Examining the long-term mortality effects of early health shocks

ABSTRACT

A growing literature in economics and other disciplines has tied exposure to early health shocks, particularly in utero influenza, to reductions in a variety of socioeconomic and health outcomes over the life course. However, less evidence exists that examines this health shock on mortality because of lack of available data. This paper uses recently released restricted-access files from the large, representative National Longitudinal Mortality Study in the United States to explore the mortality effects of the 1918 influenza pandemic for those in utero. While the results on socioeconomic outcomes mimic those in the literature, showing reductions in completed schooling and income fifty years following influenza exposure, the findings also suggest no effect on overall mortality or by categories of cause-of-death. These results are unexpected in their contrast with the many reported effects of in utero insults on later cardiovascular health as well as the literature linking education with later mortality.

KEYWORDS:

• Mortality
• in utero effects
• 1918 influenza pandemic

JEL CLASSIFICATION:

• I12
• J11

Acknowledgement

I thank the NYC RDC for access to the data and Jonathan Fisher for his assistance with the data and RDC policies. I thank Norm Johnson for help in granting initial access of the NLMS data within the RDC. I acknowledge research support from the Robert Wood Johnson Foundation Health & Society Scholars Program. The research in this paper was conducted while the author was a Special Sworn Status researcher of the U.S. Census Bureau at the NYC Census Research Data Center. Research results and conclusions expressed are those of the authors and do not necessarily reflect the views of the Census Bureau. This paper has been screened to ensure that no confidential data are revealed.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ While the public use data contains nearly all the necessary information to examine this research question, it does not contain the key element – year of birth. Although the public use data contains age, the survey year the individual was in the CPS has been removed from the public use NLMS data and several CPS data waves have been collapsed into a single file with no identifier for the survey year from the CPS. Thus, the year of birth is unavailable in the public file. A disadvantage of using year of birth, rather than quarter of birth, is the measurement error in exposure to in utero influenza. However, even the interpretation of using quarter of birth is not straightforward without clear measures of exposure for each 9-month time period and a good understanding of which trimester(s) of exposure are most important (and for which outcomes they are most important).