Changes in the Age Distribution of Mortality Over the 20th Century

Mortality has declined continuously in the United States over the course of the 20th century, and at relatively constant rates. But the constancy of mortality reductions masks significant heterogeneity by age, cause, and source. Using historical data on death by age and cause, this paper describes the characteristics of mortality decline over the 20th century. Early in the 20th century, mortality declines resulted from public health and economic measures that improved peoples' ability to withstand disease. Because nutrition and public health were more important for the young than the old, mortality reductions were concentrated at younger ages. By mid-century, medical care became more significant and other factors less so. Penicillin and sulfa drugs brought the first mortality reductions at older ages, which were coupled with continuing improvements in health at younger ages. The pattern of mortality reduction was relatively equal by age. In the latter part of the 20th century, death became increasingly medicalized. Cardiovascular disease mortality was prevented in significant part through medical intervention. Most of the additional years added to life in the last few decades of the 20th century were at older ages.

Consequences of Eliminating Federal Disability Benefits for Substance Abusers

Using annual, repeated cross-sections from national household survey data, we estimate how the January 1997 termination of federal disability insurance, Supplemental Security Income (SSI) and Disability Insurance (DI), for those with Drug Addiction and Alcoholism affected labor market outcomes among individuals targeted by the legislation. We also examine whether the policy change affected health insurance, health care utilization, and arrests. We employ propensity score methods to address differences in observed characteristics between substance users and others, and we used a difference-in-difference-in-difference approach to mitigate potential omitted variables bias. In the short-run (1997-1999), declines in SSI receipt accompanied appreciable increases in labor force participation and current employment. There was little measurable effect of the policy change on insurance and utilization, but we have limited power to detect effects on these outcomes. In the long-run (1999-2002), the rate of SSI receipt returned to earlier levels, and short-run gains in labor market outcomes waned.

The Medical Costs of The Young and Old: A Forty Year Perspective

In this paper, we examine the growth in medical care spending by age over the past 40 years. We show that between 1953 and 1987, medical spending increased disproportionately for infants, those under 1 year, and the elderly, those 65 and older. Annual spending growth for infants was 9.8 percent and growth for the elderly was 8.0 percent compared to 4.7 percent for people aged 1-64. Within the infant and the elderly population, excess spending growth was largely driven by more rapid growth of spending at the top of the medical spending distribution. Aggregate changes in outcomes for infants and the elderly are consistent with these changes in spending growth, but we do not present any causal evidence on this point.

The Effect of the 1998 Master Settlement on Prenatal Smoking

The Master Settlement Agreement (MSA) between the major tobacco companies and 46 states created an abrupt 45 cent (21%) increase in cigarette prices in November, 1998. Earlier estimates of the elasticity of prenatal smoking implied that the price rise would reduce prenatal cigarette smoking by 7% to 21%. Using birth records on 10 million U.S. births between January 1996 and February 2000, we examined the change in smoking during pregnancy and conditional smoking intensity in response to the MSA. Overall, adjusting for secular trends in smoking, prenatal smoking declined much less than predicted in response to the MSA.

The Concentration of Medical Spending: An Update

In the last two decades, Medicare spending has doubled in real terms despite the fact that the health of Medicare beneficiaries improved over this period. The goals of this paper are to document how trends in spending by age have changed among elderly Medicare beneficiaries in the last decade and to reconcile the decline in disability rates with rapid increases in spending among the elderly. First, we conclude that the trend of disproportionate spending growth among the oldest old has continued between 1985 and 1995. Spending among the younger elderly, those 65-69 rose by two percent annually in real per person terms. In contrast, spending for those over age 85 rose by four percent. Second we show that the reasons for the large increase in spending on the oldest elderly relative to the younger elderly is the rapid increase in the use of post-acute services such as home health care and skilled nursing care. Spending on post-acute care for the very old has risen 20 percent per year in the last decade.

Why is Health Related to Socioeconomic Status?

There are striking disparities in morbidity and mortality by socioeconomic status (SES) within the United States. I examine pregnancy and health at birth to investigate possible mechanisms linking SES and health. I find that a limited set of maternal health habits during pregnancy, particularly smoking habits, can explain about half (one third) of the correlation between SES and low birth weight among white (black) mothers. I show evidence on three hypotheses to explain why health habits vary by SES. First, differences in knowledge by SES create only modest differences in health behaviors by SES, explaining about 10 percent of differential smoking by education. Second, women respond to common knowledge differentially by SES, so that knowledge and its use combined explain up to one third of differential smoking by education. Third, the most important determinants of differential health behavior are 'third variables,' or variables that can simultaneously determine health habits and SES. Finally, I show evidence that network effects at the family level exacerbate differences in behavior regardless of the source.

The Effect of Maternal Depression and Substance Abuse on Child Human Capital Development

Recent models of human capital formation represent a synthesis of the human capital approach and a life cycle view of human development that is grounded in neuroscience (Heckman 2007). This model of human development, the stability of the home and parental mental health can have notable impacts on skill development in children that may affect the stock of human capital in adults (Knudsen, Heckman et al. 2006; Heckman 2007). We study effects of maternal depression and substance abuse on children born to mothers in the initial cohort of the 1979 National Longitudinal Survey of Youth (NLSY), a national household survey of high school students aged 14-22 in 1979. We follow 1587 children aged 1-5 in 1987, observing them throughout childhood and into high school. We employ a variety of methods to identify the effect of maternal depression and substance abuse on child behavioral, cognitive, and educational related outcomes. We find no evidence that maternal symptoms of depression affect contemporaneous cognitive scores in children. However, maternal depression symptoms have a moderately large effect on child behavioral problems. These findings suggest that the social benefits of effective behavioral health interventions may be understated. Based on evidence linking early life outcomes to later well-being, efforts to prevent and/or treat mental and addictive disorders in mothers and other women of childbearing age have the potential to improve outcomes of their children not only early in life, but throughout the life cycle.