Seasonal variation in child and old-age mortality in rural Ghana

Efficiency in reducing air pollutants and healthcare expenditure in the Seoul Metropolitan City of South Korea

This study analyzes efficiency in the reduction of air pollutants and the associated healthcare costs using a stochastic frontier cost function panel data approach. For the empirical analysis, we use monthly data covering 25 districts in the Seoul metropolitan city of South Korea observed over the period January 2010 to December 2017. Our results show large variations in air pollution and healthcare costs across districts and over time and their efficiency in reducing air pollutants. The study concludes that efforts are needed to apply the World Health Organization's air quality standards for designing and implementing location-specific customized policies for improving the level of air quality and its equal distribution, provision of health services, and improved efficiency in improving air quality standards. The study identifies a number of determinants of air pollutants and efficiency enhancement which provide useful pointers for policymakers for addressing the current environmental problems in South Korea.

Seasonal Variation in Mortality, Medical Care Expenditure and Institutionalization in Older People: Evidence from a Dutch Cohort of Older Health Insurance Clients

Background

The mortality rates of older people changes with the seasons. However, it has not been properly investigated whether the seasons affect medical care expenditure (MCE) and institutionalization. Seasonal variation in MCE is plausible, as MCE rises exponentially before death. It is therefore important to investigate the impact of the seasons on MCE both mediated and unmediated by mortality.

Methods

Data on mortality, MCE and institutionalization from people aged 65 and older in a region in the Netherlands from July 2007 through 2010 were retrieved from a regional health care insurer and were linked with data from the Netherlands Institute for Social Research, and Statistics Netherlands (n = 61,495). The Seasonal and Trend decomposition using Loess (STL) method was used to divide mortality rates, MCE, and institutionalization rates into a long-term trend, seasonal variation, and remaining variation. For every season we calculated the 95% confidence interval compared to the long-term trend using Welch’s t-test.

Results

The mortality rates of older people differ significantly between the seasons, and are 21% higher in the winter compared to the summer. MCE rises with 13% from the summer to the winter; this seasonal difference is higher for the non-deceased than for the deceased group (14% vs. 6%). Seasonal variation in mortality is more pronounced in men and people in residential care. Seasonal variation in MCE is more pronounced in women. Institutionalization rates are significantly higher in the winter, but the other seasons show no significant impact.

Conclusions

Seasonal changes affect mortality and the level of MCE of older people; institutionalization rates peak in the winter. Seasonal variation in MCE exists independently from patterns in mortality. Seasonal variation in mortality is similar for both institutionalized and community-dwelling elderly. Policy-makers, epidemiologists and health economists are urged to acknowledge and include the impact of the seasons in future policy and research.