The Rise in Cardiovascular Disease Mortality Spring 2021

This study explores the long-run effects of a temporary scarcity of a consumption good on individuals' preferences towards that good when the shock is over. Adamopoulou, Olivieri, and Triviza focus on people that passed their childhood during World War II and exploit the temporary fall in meat availability that they experienced early in life. They combine hand collected historical data on the number of livestock at the regional level with microdata on eating habits and meat consumption. By exploiting cohort and regional variation in a difference-in-differences estimation, the researchers show that individuals that as children were more exposed to meat scarcity tend to consume more meat during late adulthood. Consistently with medical studies on the side effects of meat overconsumption, Adamopoulou, Olivieri, and Triviza find that these individuals have also a higher probability of being overweight and suffer from cardiovascular disease. The effects are larger for women and persist intergenerationally as the adult children of mothers who have experienced meat scarcity also tend to over-consume meat. Their results point towards a behavioral channel from early-life shocks into adult health and eating habits that the researchers illustrate through a theoretical model of reference dependence and taste formation.

Leive and Ruhm examine gender and race differences in education-mortality trends among 25-64 year olds in the United States from 2001-2018. The data indicate that the relationships are heterogeneous with larger mortality reductions for less educated non-Hispanic blacks than other races and mixed results at higher levels of schooling. They also investigate the causes of death associated with changes in overall mortality rates and identify key differences across race groups and education quartiles. Drug overdoses represent the single most important contributor to increased death rates for all groups, but the sizes of these effects vary sharply. Cardiovascular disease, cancer, and HIV are the most significant sources of mortality rate reductions, with the patterns again heterogeneous across sex, race, and educational attainment. These results suggest the limitations of focusing on all-cause mortality rates when attempting to determine the sources of positive and negative health shocks affecting population subgroups. Examining specific causes of death can provide a more nuanced understanding of these trends.

Changing mortality rates among less educated Americans are difficult to interpret because the least educated groups (e.g. dropouts) become smaller and more negatively selected over time. Novosad, Rafkin, and Asher derive partial identification methods that let us calculate mortality changes at constant education percentiles from 1992-2015. They find that middle-age mortality increases among non-Hispanic whites are driven almost entirely by changes in the bottom 10% of the education distribution. Drivers of mortality change differ substantially across groups. Deaths of despair explain a large share of mortality change among young non-Hispanic whites, but a small share among older whites and almost none among non-Hispanic blacks.

Cardiac care regionalization, specifically for patients with ST-segment elevation myocardial infarction (STEMI), has been touted as a potential mechanism to reduce systematic disparities by protocolizing the treatment of these conditions. However, it is unknown whether such regionalization arrangements have widened or narrowed disparities in access, treatment, and outcomes for minority communities.