Regression Discontinuity Analysis Research Articles

Effect of no cost sharing for paediatric care on healthcare usage by household income levels: regression discontinuity design

ObjectivesTo investigate the impact of no cost sharing on paediatric care on usage and health outcomes, and whether the effect varies by household income levels.DesignRegression discontinuity design.SettingNationwide medical claims database...

Higher-Achievement Schools, Peers and Mental Health

Abstract Although many students suffer from anxiety and depression, and often identify school pressure and concerns about their futures as the main reasons for their worries, little is known about the consequences of the schooling environment on students’ mental health. Using a regression discontinuity analysis in the largest Norwegian cities, we show that eligibility to enrol in a higher-achievement high school increases the probability of enrolment in higher education and decreases the probability of diagnosis or treatment of psychological conditions. We provide suggestive evidence that changes in both teacher and peer characteristics are likely drivers of these effects.

Social Conflict and Outgroup Sentiment in South Korea: Evidence from the Yemeni Anti-Refugee Campaign

AbstractResearch on attitudes toward immigrants and refugees largely focuses on intergroup conflict and related threats imposed by outgroup members. This study shifts the analytic focus to intragroup conflict: a domestic struggle among natives over how to handle recently arrived refugees and on their perception of foreign workers in general and Muslims in particular. By exploiting an exogenous variation in the interview timing of a nationally representative survey conducted in South Korea, a “new immigration destination,” this study offers a causal estimate (local average treatment effect) of domestic societal conflict on outgroup attitudes. Results from regression discontinuity (RD) analysis show that in its aftermath—immediately following the completion of a controversial e-petition sponsored by the anti-refugee group demanding that the government extradite asylum seekers—the public opinion of Korean adults toward foreign workers and Muslims became more, not less, favorable. Heterogeneous treatment effects are also found across two respondent-level characteristics: cosmopolitan identity and relative deprivation. Specifically, the focal relationship is more pronounced among individuals who identify less with cosmopolitan citizenship and among those who are more relatively deprived.

Pre-colonial centralization and tax compliance norms in contemporary Uganda

AbstractThe paper examines the legacy of pre-colonial centralization on tax compliance norms of citizens in contemporary Uganda. Using a regression discontinuity analysis on neighboring ethnic homelands with different levels of pre-colonial centralization, we find that pre-colonial centralization is correlated with stronger norm for tax compliance. The result is explained by the legacy of location-specific capacity of centralized states in upholding authority and a strong social cohesion exhibited through higher interpersonal trust but not through trust in public institutions.

Can the Elite Stream Improve the Academic Achievement of Senior Secondary School Students? A Study of High School Students from X City in western China based on Regression Discontinuity Analysis

The fairness and efficacy of the elite stream in general senior secondary education have long been a contentious issue. Based on the longitudinal data of the students who were enrolled in five senior secondary schools in X City in western China in 2017 and 2018, this study examined the effects of elite class streaming in improving student academic performance, using regression discontinuity analysis. The research findings showed that: despite the significant differences in the grade-10 streaming examination results and the grade-12 academic achievement between the elite class and regular class students, the gap was not markedly widened after three years of senior secondary education; the elite stream did not exhibit distinct promotive effects on the advancement of students’ overall performance when the cutoff point of elite class admission was utilized as the exogenous variable to evaluate the effects of the elite stream on student performance; both the parameter estimation and non-parametric estimation results demonstrated that the elite stream had no marked effects in improving student performance and there was no gender difference or urban vs. rural difference in the impact of the elite stream on student academic achievement.

Choosing not to lead: Monetary incentives and political selection in local parliamentary systems

Using a rich database covering all local politicians in Italian municipalities, we implement a regression-discontinuity analysis to evaluate the causal effect of monetary incentives on political selection in local parliamentary systems. We find that higher expected wages lead to the selection of more educated council members and executives, but do not result into better educated mayors. Low-wage councils tend to elect mayors with almost two years more schooling than the median councillor, but this difference vanishes in high-wage councils. We rationalize this finding in a model where better educated councillors shy away from better-paid but full-time positions (such as mayor) and prefer less-paid but part-time positions (executives) that allow them to devote more time to work while in office. An analysis by politicians’ occupation and retirement status supports this explanation. Our findings thus highlight that the effects of monetary incentives are not invariant across different institutional settings, especially when the election systems include a parliamentary stage.

The Association of Medicaid expansion with prescription drug utilization and expenditure among low-income participants with asthma

Objective This study estimated the association between the 2014 Medicaid expansion and asthma-related prescription drug utilization and expenditures among low-income adult participants with asthma, including those with uncontrolled asthma, in the United States. Methods In this national analysis, using a pooled dataset from 2007–2018 Medical Expenditure Panel Surveys (MEPS), regression discontinuity (D-RD) analyses estimated the association between Medicaid expansion and utilization of and expenditures for asthma-related prescription drugs among participants with asthma aged 26–64 with incomes below vs. at/above 138% of the federal poverty level (FPL). A sub-sample analysis was also conducted among participants with uncontrolled asthma. Utilization and expenditure outcomes were estimated using two-part models with logit as the first part and generalized linear models as the second part. Results Utilization of and total cost for asthma-related prescription drugs increased by 1.89 fills (p < 0.001) and $306.59 (p < 0.001) among participants with asthma with income below 138% FPL after Medicaid expansion. The utilization and total cost of both short-acting bronchodilators and inhaled corticosteroids (ICSs) increased after Medicaid expansion among participants with asthma with incomes below 138% FPL. Among participants with uncontrolled asthma with incomes below 138% FPL, utilization and expenditures increased after Medicaid expansion for all asthma-related prescription drugs and short-acting bronchodilators. Conclusion Medicaid expansion was associated with increased utilization of and total expenditures for both quick-relief and preventive asthma medications among all low-income participants with asthma, but not with utilization of preventive medications among those with uncontrolled asthma.

Effects of being eligible for specific health guidance on health outcomes: A regression discontinuity analysis using Japan's data on specific health checkups

The significance of general health checkups and guidance is controversial. To examine the effectiveness of Japan's specific health checkup (SHC) and specific health guidance (SHG) programs, this study applied a regression discontinuity design (RDD) using the SHC results database collected by a private company. We applied a sharp RDD with a cutoff body mass index (BMI) of 25 kg/m2 for those with a waist circumference (WCF) of <85 cm in men and < 90 cm in women, with risks of hypertension, dyslipidemia or diabetes, and aged between 40 and 64 years. Study outcomes were differences in BMI, WCF, and major cardiovascular risk factors between the baseline year and the following year. We analyzed the data of baseline years of 2015, 2016, and 2017 separately and their pooled data. We judged the results to be robust significant when significant results in the same direction were found in all four analyses. A total of 1,041,607 observations out of 614,253 people were analyzed. We found robust significant results that those eligible for SHG in the baseline year had a lower BMI (both men and women) and lower WCF (men only) in the following year than those not eligible for SHG: BMI for men (−0.12 kg/m2, 95% CI [confidence interval]: −0.15 to −0.09); BMI for women (−0.09 kg/m2, 95% CI: −0.13 to −0.06); and WCF for men (−0.36 cm, 95% CI: −0.47 to −0.28) in the pooled data. Robust significant results were not found in WCF for women or in major cardiovascular risk factors.

Taxation, Fiscal Redistribution, and Local Land Use Regulation

<h3>Abstract</h3> This paper explores the role of fiscal institutions for local land use. It argues that tax-base mobility results in an incentive to expand commercial and residential land use, which is mitigated by fiscal redistribution. These predictions are investigated empirically using a dataset of German municipalities. To identify differences in the exposure to fiscal redistribution, I exploit institutional characteristics of fiscal-equalization grants using a regression-discontinuity analysis. The results support the role of fiscal incentives for local land-use regulation, as commercial and residential land use is expanded much faster, and agricultural land use declines more rapidly in municipalities exempted from fiscal redistribution.

The Causal Effect of Education on Myopia: Evidence That More Exposure to Schooling, Rather Than Increased Age, Causes the Onset of Myopia.

To distinguish the effects of age and grade on the development of myopia. Grade 1 (n = 1465, mean age 6.71 ± 0.29 years; 53.5% male) and Grade 2 students (n = 1381, mean age 7.76 ± 0.30 years; 52.5% male) were examined in 2018, with a follow-up examination in 2019. Cycloplegic spherical equivalent (SE) in diopter (D) was measured. Regression discontinuity (RD) analysis was used to assess the causal effects on refraction at each visit. The sample in a grade was divided into three 4-month age blocks according to their birth month, the youngest, middle, and the oldest. At the 2018 visit, within each grade, there were no significant differences in SE among age blocks (all P > 0.05), despite an age range of 12 months. However, comparing the youngest block in Grade 2 to the oldest block in Grade 1, an average age difference of four months, a significant difference in SE was found (0.82 ± 0.69 D vs. 1.05 ± 0.55 D, t-test P < 0.01). Formal RD analysis found a significant casual effect of grade increase on myopic refraction shift (β = -0.32 D; 95% CI, -0.73 to -0.01; P = 0.042). Consistent results were found using the 2019 data. Increased grade, rather than increasing age, is the major cause of myopic shifts in refraction. A causal link implies that interventions aimed at reducing the myopigenic exposures experienced during a school year have the potential to markedly reduce the myopic shifts in refraction associated with a grade of schooling.

NICU Versus Mother/Baby Unit Admission for Low-Acuity Infants Born at 35 Weeks' Gestation.

To estimate the effect of NICU admission of low-acuity infants born at 35 weeks' gestation versus care in a mother/baby unit, on inpatient and outpatient medical outcomes. This retrospective cohort study included 5929 low-acuity infants born at 350/7 to 356/7 weeks' gestation at 13 Kaiser Permanente Northern California hospitals with level II or level III NICUs between January 1, 2011, and December 31, 2021. Exclusion criteria included congenital anomalies and early respiratory support or antibiotics. We used multivariable regression and regression discontinuity analyses to control for confounding variables. Infants admitted to the NICU within 2 hours of birth (n = 862, 14.5%) had a 58 hour adjusted (98-hour unadjusted) longer length of stay. NICU admission was associated with an increased probability of a length of stay ≥96 hours (67% vs 21%; adjusted odds ratio [aOR], 4.94; 95% confidence interval [CI], 3.96-6.16). Regression discontinuity results suggested a similar (57 hour) increase in length of stay. Readmission risk, primarily for jaundice, was lower for those admitted to the NICU (3% vs 6%; aOR, 0.43; 95% CI, 0.27-0.69). Infants admitted to the NICU were slightly less likely to be receiving exclusive breast milk at 6-month follow-up (15% vs 25%; aOR, 0.73; 95% CI, 0.55-0.97; adjusted marginal risk difference -5%). Admitting low-acuity infants born at 35 weeks' gestation to the NICU was associated with decreased readmission, but with longer length of stay and decreased exclusive breast milk feeding at 6 months. Routine NICU admission may be unnecessary for low-acuity infants born at 35 weeks' gestation.

Robust learning algorithm based on agreement among soil sampling techniques

Environmental investigation and modelling require case-based sampling techniques in various domains such as soil, air and water as well as living populations. In most cases, a limited number of sampling techniques can be conducted into a site stemming from the impracticability of geology, time and cost. In addition, if some outliers are recorded due to natural variability and the metrological issues, the modelling process is in need of robust analysis tools. Therefore, a robustness-based sampling agreement and vigorous estimations are needed. The primary purpose of this study is to provide a consensus between different soil sampling methods when a merging is required and to make reliable estimations in case of the existence of any outlier. A machine learning algorithm has been established for reaching targets by considering robustness, transparency, accuracy as well as reproducibility. The algorithm is suited for small data sets and all steps of the algorithm demonstrated that the robust learning algorithm is not severely influenced by the presence of a few outliers. The testing performed based on regression discontinuity analysis and comparative estimations also showed that repeated double robust regression outperforms the conventional multiple least-squares regression. Thus, the learning algorithm can be recommended to the fields of environmental sciences and also may be considered in different disciplines with minor adaptations.

Impact of an external ventricular shunt (EVD) handling protocol on secondary meningitis rates: a historical cohort study with propensity score matching

BackgroundExternal ventricular drainage (EVD) is frequently used in neurosurgical procedures for cerebrospinal fluid (CSF) drainage. It is, however, associated with high infection rates, namely secondary meningitis and ventriculitis. Based on a previous high prevalence of these infections among patients with EVDs, we have proposed and implemented a protocol in an effort to decrease the infection rate. The aim of this study was to measure the effect of hospital-wide implementation of the EVD handling protocol on secondary EVD infections.Patients and methodsWe included 409 consecutive patients who received a new EVD for other indications than infectious pathologies from January 2000 until June 2012. Patients above 18 years of age were divided into pre- (n = 228) and post-protocol (n = 181) groups. Patient and disease demographics, as well as EVD data together with confounders for secondary meningitis were recorded in a database. Propensity score matching was then performed to create groups matched for sex, age, reason for drainage, type of shunt, time in situ and duration of surgery to place the EVD. Binomial logistic regression for confounder adjustment and regression discontinuity analyses were then performed on the matched cohort.ResultsInfections occurred more frequently in the pre-protocol group (23% vs 9%, p < 0.001). The incidence of infection was 33/1000 drain-days pre-protocol and 9/1000 drain-days post-protocol. Regression analysis in a propensity score-matched cohort (n = 103 in the pre- and n = 178 in the post-protocol groups) showed that the pre-protocol period was independently associated with more infections (OR 2.69; 95%-CI 1.22–5.95, p = 0.01).ConclusionsThe incidence of secondary EVD infections can be reduced significantly by the implementation of a strict hospital-wide EVD handling protocol.

The Effects of a Mathematics Remedial Program on Mathematics Success and Achievement among Beginning Mathematics Major Students : A regression discontinuity analysis

The proficiency in Mathematics skills is fundamental to success in the STEM disciplines. In the US, beginning college students who are placed in remedial/developmental Mathematics courses frequently struggle to achieve academic success (Fay,2020). Therefore, Mathematics remediation in college has become an important concern, and providing Mathematics remediation is a prevalent way to help the students who may not be fully prepared for college-level courses. Programs vary however, and the effectiveness of a particular remedial Mathematics program must be empirically demonstrated. The purpose of this study was to apply the sharp regression discontinuity (RD) technique to determine the effectiveness of the Jack Leaps Summer (JLS) Mathematic remediation program in supporting improved Mathematics learning outcomes among newly admitted Mathematics students in the South Dakota State University. The researchers studied the newly admitted Fall 2019 cohort of Mathematics majors (n=423). The results indicated that students whose pretest score was lower than the cut-off point and who were assigned to the JLS program, experienced significantly higher scores on the post-test (Math 101 final score). Based on these results, there is evidence that the JLS program is effective in meeting its primary objective.

Assessing the Effect of Abortion Restrictions: Improving Methodology and Expanding Outcomes.

Assessing the Effect of Abortion Restrictions: Improving Methodology and Expanding Outcomes.

Relationship Between Coronavirus Disease 2019 Vaccination Rates and Rare But Potentially Fatal Adverse Events: A Regression Discontinuity Analysis of Western Countries.

Owing to limited experience with the new vaccine platforms, discussion of vaccine safety is inevitable. However, media coverage of adverse events of special interest could influence the vaccination rate; thus, evaluating the outcomes of adverse events of special interest influencing vaccine administration is crucial. We conducted regression discontinuity in time analysis to calculate the local average treatment effect (LATE) using datasets from Our World in Data and Johns Hopkins University Center for Systems Science and Engineering. For the United States, the United Kingdom, and Europe, the cutoff points were April 23rd and June 23rd, April 7th, and the 14th week of 2021, respectively. The LATE of the Advisory Committee on Immunization Practices (ACIP) meeting held on April 23rd was -0.249 for all vaccines, -0.133 (-0.189 to -0.076) for Pfizer, -0.064 (-0.115 to -0.012) for Moderna, and -0.038 (-0.047 to -0.030) for Johnson &amp; Johnson. Discontinuities were observed for all three types of vaccines in the United States. The June 23rd meeting of the ACIP (mRNA vaccines and myocarditis) did not convene any discontinuities. Furthermore, there was no significant drop in the weekly average vaccination rates in Europe following the European Medicines Agency (EMA) statement on April 7th. Conversely, there was a significant drop in the first-dose vaccination rates in the United Kingdom related to the EMA report. The first-dose vaccination rate for all vaccines changed by -0.104 (-0.176 to -0.032). Although monitoring and reporting of adverse events of special interest are important, a careful approach towards public announcements is warranted.

The effect of population-based blood pressure screening on long-term cardiometabolic morbidity and mortality in Germany: A regression discontinuity analysis.

Hypertension represents one of the major risk factors for cardiovascular morbidity and mortality globally. Early detection and treatment of this condition is vital to prevent complications. However, hypertension often goes undetected, and even if detected, not every patient receives adequate treatment. Identifying simple and effective interventions is therefore crucial to fight this problem and allow more patients to receive the treatment they need. Therefore, we aim at investigating the impact of a population-based blood pressure (BP) screening and the subsequent "low-threshold" information treatment on long-term cardiovascular disease (CVD) morbidity and mortality. We examined the impact of a BP screening embedded in a population-based cohort study in Germany and subsequent personalized "light touch" information treatment, including a hypertension diagnosis and a recommendation to seek medical attention. We pooled four waves of the KORA study, carried out between 1984 and 1996 (N = 14,592). Using a sharp multivariate regression discontinuity (RD) design, we estimated the impact of the information treatment on CVD mortality and morbidity over 16.9 years. Additionally, we investigated potential intermediate outcomes, such as hypertension awareness, BP, and behavior after 7 years. No evidence of effect of BP screening was observed on CVD mortality (hazard ratio (HR) = 1.172 [95% confidence interval (CI): 0.725, 1.896]) or on any (fatal or nonfatal) long-term CVD event (HR = 1.022 [0.636, 1.641]) for individuals just above (versus below) the threshold for hypertension. Stratification for previous self-reported diagnosis of hypertension at baseline did not reveal any differential effect. The intermediate outcomes, including awareness of hypertension, were also unaffected by the information treatment. However, these results should be interpreted with caution since the analysis might not be sufficiently powered to detect a potential intervention effect. The study does not provide evidence of an effect of the assessed BP screening and subsequent information treatment on BP, health behavior, or long-term CVD mortality and morbidity. Future studies should consider larger datasets to detect possible effects and a shorter follow-up for the intermediate outcomes (i.e., BP and behavior) to detect short-, medium-, and long-term effects of the intervention along the causal pathway.

Can promoting ethanol gasoline usage improve air quality? Evidence from Tianjin, China

Promoting the use of ethanol gasoline is an important approach for China to achieve sustainable and high-quality development. Based on the daily air quality data of Tianjin, China, from 2013 to 2020, this paper investigates whether the implementation of the ethanol gasoline policy helped improve air quality using regression discontinuity analysis. We find that the implementation of the ethanol gasoline policy had a very limited positive effect on the overall air quality index (AQI) and no obvious effect on the reduction of particulate matter (PM2.5 and PM10). However, the results reveal that the ethanol gasoline policy reduced SO2, NO2, and CO by about 36%, 19%, and 20%, respectively. These findings provide policy insights for other cities in China and other rapidly developing cities in the world to promote the use of ethanol gasoline.

Leading-Digit Bias Influences the Decision to Transfuse Hospitalized Patients

Leading-digit bias is a heuristic whereby people overemphasize the left-most digit when evaluating numbers (eg 19.99 vs 20). We hypothesized that leading-digit bias influences the interpretation of hemoglobin (Hb) values and therefore red cell transfusion decisions among hospitalized patients. To test our hypothesis, we examined all inpatient red cell transfusions at the University Health Network from January 2016 to September 2021 (n=226,378 units; 4 months missing). We performed a retrospective analysis of pre-transfusion Hb levels compared the frequency of transfusion at 79 vs. 80 g/L in a quadratic regression discontinuity design. Secondary analysis explored other leading-digit thresholds and Benford numbers served as tracer analyses. All analyses performed using R-Studio Version 4.0.2. Our primary analysis included 9,585 red cell units, of which 1,150 were transfused at Hb=79 and 610 at Hb=80. Regression discontinuity analysis showed the threshold accounted for 572 additional red cell units transfused (p=0.006) (Figure 1). The effect was consistent across all subgroups larger than 5000, present in data with and without exclusions, and absent for Benford numbers. Our study is the first to establish leading-digit bias in red cell transfusion. Our findings might be translated into research utilizing quasi-experimental methodology and inform guidelines for transfusion thresholds. Figure 1. Unadjusted regression discontinuity analysis of pre-transfusion hemoglobin (g/L) comparing transfusion frequency above and below bias threshold Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Mass media, air quality, and management turnover

This study investigates whether and how local air pollution shapes firm managers’ mobility when mass media raising public awareness. To establish causality, we introduce an exogenous shock of spatial changes for air pollution by conducting spatial regression discontinuity (RD) analyses across the Huai River boundary in China. We show that air pollution has significant positive effects on firm management turnover, and the effects are strengthened by the release of the documentary Under the Dome which heighten public concerns for air pollution. Plausible mechanism is that aroused public attentions on the damages from air pollutants on human health induce managers to escape from pollution.