Modern Medicine and the Twentieth Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs

Modern Medicine and the Twentieth Century Decline in Mortality: Evidence on the Impact of Sulfa Drugs

Seema Jayachandran, Adriana Lleras-Muney, and Kimberly V. Smith

American Economic Journal: Applied Economics 2 (April 2010): 118–146

Abstract

This paper studies the contribution of sulfa drugs, a groundbreaking medical innovation in the 1930s, to declines in US mortality. For several infectious diseases, sulfa drugs represented the first effective treatment. Using time-series and difference-in-differences methods, we find that sulfa drugs led to a 24 to 36 percent decline in maternal mortality, 17 to 32 percent decline in pneumonia mortality, and 52 to 65 percent decline in scarlet fever mortality between 1937 and 1943. Altogether, sulfa drugs reduced mortality by 2 to 3 percent and increased life expectancy by 0.4 to 0.7 years. We also find that sulfa drugs benefited whites more than blacks. 

(JEL I12, L65, N32, N72)

http://pubs.aeaweb.org/doi/pdfplus/10.1257/app.2.2.118

Ungated version:

http://www.econ.ucla.edu/alleras/research/papers/sulfa_final.pdf

The Conquest of Pestilence in New York City

One of the admirable things about Glaeser's book is its historical scope. One image from the book (a slightly different online version of which I found on the website http://gothamist.com) that particularly resonated with me is below.

Institute of Health Metrics and Evaluation

The publications page of this Institute is well-worth checking out every few months as they are producing some very interesting papers and data. Recent work includes a paper examining the contribution of education gains across 175 countries from 1970 to 2009 to improving child mortality. They are also, inter alia, creating a substantial volume of global data-sets on mortality conditions, and conducting work on methodological considerations in measuring and analysing mortality data.

Visualising Mortality - Hans Rosling

Doing the rounds on the blogworld - quite brilliant!

Two New Papers On Malthus

As if we needed any reminding of it in this climate, economics is often known as the “dismal science”. Malthus is largely to blame for this unfortunate term, thanks to his pessimistic theories on the nature of population growth and mortality. In a simple Malthusian world, an increase in wages increases population. This only results in an increase in mortality rates, ultimately returning society to its original equilibrium with no permanent increase in welfare.

Two recent papers by UCD economists re-examine this issue. Cormac Ó’Gráda and Morgan Kelly (Living Standards and Mortality since the Middle Ages) find that all strata of English society, including the nobility, were affected by food shortages before the Black Death. The relationship between food prices and mortality disappears in the mid 17th century (although not in London), but then reappears in the early 18th century. Interestingly (given Malthus’ objections to the Poor Laws), the authors suggest that social welfare had a part to play in this. This paper is also discussed on the Economic Logic blog.

Research in this area has tended to focus on England; however we know that the UK was exceptional for several reasons. Alan Fernihough (Malthusian Dynamics in a Diverging Europe: Northern Italy 1650-1881) examines the evidence for Italy. He finds support for the existence of Malthusian checks into the late 1800s. Both papers are relevant for the debate on the stages of economic growth (e.g. Galor and Weil, Population, technology, and growth: From Malthusian stagnation to the demographic transition and beyond).

Mortality consequences of receiving income

Given the falls in income that people in Ireland are experiencing & will continue to experience one might wonder is there upside? Well it turns out that the receipt of income can have a short run effect on mortality: increasing it, that is. So given that there is less of that around, maybe its not all bad news.

The short term mortality consequences of income receipt
William Evans Timothy Moore

Many studies find that households increase their consumption after the receipt of expected income payments, a result inconsistent with the life-cycle /permanent income hypothesis. Consumption can increase adverse health events, such as traffic accidents, heart attacks and strokes. In this paper, we examine the short-term mortality consequences of income receipt. We find that mortality increases following the arrival of monthly Social Security payments, regular wage payments for military personnel, the 2001 tax rebates, and Alaska Permanent Fund dividend payments. The increase in short-run mortality is large, potentially eliminating some of the protective benefits of additional income.

Registering Deaths in Japan

The issue of incentives for registering births and deaths, in general, is a tricky issue for research on historical health conditions. This story on the BBC website caught my eye today. The Japanese authorities are effectively trying to clean up their own data-bases by tracking down the many people they have listed on their books who are 100 years old or more. I am sure many of them will turn out to be sprightly old people who have obeyed a regimine of oily fish and exercise for their life time. However, it seems that some of them are actually long dead, including one lady whose bones were found in a rucksack and another person whose registered address was bulldozed 20 years ago. At least one potential reason for the prevalance of centenarians is that their benefits can still be claimed after their death by unscrupulous relatives.

The effects on mortality of nurses striking

The health sector in Ireland has experienced a fair amount of industrial strife in recent years with nurses in particular taking industrial action over pay and other issues. Understandably this generates a lot of anxiety amongst the public or at least those directly or indirectly affected by this. So it is interesting to know whether such industrial action has any consequences for the health of patients. The paper below finds that it does have negative effects & fairly sizable ones at that. This underlines the importance of avoiding these break-downs in normal industrial relations.
Do strikes kill? evidence from New York state
J Gruber, S A Kleiner

Concerns over the impacts of hospital strikes on patient welfare led to substantial delay in the ability of hospitals to unionize. Once allowed, hospitals unionized rapidly and now represent one of the largest union sectors of the U.S. economy. Were the original fears of harmful hospital strikes realized as a result? In this paper we analyze the effects of nurses’ strikes in hospitals on patient outcomes. We utilize a unique dataset collected on nurses’ strikes over the 1984 to 2004 period in New York State, and match these strikes to a restricted use hospital discharge database which provides information on treatment intensity, patient mortality and hospital readmission. Controlling for hospital specific heterogeneity, patient demographics and disease severity, the results show that nurses’ strikes increase in-hospital mortality by 19.4% and 30-day readmission by 6.5% for patients admitted during a strike, with little change in patient demographics, disease severity or treatment intensity. This study provides some of the first analytical evidence on the effects of health care strikes on patients, and suggests that hospitals functioning during nurses’ strikes are doing so at a lower quality of patient care.
NBER Working Paper No. 15855 (March 2010)
http://www.nber.org/papers/w15855