerational educational mobility among the young females in India is about 0.69 (the upper limit being 1). The upwards component of the overall intergenerational educational mobility is 0.55 (that is, nearly four-fifth of the overall). Also, the intergenerational educational mobility is slightly higher in the ‘Scheduled Castes and Tribes (SC/ST)’ compared to the ‘Other Backward Castes (OBC)’ as well as ‘Others’ castes. But the upward mobility is substantially higher in the ‘Others’ caste group compared to SC/STs. The upward mobility among the OBCs is higher than that of SC/STs but lower than that of the ‘Others’ category. Also, the overall mobility as well as upward mobility is higher in urban areas. Moreover, there are large inter-state variations with the economically and demographically poorer states having substantially lower overall as well as upward mobility than the economically and demographically advanced states.

Association between Public Health Care Access and Financing of Health Infrastructure in India

Health financing is presumed to have an immense importance in designing the delivery mechanism in health care service. Financing in public health care institutions (comprising local, state and central governments, along with autonomous public sector bodies) is not observed to be adequate in India as compared to the global standard. As a result, the participation of private health care institutions in this health care domain is urgently called for to address the gap between demand for and supply of health care services. Health financing by non-governmental organizations (NGOs) as well as the government initiatives in the form of public–private partnership (PPP) signifies an alternative delivery mechanism in meeting the demand of such services. An attempt has been made in the study to examine the interstate variation of public health care access in India by considering a comprehensive index on public health care access. In addition, the study sheds some lights on the association between the outreach of health care access and the financing of the health care infrastructure in the context of different states of India. Empirical evidence suggested that the more health care financing by the government, the greater the outreach of the public health care services of a state. Thus, a significant contribution in health financing would facilitate the access of public health care by addressing the supply-side problems of the outreach of health care services in the Indian economy.

Do Changes in Health Insurance Coverage Explain Interstate Variation in Emergency Department Utilization?

Emergency department (ED) utilization has increased nationally, leading to overcrowding, which in turn increases wait times, adverse clinical outcomes, and costs. We constructed a state‐level panel dataset of 50 U.S. states and the District of Columbia from 1999 to 2011 and used a first‐differencing regression model to investigate the extent to which changes in public and private health insurance coverage could account for increased ED utilization. We found that changes in health insurance coverage explained some of the variations in ED utilization; however, the magnitudes of health insurance coverage variables were very small relative to the mean of ED utilization. This suggests that anticipated increases in private health insurance coverage and the Medicaid expansion due to the Affordable Care Act will not drive large changes in ED utilization.

Population Health: Assessing Gains and Addressing Challenges Ahead

In 2015 we published the volume Disaster Response: Medical and Health Policies, a compilation of articles from World Medical & Health Policy offering research and insights from medical professionals and policy scholars to help improve interventions and reduce suffering when disasters occur, whether they result from natural or human-made threats (Nicogossian & Stabile, 2015). In this first issue of 2016 we continue that initiative, begun in collaboration with our colleague Dr. David McCann, to whose memory Disaster Response is dedicated, by adding several articles to the existing body of literature. Drs. Lisa Moreno-Walton and Kristi Koenig apply their expertise in emergency medicine to a consideration of the question of how gender impacts disaster resilience and survival within diverse populations through a review of the relevant literature in their article “Disaster Resilience: Addressing Gender Disparities.” They identify five categories of gender-related disparities: biology, responsibility for dependents, development of skills, clothing, and vulnerability to assault and trafficking. Identification of gender disparities is a first step in improving policy to enhance survival across a wide range of disaster scenarios when future events occur. A consideration of the effectiveness of integrated care teams, one approach humanitarian organizations may use to support community resilience following mass fatality disasters, is offered by Professor Lavonne M. Adams of the Harris College of Nursing & Health Sciences at Texas Christian University in “Promoting Disaster Resilience through Use of Interdisciplinary Teams: A Program Evaluation of the Integrated Care Team Approach.” And in “State Mandate Influences on FEMA-Approved Hazard Mitigation Plans Under the Disaster Management Act of 2000” Professor Oluponmile Olonilua of Texas Southern University addresses the question of whether or not such mandates materially impact policy outcomes of interest. Emergency departments are a critical component of the health-care infrastructure, so understanding influences on their capacity could help in crafting policy to enhance preparedness for both disaster scenarios and more routine crises. In the United States, emergency department utilization has increased nationally, leading to overcrowding, which in turn increases wait times, adverse clinical outcomes, and costs. Niyousha Hosseinichimeh, Erika G. Martin, and Stephen Weinberg investigate one potential factor in their article, “Do Changes in Health Insurance Coverage Explain Interstate Variation in Emergency Department Utilization?” More slow moving, but no less impactful crises loom on the public-health horizon in the form of widespread obesity and antibiotic resistance. The policy implications of therapies designed to mitigate or work around the negative impacts of these are considered in articles on bariatric surgery and fecal microbiota therapy, a non-antibiotic treatment alternative for Clostridium (C.) difficile infection (CDI). David B. Muhlestein, Thomas Wickizer, and Abigail Shoben examine effects of regulations regarding bariatric surgery procedures in the United States in “The Spillover Effect of a Change in Medicare Reimbursements on Provider Behavior in the Non-Medicare Population for Bariatric Surgery.” Shahad Salman, George Vardatsikos, Denise Avard, Nicole Palmour, Ken Dewar, and Ma'n H. Zawati examine implications of emerging Canadian policy in “FMT Happens: Regulating Fecal Microbiota Therapy in Canada; What You Need to Know.” All adverse health outcomes represent potential disasters to those who suffer them. This point is raised in Kristi Heather Kenyon's review of The AIDS Generation: Stories of Survival and Resilience, in which the book's author Perry N. Halkitis refers to the AIDS pandemic as “our natural disaster.” Health-care providers and policymakers must continuously confer and collaborate to devise health-improving and life-saving solutions. Health Behavior Change in Populations, a textbook edited by Scott Kahan, Andrea C. Gielen, Peter J. Fagan, and Lawrence W. Green, and reviewed in this issue by Michael Plouffe and Liang-Kim Ong of University College, London, offers some tools for improving population health outcomes. Our journal remains dedicated to this ongoing pursuit. We encourage physicians and all health-care professionals to actively engage in all aspects of policy formulation to ensure that community health and rights are protected and included in the debates leading to responsible and effective legislation.

Performance of India’s States on the Millennium Development Goals

The implementation of the Millennium Development Goals (MDGs) has just ended and a new more comprehensive international development agenda—the Sustainable Development Goals (SDGs)—has taken its place. An assessment of India’s performance on the MDGs is, therefore, crucial at this time to draw lessons for the SDGs. While India has made major gains in poverty reduction, access to water, combating deadly diseases and halting deforestation and biodiversity loss, its performance on crucial education, health and sanitation indicators has been weak which has serious consequences for its human development and future growth. This article focuses particularly on a comparative assessment of the performance of individual states by developing an MDG composite performance index. While all states have made improvements since 1990 on the MDGs, some have progressed far more than others and 10 states have been identified as particularly lagging behind. The article also identifies five major factors or ‘drivers’ explaining these interstate variations. JEL Classification: O1, O2, O5

Geographic variation in suicide rates in Australian farmers: Why is the problem more frequent in Queensland than in New South Wales?

ABSTRACTResearch on farmer suicide is limited in explaining the variations in farmers’ demographic characteristics. This study examines farmer suicides in two Australian states: Queensland (QLD) and New South Wales (NSW). Standardized suicide rates over 2000–2009 showed a 2 times higher prevalence of suicide in QLD than NSW (147 vs. 92 cases, respectively). Differences in age and suicide method were observed between states, although they do not appear to account for the sizeable intra- and interstate variations. Suicide prevention initiatives for farmers should account for different age groups and also specific place-based risk factors that may vary between and within jurisdictions.

Inter State Disparities in Higher Education: An Empirical Analysis

Human resource development is considered as pre-requisite to investment in physical capital. Education play a crucial role in human capital formation which enlarges people's income earning opportunities and enables them to achieve a better quality of life at a given level of income in India. Different five years plans have emphasized on educational development. The National Policy on Education of 1968 initiated a continuous effort to increase educational opportunities, to improve the quality of education at all stages and to develop the science and technology. Priority has been given for human resource development and social sector programmes and policies related to education, health etc., even in the agenda of second generation reforms. In spite of considerable steps taken by government education development particularly higher education is still lope sided. Interstate variations in terms of access and development of education are serious issue of concern in India. Keeping this issue in mind this research has been undertaken to study the interstate disparities in education development particularly higher education in India during the time period 1999 to 2015.

Factors Discriminating Credit Growth: A Comparison of Punjab and Kerala

The role of credit in commercial agriculture is inimitable. The study examined the factors discriminating credit growth in Punjab and Kerala from1983-84 to 2011–12. The credit growth is highly influenced by factors like net irrigated area per 1000 hectare of net sown area and average size of operational holdings. The reason was the dependency of Punjab on credit for irrigation needscompared to a rain fedagriculture in Kerala. Moreover the smaller size of the operational land holding in Kerala limits tractorization or other forms of mechanization. The next important factors differentiating the credit growth in both the states were area under high yielding varieties and fertilizer consumption per 1000 hectares of net sown area which had a substantial impact on the inter-state credit growth variability. The high input intensive agriculture in Punjab due to the advent of green revolution could be the root cause. Other factors like GSDP at constant prices, per capita income and number of tractors per 1000 hectare of net sown area also discriminate the credit growth. The main reason for the difference in credit growth between the two states is the variation in the climatic conditions, land distribution and cropping pattern.

Agricultural Growth and Regional Disparity in India: A Convergence Analysis

The deceleration in growth trends in agricultural output and yield rate is a matter of great concern in recent years in India. This study makes an attempt to examine the growth performances of agricultural production and productivity of major States of India and the nature and extent of disparity in the performances of agriculture. The growth performances have been analyzed considering three distinct phases of agricultural development in India viz the first phase of green revolution 1970-71 to 1979-80, second phase of green revolution 1980-81 to 1990-91, and the period after economic reform 1991-92 to 2007-08). The agricultural infrastructural index, constructed using Principle Component Analysis, reveals the prevalence of a wide inter-state variation in agricultural infrastructure in India. Moreover, using Generalized Method of Moments (GMM) under the panel data framework, the study attempts to examine the trends of convergence/divergence of per capita value of agricultural output over the period 1970-71 to 2007-08. The results of conditional convergence establish the argument that variations in the provision of agricultural infrastructure and natural factor like rainfall play the divergent role in accruing benefits from agriculture in India. The skewed distribution of public and private investment in favor of agriculturally developed states has been found to be responsible for enhancing the disparity in agricultural infrastructure and thus, to the per capita net state domestic product across states in India. Sri Lankan Journal of Agricultural Economics Vol. (16) No. 1 (2014) pp. 61-77

Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012

BackgroundThere is growing concern about potential overuse of, and toxicity from, opioid analgesics. No nationally representative study has examined inter-state variations in opioid use and impact of policy on opioid use among older adults. MethodsWe used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. We excluded those with a cancer diagnosis. Multilevel, multivariable regression analyses evaluated rates of prolonged prescriptions for schedule II, schedule III, and combination II/III opioid for each state, adjusting for patient characteristics. ResultsThe percent of Part D recipients receiving prescriptions for combined schedule II/III opioid more than 90 days in a year increased from 4.62% in 2007 to 7.35% in 2012. Large variations existed among states in rates of opioid prescriptions: from 2.84% in New York to 10.93% in Utah, in 2012 data. The state variation was larger for schedule III than schedule II. Individual characteristics independently associated with prolonged use included older age, female gender, white race, low income, living in a lower-education area, and comorbidity of drug abuse, rheumatoid arthritis, and depression. Only state law regulating pain clinic was associated with reduction of schedule II opioid prescriptions. Prolonged opioid prescription use increased the odds of opioid overdose-related emergency room visits or hospitalization by 60%. ConclusionsAnalyses of Medicare Part D data demonstrated a substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states.

MEASURING EARLY LIFE DISPARITY IN INDIA.

Early life disparity - defined as the average life years lost due to death by the age of 60 years - can be used to assess more systematically the effect of savings from death at a young age. In addition, it can give valuable insight into the consequences of death in the early stages of life. Early life disparity can further be categorized into child life disparity (0-14 years) and adult life disparity (15-60 years). This study estimated early life disparity using complete life tables for the period 1970-1975 to 2006-2010, which were constructed from abridged life tables and death rates provided by the Sample Registration System (SRS) in India. The contribution of premature deaths to the difference in life disparity was estimated using a replacement algorithm. The findings clearly indicated an overall declining trend in early life disparity in India, with a notable reduction in child life disparity, and a deceleration of adult life disparity during the period 1970-1975 to 2006-2010. Interstate variations in early life disparity were seen to converge with time. Decomposition analysis suggested that these variations could be minimized further by averting death during childhood.

Clozapine for Schizophrenia: State Variation in Evidence-Based Practice

Clozapine is the only antipsychoticwith known efficacy in treatment-resistant schizophrenia. Although 20% to 30% of individuals with schizophrenia have treatment-resistant conditions, clozapine accounts for only about 5% of their antipsychotic starts (1).We updated our previous analysis (2001–2005) by examining more recent (2006–2009) trends and patterns across 46 state Medicaid programs. Overall, clozapine accounted for 4.8% (95% confidence interval [CI]54.8%–4.9%) of antipsychotic use in schizophrenia, with a slight decline during this period: 5.7% (CI55.6%–5.8%) in 2006; 4.9% (CI54.8%–5.0%) in 2007; 4.6% (CI54.5%–4.6%) in 2008; and 4.3% (CI54.2%–4.4%) in 2009. Figure 1 shows substantial interstate variation. Clozapine was least commonly used in the Deep South and more commonly used in New England, the Rocky Mountain West, and Washington. The highest rate was in SouthDakota (15.6%, CI514.0%–17.2%) and the lowest in Louisiana (2.0%, CI51.9%–2.2%). Fiscal stress has been linked to lower clozapine use (2), as has inadequate staffing to monitor clozapine (3). The state variations are broadly consistent with known variations in overall Medicaid spending for disabled beneficiaries. Patient reluctance about blood monitoring and concerns over tolerability are unlikely to explain the variation. These findings underscore the need to determine the extent to which state variation can be explained by local practice environments or state policy factors. Interventions and policies are needed to promote appropriate clozapine treatment of Medicaid-insured patients with treatment-resistant schizophrenia.

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD: Race, Age, and State Characteristics.

Although multiple factors influence access to nephrologist care in patients with CKD stages 4-5, the geographic determinants within the United States are incompletely understood. In this study, we examined interstate differences in nephrologist care among patients approaching ESRD. This national, population-based analysis included 373,986 adult patients from the US Renal Data System, who initiated maintenance dialysis between 2005 and 2009. Multilevel logistic regression was used to examine interstate variation in nephrologist care (≥12 months before ESRD) for overall and four race-age subpopulations (black or white and older or younger than 65 years). The average state-level probability of having received nephrologist care in all states combined was 28.8% (95% confidence interval, 25.2% to 32.7%) overall and was lowest (24.3%) in the younger black subpopulation. Even at these lower levels, state-level probabilities varied considerably across states in overall and subpopulations (all P<0.001). Overall, excluding the states in the upper and lower five percentiles, the remaining states had a probability of receiving care that varied from 18.5% to 41.9%. The lower probability of receiving nephrologist care for blacks than whites among younger patients noted in most states was attenuated in older patients. Geographically, all New England states and most Midwest states had higher than average probability, whereas most Middle Atlantic and Southern states had lower than average probability. After controlling for patient factors, three state-characteristic categories, including general healthcare access measured by percentage of uninsured persons and Medicaid program performance scores, preventive care measured by percentage of receiving recommended preventive care, and socioeconomic status, contributed 55%-66% of interstate variation. Patients living in states with better health service and socioeconomic characteristics were more likely to receive predialysis nephrologist care. The reported national black-white difference in nephrologist care was primarily driven by younger black patients being the least likely to receive care.