Macroeconomic Modeling of Tax Policy: A Comparison of Current Methodologies

The macroeconomic effects of tax reform are a subject of significant discussion and controversy. In 2015, the House of Representatives adopted a new “dynamic scoring” rule requiring a point estimate within the budget window of the deficit effect due to the macroeconomic response to certain proposed tax legislation. The revenue estimates provided by the staff of the Joint Committee on Taxation (JCT) for major tax bills often play a critical role in Congressional deliberations and public discussion of those bills. The JCT has long had macroeconomic analytic capability, and in recent years, responding to Congress’ interest in macrodynamic estimates for purposes of scoring legislation, outside think tank groups — notably the Tax Policy Center and the Tax Foundation — have also developed macrodynamic estimation models. The May 2017 National Tax Association (NTA) Spring Symposium brought together the JCT with the Tax Foundation and the Tax Policy Center for a panel discussion regarding their respective macrodynamic estimating approaches. This paper reports on that discussion. Below each organization provides a general description of their macrodynamic modeling methodology and answers five questions posed by the convening authors

Clinical Differences between Younger and Older Adults with HIV/AIDS Starting Antiretroviral Therapy in Uganda and Zimbabwe: A Secondary Analysis of the DART Trial

Objective: Clinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low–income African countries. Methods: Setting:: HIV clinics in Uganda and Zimbabwe. Design:: Secondary exploratory cross-sectional analysis of the DART randomized controlled trial. Outcome Measures: Clinical and laboratory characteristics were compared between adults aged 18-49 years (younger) and ≥ 50 years (older), using two exploratory multivariable logistic regression models, one with HIV viral load (measured in a subset pre-ART) and one without. Results: A total of 3316 eligible participants enrolled in DART were available for analysis; 219 (7%) were ≥ 50 years and 1160 (35%) were male. Across the two adjusted regression models, older adults had significantly higher systolic blood pressure, lower creatinine clearance and were consistently less likely to be females compared to younger adults with HIV. Paradoxically, the models separately suggested that older adults had statistically significant (but not clinically important) higher CD4+ cell counts and higher plasma HIV–1 viral copies at initiation. Crude associations between older age and higher baseline hemoglobin, body mass index, diastolic blood pressure and lower WHO clinical stage were not sustained in the adjusted analysis. Conclusions: Our study found clinical and immunological differences between younger and older adults, in a cohort of Africans starting antiretroviral therapy. Further investigations should explore how these differences could be used to ensure equity in service delivery and affect outcomes of antiretroviral therapy

Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda

Background: Traditional herbal medicines are commonly used in sub-Saharan Africa and some herbs are known to be hepatotoxic. However little is known about the effect of herbal medicines on liver disease in sub-Saharan Africa. Methods: 500 HIV-infected participants in a rural HIV care program in Rakai, Uganda, were frequency matched to 500 HIV-uninfected participants. Participants were asked about traditional herbal medicine use and assessed for other potential risk factors for liver disease. All participants underwent transient elastography (FibroScan®) to quantify liver fibrosis. The association between herb use and significant liver fibrosis was measured with adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CI) using modified Poisson multivariable logistic regression. Results: 19 unique herbs from 13 plant families were used by 42/1000 of all participants, including 9/500 HIV-infected participants. The three most-used plant families were Asteraceae, Fabaceae, and Lamiaceae. Among all participants, use of any herb (adjPRR = 2.2, 95% CI 1.3–3.5, p = 0.002), herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 2.9–8.7, p<0.001), and herbs from the Lamiaceae family (adjPRR = 3.4, 95% CI 1.2–9.2, p = 0.017) were associated with significant liver fibrosis. Among HIV infected participants, use of any herb (adjPRR = 2.3, 95% CI 1.0–5.0, p = 0.044) and use of herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 1.7–14.7, p = 0.004) were associated with increased liver fibrosis. Conclusions: Traditional herbal medicine use was independently associated with a substantial increase in significant liver fibrosis in both HIV-infected and HIV-uninfected study participants. Pharmacokinetic and prospective clinical studies are needed to inform herb safety recommendations in sub-Saharan Africa. Counseling about herb use should be part of routine health counseling and counseling of HIV-infected persons in Uganda

Clinical differences between younger and older adults with HIV/AIDS starting antiretroviral therapy in Uganda and Zimbabwe: a secondary analysis of the DART trial

Clinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low-income African countries

Cardiovascular Health Effects of 100% Fruit Juice Versus Whole Fruit in Postmenopausal Women: Results from the Women’s Health Initiative

Thesis (Master's)--University of Washington, 2016-12Introduction We investigated whether 100% fruit juice and whole fruit were independently related to incident hypertension or incident type 2 diabetes. Methods We included women 50-79 years old enrolled in the Women’s Health Initiative. The risk of incident hypertension was analyzed in 80,539 participants and risk of incident diabetes in 114,219 participants. One hundred percent fruit juice and whole fruit intake were assessed by baseline food frequency questionnaire. Standardized questionnaires assessed medical history and other characteristics at baseline and every 6-12 months during follow-up. Cox regression, adjusted for demographic, socioeconomic, behavioral, and dietary variables (including total energy intake) was used to estimate hazard ratios (HR) for the associations between 100% fruit juice and whole fruit consumption and incident hypertension and diabetes during a mean of 7.8 years of follow-up. Results In multivariable analyses, there was no association between 100% fruit juice consumption and incident hypertension (highest vs. lowest quintile, HR 1.00, 95% CI 0.97-1.03) or incident diabetes (HR 0.98, 95% CI 0.92-1.04). There was also no association between whole fruit consumption and incident hypertension (HR 1.20, 95% CI 0.98-1.05) or incident diabetes (HR 1.03, 95% CI 0.96-1.10). Conclusion Greater consumption of 100% fruit juice or whole fruit was not associated with risk of incident hypertension or diabetes among postmenopausal US women

Logistic regression model for characteristics at ART initiation for adults who were older (≥ 50 years) compared to younger ones (18-50 years) (N=3316).

<p>Abbreviations: ALT – Alanine transaminase; AST – Aspartate transaminase; BMI – Body Mass Index; clear. – clearance; CD4+ – Cluster of Differentiation; CI – Confidence Interval; cp – copies; Cr. – Creatinine; IQR – Inter Quartile Range; Kg – Kilogramme; M² – Meter; SD – Standard Deviation; WHO – World Health Organization; <i>d</i>L – deciliter; g – grams; Hg – mercury; mmol – millimols; mL − milliliter; mm – millimeters; µL – microliter</p><p>* n=968 (</p><p>< 50 years n = 912; > 50 years n = 56) in log 10 copies per milliliter.</p><p>§ <i>Baseline adjusted model;</i> Ω <i>- model with viral load, interaction between gender and hemoglobin; and creatinine clearance (BMI excluded</i>)</p><p>α − WHO stages 2, 3 & 4 included as a linear trend</p

Characteristics at ART initiation stratified by age < 50 years and age ≥ 50 years.

<p>Abbreviations: ALT – Alanine transaminase; AST – Aspartate transaminase; BMI – Body Mass Index; CD4+ – Cluster of Differentiation; CI – Confidence Interval; cp – copies; IQR – Inter Quartile Range; neg – negative; OR – Odds Ratio; pos – positive; SD – Standard Deviation; WHO – World Health Organization; <i>d</i>L – deciliter; g – grams; Hg – mercury; mmol – millimols; mL − milliliter; mm – millimeters; µL – microliter</p><p>* <i>n=968 (< 50 years n = 912; > 50 years n = 56</i>)<i>.</i></p

Characteristics of participants reporting current herb use.

<p>L (Liters), HBsAg (Hepatitis B Surface Antigen), HIV (Human Immunodeficiency Virus).</p

Association of herbs with significant liver fibrosis in HIV-infected participants.

<p>Multivariate model for HIV-infected participants adjusts for: age, occupational fishing, positive Hepatitis B surface antigen, gender, heavy liquor use (≥1.25 L/week), ART, and CD4 nadir. Only participants with a valid TE scan (468/500) were included in the model. CI (Confidence Interval).</p