The 2020 US mortality totaled 2.8 million after early March, which is 17.3% higher than age-population-weighted mortality over the same time interval in 2017 to 2019, for a total excess death count ...of 413,592. We use data on weekly death counts by cause, as well as life tables, to quantify excess mortality and life years lost from both COVID-19 and non-COVID-19 causes by race/ethnicity, age, and gender/sex. Excess mortality from non-COVID-19 causes is substantial and much more heavily concentrated among males and minorities, especially Black, non-Hispanic males, than COVID-19 deaths. Thirty-four percent of the excess life years lost for males is from non-COVID-19 causes. While minorities represent 36% of COVID-19 deaths, they represent 70% of non-COVID-19 related excess deaths and 58% of non-COVID-19 excess life years lost. Black, non-Hispanic males represent only 6.9% of the population, but they are responsible for 8.9% of COVID-19 deaths and 28% of 2020 excess deaths from non-COVID-19 causes. For this group, nearly half of the excess life years lost in 2020 are due to non-COVID-19 causes.
The COVID-19 pandemic in the US has been particularly devastating for nursing home residents. A key question is how have some nursing homes been able to effectively protect their residents, while ...others have not? Using data on the universe of US nursing homes, we examine whether establishment quality is predictive of COVID-19 mortality. Higher-quality nursing homes, as measured by CMS overall five-star rating, have substantially lower COVID-19 mortality through September of 2020. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases and deaths may come at some cost, as high-quality homes have substantially higher non-COVID deaths. The positive correlation between establishment quality and non-COVID mortality is strong enough that high-quality homes also have more total deaths than their low-quality counterparts and this relationship has grown with time. As of late April 2021, five-star homes have experienced 8.4 percent more total deaths than one-star homes.
Visualization of the transcriptome and the nuclear organization in situ has been challenging for single-cell analysis. Here, we demonstrate a multiplexed single-molecule in situ method, intron ...seqFISH, that allows imaging of 10,421 genes at their nascent transcription active sites in single cells, followed by mRNA and lncRNA seqFISH and immunofluorescence. This nascent transcriptome-profiling method can identify different cell types and states with mouse embryonic stem cells and fibroblasts. The nascent sites of RNA synthesis tend to be localized on the surfaces of chromosome territories, and their organization in individual cells is highly variable. Surprisingly, the global nascent transcription oscillated asynchronously in individual cells with a period of 2 hr in mouse embryonic stem cells, as well as in fibroblasts. Together, spatial genomics of the nascent transcriptome by intron seqFISH reveals nuclear organizational principles and fast dynamics in single cells that are otherwise obscured.
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•Intron seqFISH allows in situ visualization of nascent transcription in single cells•Single-cell nascent transcriptome can distinguish cell types and states•Transcriptionally active loci are positioned at the surface of chromosome territories•Nascent transcriptome oscillates with a 2-hr period asynchronously in many cells
Development of intron seqFISH allows in situ profiling and visualization of nascent transcription at the single-cell level, revealing spatial and temporal features of nascent transcriptome.
This study quantifies the moral hazard effect of health insurance on medical expenditure by estimating a dynamic model of within-year medical care consumption that allows for insurance selection, ...endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has nonlinear cost-sharing features. The results suggest that moral hazard accounts for 53.1%, on average, of total annual medical expenditure when insured. This estimate is significantly different, and generally larger, than that produced by an alternative model that is representative of the annual medical care decision-making models commonly found in the literature.
We examine the impact of early state and local COVID-19 policies to encourage social distancing. Outcomes are daily foot traffic at establishments spanning ten key industries, across which ...transmission risk varies substantially. Policies include state of emergency declarations, blunt general restrictions such as stay-at-home (SAH) orders, and targeted rules such as restrictions on bars, restaurants, entertainment venues, and schools. Exploiting variation in the timing of policies in difference-in-difference models, we show that much of the decline in foot traffic early in the pandemic was due to private precautionary behavior. SAH orders explain almost none of the foot traffic decline in industries with high risk of virus transmission, but they do explain a substantial share of the decline in moderate- to low-risk industries such as outdoor sports and visits to parks. Targeted restrictions tend to impact intended industries, as well as complementary ones. We show that the impact of targeted restrictions is largest in counties with no SAH restrictions, suggesting that better targeting of public restrictions can have important efficiency gains.
Abstract Evidence across disciplines suggests that talk therapy is more curative than antidepressants for mild-to-moderate depression and anxiety. Yet, few patients use it. We develop a dynamic ...choice model to analyse patient demand for the treatment of depression and anxiety. The model incorporates myriad potential impediments to therapy use along with links between mental health improvements and earnings. The estimated model reveals that mental health improvements are valuable, directly through utility and indirectly through earnings. However, patient reluctance to use therapy is nearly impervious to reasonable counterfactual policies (e.g. lowering prices or removing other costs). Patient behaviour might reflect stigma, biases in beliefs about the effectiveness of therapy, or a distaste for discussing personal or painful issues with a stranger. More broadly, the benefits of therapy estimated in randomized trials tell only half the story. If patients do not use treatments outside of an experimental setting—and we fail to understand why or how to get them to—estimated treatment effects cannot be leveraged.
Medicaid spends nearly 100 billion dollars annually on home and community-based care for the disabled. Much of this care is provided by personal care aides, few of whom have received training related ...to the services they provide. We conducted a randomized controlled trial to estimate their demand for training. We find that 13 percent of these caregivers complete training without an incentive. Paying the caregivers four times their hourly wage increases training completion by roughly nine percentage points. Additional experimental variation suggests that among individuals confirmed to be aware of the training, the financial incentive increases completion from 35 to 58 percent. Demand curves based on these results suggest that while many caregivers value the opportunity to train, policies aimed at universal take up require large financial incentives.
Public policies aimed at improving health may have indirect effects on outcomes such as education and employment. We study the labor market effects of the US Food and Drug Administration's 2007 ...expanded black box warning on antidepressants. Our difference-in-differences estimates imply that the warning reduced employment by 6.1 percent among women aged 35–49 with a history of depression. We explore potential mechanisms and find that antidepressant and psychotherapy use among women aged 35–49 decreased after the warning. Our analysis suggests that the 2007 warning reduced US labor force participation by 0.23 percentage points, leading to $11.8 billion in lost wages.
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