Affiliates' Research in Medical Journals, Spring 2021


Many NBER-affiliated researchers publish some of their findings in medical and other journals that preclude pre-publication distribution. This makes it impossible to include these papers in the NBER Working Paper Series. This is a partial listing of recent papers in this category by NBER affiliates.

Changes in Health Services Use among Commercially Insured US Populations during the COVID-19 Pandemic
Whaley CM, Pera MF, Cantor J, Chang J, Velasco J, Hagg HK, Sood N, Bravata DM. JAMA Network Open 3(11), November 2020, e2024984.

Non-COVID health services use is known to have been disrupted by the COVID-19 pandemic, with reduced in-person and increased telemedicine visits. However, estimates of the size and nature of these changes across the US population have been limited, leading these researchers to examine changes in non-COVID health care use among a large commercially insured population — 6.8 million individuals — during the initial phase of the pandemic in the United States. Health insurance claims for patients from all 50 states who receive health insurance through their employers were aggregated to measure monthly utilization per 100,000 employees. Changes in care in March and April 2020 were compared to changes in prior two-month periods. Overall health care use declined by 23 percent in March 2020 and by 52 percent in April 2020 relative to existing time trends. This was driven by dramatic reductions in the use of preventive care and many elective procedures. In contrast there were small or no changes in the use of nonelective care and no change or an increase in use of prescription drugs. Use of telemedicine increased rapidly relative to prior time periods (1270 percent in March 2020 and 4081 percent in April 2020), but offset only approximately 40 percent of the decline in in-person visits, suggesting many unmet primary care needs. Patients living in zip codes with lower-income or majority racial/ethnic minority populations experienced smaller reductions in in-person visits and also had lower rates of adoption of telemedicine. The results of this study highlight the profound shock to the health care delivery system created by the COVID-19 pandemic and indicate that, if the current trends continue, innovative approaches will be needed to ensure patients receive timely access to important care.

The Effects of ACA Medicaid Expansions on Health after 5 Years
Semprini J, Lyu W, Shane DM, Wehby GLMedical Care Research and Review, November 2020.

Medicaid expansion under the Patient Protection and Affordable Care Act are known to have increased health insurance coverage and access to care, particularly among low-income adults. There has also been some evidence of improved patient health, but past studies have only examined the first year or two after expansion, and health effects may accumulate over time. This study examines effects of the Medicaid expansions on self-rated health status by income category over five years beginning in 2014, the first year when most of the expansions occurred. Data on 225,674 adults aged 25 to 64 are from a large, nationally representative survey, the Behavioral Risk Factor Surveillance System (BRFSS). A difference-in-differences design compares trends in 22 states that expanded Medicaid in 2014 to those in states that did not expand under the ACA, and those that had full or near full expansions prior to 2014. Among adults below the federal poverty level, there was improvement in health status on a 5-point scale from poor to excellent health in each year, across demographic subgroups, with 2015, 2017, and 2018 changes statistically significant. The effect is largest in 2018, a nearly 3.1 percent improvement relative to the pre-expansion rate. The 2018 effect is more than twice as large as the 2014 effect, and the difference between the two years is statistically significant. However, differences in effects across the five years are not jointly significant. These effects dissipated at higher income levels. Changes in an additional health measure, days not in good physical or mental health, could not be distinguished from no effect in most years. Overall, the researchers conclude that their results provide only minimal evidence for health effects intensifying over time, suggesting that health gains thus far have mostly occurred early on due to unmet needs among those previously uninsured.

Association of E-cigarette Advertising with E-cigarette and Cigarette Use among US Adults
Ali FRM, Dave DM, Colman GJ, Wang X, Saffer H, Marynak KL, Dench D, Grossman MAddiction, December 2020.

The demand for e-cigarettes has substantially increased every year since they were introduced in 2007. Although TV and radio advertising for cigarettes has been prohibited since 1971, advertising for e-cigarettes remains largely unregulated. The few prior studies of this advertising have focused largely on youth and relied upon self-reported advertising exposure information. The current study focuses on adults, using detailed information on actual advertisement placements in magazines and on television to yield plausibly exogenous measures of advertising exposure. Data are from 98,746 adults who responded to the 2013–14 National Adult Tobacco Survey (NATS), linked to Kantar Media and National Consumer Study data to construct measures of advertisement exposure in the past six months. The relationship between advertisement measures and outcomes was estimated using logistic and Poisson regressions, controlling for socio-demographics, state cigarette taxes and state and year fixed effects. Exposure to one additional e-cigarette advertisement on television was associated with significant increases in awareness, ever use and current use of e-cigarettes among all adults. This exposure also was associated with a 0.11 percentage point increase in current cigarette use among all adults and an increase in cigarette consumption of 2.24 cigarettes per month among adults aged 45 and above. It is known that e-cigarette advertising can trigger cravings to smoke, which is an important concern given the serious health consequences of smoking even a small number of cigarettes per day.

Comparison of Knowledge and Information-Seeking Behavior after General COVID-19 Public Health Messages and Messages Tailored for Black and Latinx Communities: A Randomized Controlled Trial
Alsan M, Stanford FC, Banerjee ABreza EChandrasekhar AG, Eichmeyer S, Goldsmith-Pinkham P, Ogbu-Nwobodo L, Olken BA, Torres C, Sankar A, Vautrey PL, Duflo EAnnals of Internal Medicine, December 2020, M20–6141.

The racial and ethnic disparities in COVID-19 prevalence and health outcomes reflect a complex set of factors, including systemic racism, inequality in access to health services, educational opportunities, and occupational differences. The paucity of public health messages that directly address communities of color might also contribute to racial and ethnic disparities in knowledge and behavior related to COVID. This randomized controlled trial included 7174 self-identified Black and 4520 Latinx adults recruited by an online survey company in May 2020. The study concluded prior to the Black Lives Matter protests of June 2020. In the intervention group, individuals answered sociodemographic questions, saw three videos, and then completed the outcome survey questions. In the control group, respondents answered all survey questions first and then viewed three video messages regarding COVID-19 that varied by physician race/ethnicity, acknowledgement of racism/inequality, and mention of community mask-wearing rates. COVID knowledge was measured by participant identification of three prevention practices, three symptoms, and knowing that COVID can be asymptomatically transmitted. Although the level of knowledge was already relatively high at baseline (72.7 percent having all accurate responses and 12.4 percent having just one item incorrect), the effect of the intervention on knowledge was clear and significant, with a knowledge level of 80.3 percent among those who received any intervention. The effect on knowledge was more pronounced for participants with more than a high school education. The effectiveness of the messages was not increased by tailoring them to specific communities or by acknowledgment of racism, fear of deportation, or economic inequality. The intervention did not significantly change information-seeking behavior, measured by asking whether the participant was interested in links to web pages or videos. The desire for additional information increased slightly with race-concordant messages for Black (but not Latinx) respondents. This provides evidence that a diverse physician workforce can be an effective channel to communicate life-saving information at a time when a novel virus is disproportionately affecting communities of color. 

Response to Propoxyphene Market Withdrawal: Analgesic Substitutes, Doses, and Adverse Events
Jeffery MM, Morden NE, Larochelle M, Shah ND, Hooten WM, Meara EMedical Care 58(1), January 2020, pp. 4–12.

Health Technology Assessment for Vaccines against Rare, Severe Infections: Properly Accounting for Serogroup B Meningococcal Vaccination’s Full Social and Economic Benefits
Stawasz A, Huang L, Kirby P, Bloom DEFrontiers in Public Health 8(261), July 2020.

Methodological Considerations in Designing and Implementing the Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI–DAD)
Banerjee J, Jain U, Khobragade P, Weerman B, Hu P, Chien S, Dey S, Chatterjee P, Saxton J, Keller B, Crimmins E, Toga A, Jain A, Shanthi GS, Kurup R, Raman A, Chakrabarti SS, Varghese M, John JP, Joshi H, Koul P, Goswami D, Talukdar A, Mohanty RR, Yadati YSR, Padmaja M, Sankhe L, Pedgaonkar S, Arokiasamy P, Bloom DE, Langa K, Jovicich J, Dey AB, Lee J, Gambhir IS, Rajguru C. Biodemography and Social Biology 65(3), July 2020, pp. 189–213.

The Impact of Nursing Staff on Satisfaction Scores for US Hospitals: A Production Function Approach
Delhy R, Dor A, Pittman P. Medical Care Research and Review, August 2020.

Financial Integration’s Impact on Care Delivery and Payment Reforms: A Survey of Hospitals and Physician Practices
Fisher ES, Shortell SM, O'Malley AJ, Fraze TK, Wood A, Palm M, Colla CH, Rosenthal MB, Rodriguez HP, Lewis VA, Woloshin S, Shah N, Meara EHealth Affairs 39(8), August 2020, pp. 1302–1311.

Landscape of Health Systems in the United States
Furukawa MF, Machta RM, Barrett KA, Jones DJ, Shortell SM, Scanlon DP, Lewis VA, O'Malley AJ, Meara ER, Rich EC. Medical Care Research and Review 77(4), August 2020, pp. 357–366.

Optimal Staffing in Community Health Centers to Improve Quality of Care
Lou Q, Dor A, Pittman P. Health Services Research, 56(1), October 2020, pp. 112–122.

School and Community Involvement of Adolescents with Chronic Health Conditions
Noonan K, Reichman NE, Corman H, Jiménez ME. Journal of Adolescent Health 67(4), October 2020, pp. 576–582.

Revisiting the Association between Temperature and COVID-19 Transmissibility across 117 Countries
Chen S, Prettner K, Cao B, Geldsetzer P, Kuhn M, Bloom DE, Bärnighausen T, Wang C. European Respiratory Journal Open Research 6, October 2020.

COVID-19 and Parent-Child Psychological Well-Being
Gassman-Pines A, Ananat EO, Fitz-Henley J. Pediatrics 146(4), October 2020, e2020007294.

Role of Nurse Practitioners in Caring for Patients with Complex Health Needs
Fraze TK, Briggs ADM, Whitcomb EK, Peck KA, Meara EMedical Care 58(10), October 2020, pp. 853–860.

Incentive Programmes for Smoking Cessation: Cluster Randomized Trial in Workplaces in Thailand
White JS, Lowenstein C, Srivirojana N, Jampaklay A, Dow WHBMJ 371, October 2020, m3797.

Initial Economic Damage from the COVID-19 Pandemic in the United States Is More Widespread across Ages and Geographies than Initial Mortality Impacts
Polyakova M, Kocks G, Udalova V, Finkelstein APNAS 117(45), October 2020, pp. 27934–27939.

Organizational Integration, Practice Capabilities, and Outcomes in Clinically Complex Medicare Beneficiaries
Colla C, Yang W, Mainor AJ, Meara E, Ouayogode MH, Lewis VA, Shortell S, Fisher E. Health Services Research 55(S3), October 2020, pp. 1085–1097.

Pediatric Hospital Services within a One-Hour Drive: A National Study
Chien AT, Pandey A, Lu S, Bucholz EM, Toomey SL, Cutler DM, Beaulieu ND. Pediatrics 146(5), November 2020, e20201724.

Sources of Hospital Variation in Postacute Care Spending after Cardiac Surgery
Thompson MP, Yost ML, Syrjamaki JD, Norton EC, Nathan H, Theurer P, Prager RL, Pagani FD, Likosky DS. Circulation: Cardiovascular Quality and Outcomes 13, November 2020, pp.1–10.

Livestock Plants and COVID-19 Transmission
Taylor CA, Boulos C, Almond DPNAS 117(50), November 2020, pp. 31706–31715.

Optimizing the Efficiency and Implementation of Cash Transfers to Improve Adherence to Antiretroviral Therapy: Study Protocol for a Cluster Randomized Controlled Trial
Packel L, Njau P, Fahey C, Ramadhani A, Dow WH, Jewell NP, McCoy S. Trials 21, November 2020.

Long-Term Healthcare Provider Availability following Large-Scale Hurricanes: A Difference-in-Differences Study
Bell SA, Klasa K, Iwashyna TJ, Norton EC, Davis MA. PLOS ONE 15(11), November 2020, pp. 1–13.

Increases in BMI and Chronic Pain for US Adults in Midlife, 1992 to 2016
Stokes AC, Xie W, Lundberg DJ, Hempstead K, Zajacova A, Zimmer Z, Glei DA, Meara EPreston SHSSM Population Health 12, December 2020, 100644.

The Interplay among Demography, Health, and the COVID-19 Pandemic in India
Agarwal A, Bloom DE, Shet A. Aarthika Charche: FPI Journal of Economics & Governance 5(2), July-December 2020, pp. 5–18.

Comparing Health Outcomes of Privileged US Citizens with Those of Average Residents of Other Developed Countries
Emanuel EJ, Gudbranson E, Van Parys J, Gørtz M, Helgeland J, Skinner JJAMA Internal Medicine 181(3), December 2020, pp. 339–344.

Global Evidence for Ultraviolet Radiation Decreasing COVID-19 Growth Rates
Carleton T, Cornetet J, Huybers P, Meng KC, Proctor J. PNAS 118(1), January 2021, e2012370118.

Social Determinants of Mortality from COVID-19: A Simulation Study Using NHANES
Seligman B, Ferranna M, Bloom DEPLOS Medicine 18(1), January 2021, e10003490.

Trends in Pediatric Hospitalizations for Coronavirus Disease 2019
Levin Z, Choyke K, Georgiou A, Sen S, Karaca-Mandic PJAMA Pediatrics, January 2021.

An Algorithmic Approach to Reducing Unexplained Pain Disparities in Underserved Populations
Pierson E, Cutler DM, Leskovec J, Mullainathan S, Obermeyer Z. Natural Medicine 27(1), January 2021, pp. 136–140.

The Effects of Accountable Care Organizations Forming Preferred Skilled Nursing Facility Networks on Market Share, Patient Composition, and Outcomes
Gu J, Huckfeldt P, Sood NMedical Care, January 2021.

Hospital-Physician Integration and Medicare’s Site-Based Outpatient Payments
Post B, Norton EC, Hollenbeck B, Buchmueller T, Ryan AM. Health Services Research 56(1), January 2021, pp. 7–15.

Comparison of Diabetes Medications Used by Adults with Commercial Insurance vs. Medicare Advantage, 2016 to 2019
McCoy RG, Van Houten HK, Deng Y, Karaca-Mandic P, Ross JS, Montori VM, Shah ND. JAMA Network Open 4(2), February 2021, e2035792.

Assessment of Electronic Health Record Use between US and Non-US Health Systems
Holmgren AJ, Downing NL, Bates DW, Shanafelt TD, Milstein A, Sharp CD, Cutler DMHuckman RS, Schulman KA. JAMA Internal Medicine 181(2), February 2021, pp. 251–259.

Data Needs in Opioid Systems Modeling: Challenges and Future Directions
Jalali MS, Ewing E, Bannister CB, Glos L, Eggers S, Lim TY, Stringfellow E, Stafford CA, Pacula RL, Jalal H, Kazemi-Tabrizi R. American Journal of Preventative Medicine 60(2), February 2021, pp. e95–e105.

Racial Disparities in Excess All-Cause Mortality during the Early COVID-19 Pandemic Varied Substantially across States
Polyakova M, Udalova V, Kocks G, Genadek K, Finlay K, Finkelstein ANHealth Affairs 40(2), February 2021.

Institutions for Mental Diseases Medicaid Waivers: Impact on Payments for Substance Use Treatment Facilities
Maclean JC, Wen H, Simon KI, Saloner B. Health Affairs 40(2), February 2021.

Nonsimultaneous Kidney Exchange Cycles in Resource-Restricted Countries without Non-directed Donation – A Prospective Single-Center Cohort Study
Kute VB, Patel HV, Modi PR, Rizvi SJ, Shah PR, Engineer DP, Banerjee S, Meshram HS, Butala BP, Modi MP, Gandhi S, Patel AH, Mishra VV, Roth AE, Kopke JE, Rees MA. Transplant International, February 2021.

How New Models of Vaccine Development for COVID-19 Have Helped Address an Epic Public Health Crisis
Bloom DE, Cadarette D, Ferranna M, Hyer RN, Tortorice DL. Health Affairs 40(3), February 2021, pp. 1–8.

Health of Infants Born to Venezuelan Refugees in Colombia
Guarnizo-Herreño CC, Wehby GLJournal of Immigrant and Minority Health 23, February 2021, pp. 222–231.

Heterogeneous Effects of Affordable Care Act Medicaid Expansions among Women with Dependent Children by State-Level Pre-expansion Eligibility
Lyu W, Wehby GLJournal of Women’s Health, February 2021, F2021.

Physician Variation in the De-adoption of Ineffective Statin and Fibrate Therapy
Everhart A, Desai N, Dowd B, Herrin J, Higuera L, Jeffery MM, Jena AB, Ross JS, Shah ND, Smith LB, Karaca‐Mandic PHealth Services Research, February 2021.

Current US State Cannabis Sales Limits Allow Large Doses for Use or Diversion
Pacula RL, Blanchette JG, Lira MC, Smart R, Naimi TS. American Journal of Preventative Medicine, February 2021.

The Impact of Driving Time to Family Planning Facilities on Preventive Service Use in Ohio
Ellison J, Griffith K, Thursby M, Slusky DJG, Bor J. American Journal of Preventive Medicine, February 2021.

Provider Teams Outperform Solo Providers in Managing Chronic Diseases and Could Improve the Value of Care
Pany MJ, Chen L, Sheridan B, Huckman RSHealth Affairs 40(3), March 2021.

Estimates of ACO Savings in the Presence of Provider and Beneficiary Selection
Ouayogodé MH, Meara EHo KSnyder CM, Colla CH. Healthcare 9(1), March 2021, 100460.