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Nurchis MC, Radio FC, Salmasi L, Heidar Alizadeh A, Raspolini GM, Altamura G, Tartaglia M, Dallapiccola B, Pizzo E, Gianino MM, Damiani G. Cost-Effectiveness of Whole-Genome vs Whole-Exome Sequencing Among Children With Suspected Genetic Disorders. JAMA Netw Open 2024; 7:e2353514. [PMID: 38277144 PMCID: PMC10818217 DOI: 10.1001/jamanetworkopen.2023.53514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024] Open
Abstract
Importance The diagnosis of rare diseases and other genetic conditions can be daunting due to vague or poorly defined clinical features that are not recognized even by experienced clinicians. Next-generation sequencing technologies, such as whole-genome sequencing (WGS) and whole-exome sequencing (WES), have greatly enhanced the diagnosis of genetic diseases by expanding the ability to sequence a large part of the genome, rendering a cost-effectiveness comparison between them necessary. Objective To assess the cost-effectiveness of WGS compared with WES and conventional testing in children with suspected genetic disorders. Design, Setting, and Participants In this economic evaluation, a bayesian Markov model was implemented from January 1 to June 30, 2023. The model was developed using data from a cohort of 870 pediatric patients with suspected genetic disorders who were enrolled and underwent testing in the Ospedale Pediatrico Bambino Gesù, Rome, Italy, from January 1, 2015, to December 31, 2022. The robustness of the model was assessed through probabilistic sensitivity analysis and value of information analysis. Main Outcomes and Measures Overall costs, number of definitive diagnoses, and incremental cost-effectiveness ratios per diagnosis were measured. The cost-effectiveness analyses involved 4 comparisons: first-tier WGS with standard of care; first-tier WGS with first-tier WES; first-tier WGS with second-tier WES; and first-tier WGS with second-tier WGS. Results The ages of the 870 participants ranged from 0 to 18 years (539 [62%] girls). The results of the analysis suggested that adopting WGS as a first-tier strategy would be cost-effective compared with all other explored options. For all threshold levels above €29 800 (US $32 408) per diagnosis that were tested up to €50 000 (US $54 375) per diagnosis, first-line WGS vs second-line WES strategy (ie, 54.6%) had the highest probability of being cost-effective, followed by first-line vs second-line WGS (ie, 54.3%), first-line WGS vs the standard of care alternative (ie, 53.2%), and first-line WGS vs first-line WES (ie, 51.1%). Based on sensitivity analyses, these estimates remained robust to assumptions and parameter uncertainty. Conclusions and Relevance The findings of this economic evaluation encourage the development of policy changes at various levels (ie, macro, meso, and micro) of international health systems to ensure an efficient adoption of WGS in clinical practice and its equitable access.
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Affiliation(s)
- Mario Cesare Nurchis
- School of Economics, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | | | - Luca Salmasi
- Department of Economics and Finance, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Aurora Heidar Alizadeh
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Marco Raspolini
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gerardo Altamura
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Bruno Dallapiccola
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Maria Michela Gianino
- Department of Public Health Sciences and Paediatrics, Università di Torino, Turin, Italy
| | - Gianfranco Damiani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
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Nurchis MC, Radio FC, Salmasi L, Heidar Alizadeh A, Raspolini GM, Altamura G, Tartaglia M, Dallapiccola B, Damiani G. Bayesian cost-effectiveness analysis of Whole genome sequencing versus Whole exome sequencing in a pediatric population with suspected genetic disorders. Eur J Health Econ 2023:10.1007/s10198-023-01644-0. [PMID: 37975990 DOI: 10.1007/s10198-023-01644-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Genetic diseases are medical conditions caused by sequence or structural changes in an individual's genome. Whole exome sequencing (WES) and whole genome sequencing (WGS) are increasingly used for diagnosing suspected genetic conditions in children to reduce the diagnostic delay and accelerating the implementation of appropriate treatments. While more information is becoming available on clinical efficacy and economic sustainability of WES, the broad implementation of WGS is still hindered by higher complexity and economic issues. The aim of this study is to estimate the cost-effectiveness of WGS versus WES and standard testing for pediatric patients with suspected genetic disorders. A Bayesian decision tree model was set up. Model parameters were retrieved both from hospital administrative datasets and scientific literature. The analysis considered a lifetime time frame and adopted the perspective of the Italian National Health Service (NHS). Bayesian inference was performed using the Markov Chain Monte Carlo simulation method. Uncertainty was explored through a probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI). The present analysis showed that implementing first-line WGS would be a cost-effective strategy, against the majority of the other tested alternatives at a threshold of €30,000-50,000, for diagnosing outpatient pediatric patients with suspected genetic disorders. According to the sensitivity analyses, the findings were robust to most assumption and parameter uncertainty. Lessons learnt from this modeling study reinforces the adoption of first-line WGS, as a cost-effective strategy, depending on actual difficulties for the NHS to properly allocate limited resources.
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Affiliation(s)
- Mario Cesare Nurchis
- School of Economics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy.
| | | | - Luca Salmasi
- Department of Economics and Finance, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Aurora Heidar Alizadeh
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Gian Marco Raspolini
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Gerardo Altamura
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù IRCCS, 00146, Rome, Italy
| | - Bruno Dallapiccola
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù IRCCS, 00146, Rome, Italy
| | - Gianfranco Damiani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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Celidoni M, Costa-Font J, Salmasi L. Mobility restrictions and alcohol use during lockdown: "A still and dry pandemic for the many"? Econ Hum Biol 2023; 50:101268. [PMID: 37517160 DOI: 10.1016/j.ehb.2023.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023]
Abstract
Unexpected mobility disruptions during lockdown during the first wave of COVID-19 became 'tipping points' with the potential to alter pre-pandemic routines sensitive to socialisation. This paper investigates the impact of lockdown exposure on alcohol consumption. We document two findings using information from the Google Mobility Report and longitudinal data from the Understanding Society survey (UKHLS) in the United Kingdom. First, we find a sharp reduction in both actual mobility and alcohol use (consistent with a "still and dry pandemic for the many" hypothesis). However, we document an increase in alcohol use among heavy drinkers, implying a split behavioural response to COVID-19 mobility restrictions based on alcohol use prior to the pandemic. Second, using the predictions of the prevalence-response elasticity theory, we find that the pandemic's reduction in social contacts is responsible for a 2.8 percentage point reduction in drinking among men.
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Affiliation(s)
- Martina Celidoni
- Department of Economics and Management, University of Padova, Via Del Santo 33, 35123 Padua, Italy
| | - Joan Costa-Font
- Department of Health Policy, London School of Economics and Political Science (LSE), IZA Bonn & CESIfo Munich, Houghton Street WC2A 2AE, London, UK
| | - Luca Salmasi
- Department of Economics and Finance, Catholic University, Rome - Largo Francesco Vito 1, 00168 Rome, Italy.
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Costa-Font J, Rudisill C, Harrison S, Salmasi L. The social value of a SARS-CoV-2 vaccine: Willingness to pay estimates from four western countries. Health Econ 2023. [PMID: 37151130 DOI: 10.1002/hec.4690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 03/23/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023]
Abstract
SARS-CoV-2 vaccines give rise to positive externalities on population health, society and the economy in addition to protecting the health of vaccinated individuals. Hence, the social value of such a vaccine exceeds its market value. This paper estimates the willingness to pay (WTP) for a hypothetical SARS-CoV-2 vaccine (or shadow prices), in four countries, namely the United States (US), the United Kingdom, Spain and Italy during the first wave of the pandemic when COVID-19 vaccines were in development but not yet approved. WTP estimates are elicited using a payment card method to avoid "yea saying" biases, and we study the effect of protest responses, sample selection bias, as well as the influence of trust in government and risk exposure when estimating the WTP. Our estimates suggest evidence of an average value of a hypothetical vaccine of 100-200 US dollars once adjusted for purchasing power parity. Estimates are robust to a number of checks.
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Affiliation(s)
- Joan Costa-Font
- Department of Health Policy, London School of Economics and Political Science, IZA & CESIfo, London, UK
| | - Caroline Rudisill
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sayward Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Luca Salmasi
- Department of Economics and Finance, Università Cattolica del Sacro Cuore, Roma, Italy
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Celidoni M, Costa-Font J, Salmasi L. Too Healthy to Fall Sick? Longevity Expectations and Protective Health Behaviours during the First Wave of COVID-19. J Econ Behav Organ 2022; 202:733-745. [PMID: 35991963 PMCID: PMC9376346 DOI: 10.1016/j.jebo.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Longevity expectations (LE) are subjective assessments of future health status that can influence a number of individual health protective decisions. This is especially true during a pandemic such as COVID-19, as the risk of ill health depends more than ever on such protective decisions. This paper examines the causal effect of LE on some protective health behaviors and a number of decisions regarding forgoing health care using individual differences in LE. We use data from the Survey of Health Ageing and Retirement in Europe, and we draw on an instrumental variable strategy exploiting individual level information on parental age at death. Consistent with the too healthy to be sick hypothesis, we find that individuals, exhibiting higher expected longevity, are more likely to engage in protective behaviours, and are less likely to forgo medical treatment. We estimate that a one standard deviation increase in LE increases the probability to comply always with social distancing by 0.6%, to meet people less often by 0.4% and decreases the probability to forgo any medical treatment by 0.6%. Our estimates vary depending on supply side restrictions influencing the availability of health care, as well as individual characteristics such as their gender and the presence of pre-existing health conditions.
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Affiliation(s)
- Martina Celidoni
- Department of Economics and Management, University of Padova, Italy
| | - Joan Costa-Font
- Department of Health Policy, London School of Economics and Political Science (LSE), IZA Bonn & CESIfo Munich, London, UK
| | - Luca Salmasi
- Department of Economics and Finance, Università Cattolica del Sacro Cuore, Italy
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Marsilio M, Roldan ET, Salmasi L, Villa S. Operations management solutions to improve ED patient flows: evidence from the Italian NHS. BMC Health Serv Res 2022; 22:974. [PMID: 35908053 PMCID: PMC9338603 DOI: 10.1186/s12913-022-08339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Overcrowding occurs when the identified need for emergency services outweighs the available resources in the emergency department (ED). Literature shows that ED overcrowding impacts the overall quality of the entire hospital production system, as confirmed by the recent COVID-19 pandemic. This study aims to identify the most relevant variables that cause ED overcrowding using the input-process-output model with the aim of providing managers and policy makers with useful hints for how to effectively redesign ED operations. Methods A mixed-method approach is used, blending qualitative inquiry with quantitative investigation in order to: i) identifying and operationalizing the main components of the model that can be addressed by hospital operation management teams and ii) testing and measuring how these components can influence ED LOS. Results With a dashboard of indicators developed following the input-process-output model, the analysis identifies the most significant variables that have an impact on ED overcrowding: the type (age and complexity) and volume of patients (input), the actual ED structural capacity (in terms of both people and technology) and the ED physician-to-nurse ratio (process), and the hospital discharging process (output). Conclusions The present paper represents an original contribution regarding two different aspects. First, this study combines different research methodologies with the aim of capturing relevant information that by relying on just one research method, may otherwise be missed. Second, this study adopts a hospitalwide approach, adding to our understanding of ED overcrowding, which has thus far focused mainly on single aspects of ED operations.
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Affiliation(s)
- Marta Marsilio
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, Milano, Italy.
| | - Eugenia Tomas Roldan
- CERISMAS (Research Centre in Health Care Management), Università Cattolica del Sacro Cuore, Milano, Italy
| | - Luca Salmasi
- Department of Economics and Finance, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Villa
- Department of Management, Università Cattolica del Sacro Cuore, Milano, Italy
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Nucci D, Chiavarini M, Duca E, Pieroni L, Salmasi L, Minelli L. Pre-pregnancy body mass index, gestational weight gain and adverse birth outcomes: some evidence from Italy. Ann Ig 2019; 30:140-152. [PMID: 29465151 DOI: 10.7416/ai.2018.2205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Overweight and obese women present an increased risk of poor maternal and child health outcomes. The aim of this paper is to analyze the joint effects of pre-pregnancy body mass index and inadequate gestational weight gain on birth weight and gestational age in an Italian sample of pregnant women. METHODS Data were obtained from a sample of about 2,000 pregnant women at the University Teaching Hospital of Perugia University (Italy) in 2013. We used the revised classification proposed by Institute of Medicine to identify gestational weight gains considered as appropriate. Logistic regression models were used to estimate the adjusted odds-ratios of women belonging to any BMI class different from normal (used as the reference category) and of women who increased their weight by an amount smaller or greater than normal, controlling for a large set of observable confounders. RESULTS Higher probability of low birth weight was associated with both obesity (OR = 1.9124, s.e. = 0.526) and less than normal weight gains (OR = 2.3614, s.e. = 0.388). The probability of fetal macrosomia was found to be positively associated with more than normal weight increases (OR = 2.6232, s.e. = 0.465). Pre-term deliveries were associated with less than normal gestational weight gains (OR 1.7338, s.e. = 0.320). CONCLUSION Overweight and obesity represent a big issue for public health. In particular, weight management during pregnancy and pre-pregnancy could determine negative health outcomes in newborns. In our study we found that inadequate weight variations during pregnancy, according to the Classification of the Institute of Medicine, negatively influence health conditions at birth. Stronger initiatives, especially in terms of midwifery, nurse training and informative policies should be adopted by policy makers.
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Affiliation(s)
- D Nucci
- Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy - Digestive Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M Chiavarini
- Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - E Duca
- General Direction, Azienda Ospedaliera of Perugia "Santa Maria della Misericordia", Italy
| | - L Pieroni
- Department of Political Sciences, University of Perugia, Perugia, Italy
| | - L Salmasi
- Department of Political Sciences, University of Perugia, Perugia, Italy
| | - L Minelli
- Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy - Digestive Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Salmasi L, Capobianco E. Predictive Assessment of Cancer Center Catchment Area from Electronic Health Records. Front Public Health 2017; 5:303. [PMID: 29201863 PMCID: PMC5696335 DOI: 10.3389/fpubh.2017.00303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/31/2017] [Indexed: 11/17/2022] Open
Abstract
Healthcare facilities (HF) may identify catchment areas (CA) by selecting criteria that depend on various factors. These refer to hospital activities, geographical definition, patient covariates, and more. The analyses that were traditionally pursued have a limiting factor in the consideration of only static conditions. Instead, some of the CA determinants involve influences occurring at both temporal and spatial scales. The study of CA in the cancer context means choosing between HF, usually divided into general hospitals versus oncological centers (OCs). In the CA context, electronic health records (EHRs) promise to be a valuable source of information, one driving the next-generation patient-driven clinical decision support systems. Among the challenges, digital health requires the re-definition of a role of stochastic modeling to deal with emerging complexities from data heterogeneity. To model CA with cancer EHR, we have chosen a computational framework centered on a logistic model, as a reference, and on a multivariate statistical approach. We also provided a battery of tests for CA assessment. Our results indicate that a more refined CA model’s structure yields superior discrimination power between health facilities. The increased significance was also visualized by comparative evaluations with ad hoc geo-localized maps. Notably, a cancer-specific spatial effect can be noticed, especially for breast cancer and through OCs. To mitigate the data distributional influences, bootstrap analysis was performed, and gains in some cancer-specific and spatially concentrated regions were obtained. Finally, when the temporal dynamics are assessed along a 3-year timeframe, negligible differential effects appear between predicted probabilities observed between standard critical values and bootstrapped values. In conclusion, for interpreting CA in terms of both spatial and temporal dynamics, sophisticated models are required. The one here proposed suggests that bootstrap can improve test accuracy. We recommend that evidences from stochastic modeling are merged with visual analytics, as this combination may be exploited by policy-makers in support to quantitative CA assessment.
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Affiliation(s)
- Luca Salmasi
- Department of Political Science, University of Perugia, Perugia, Italy
| | - Enrico Capobianco
- Center for Computational Science, University of Miami, Coral Gables, FL, United States
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Pasqualini M, Lanari D, Minelli L, Pieroni L, Salmasi L. Health and income inequalities in Europe: What is the role of circumstances? Econ Hum Biol 2017; 26:164-173. [PMID: 28445843 DOI: 10.1016/j.ehb.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/30/2017] [Indexed: 06/07/2023]
Abstract
Equality of opportunity theories distinguish between inequalities due to individual effort and those due to external circumstances. Recent research has shown that half of the variability in income of World population was determined by country of birth and income distribution. Since health and income are generally strictly related, the aim of this paper is to estimate how much variability in income and health is determined by external circumstances. We use data from the Survey of Health, Ageing and Retirement (SHARE) and the English Longitudinal Survey on Ageing (ELSA), two comparable multidisciplinary surveys that provide micro-level data on health and financial resources among the elderly for a large number of European countries. Our baseline estimation shows that about 20% of the variability in income is explained by current country-specific circumstances, while health outcomes range from 12% using BMI to 19% using self-rated health. By including early-life circumstances, the explained variability increases almost 20 percentage points for income and for self-rated health but less for other health outcomes. Finally, by controlling for endogeneity issues linked with effort, our estimates indicate that circumstances better explain variability in health outcomes. Results are robust to some tests, and the implications of these findings are discussed.
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Affiliation(s)
- M Pasqualini
- Department of Statistical Science, University of Rome La Sapienza, Italy
| | - D Lanari
- Department of Medicine, University of Perugia, Italy
| | - L Minelli
- Department of Experimental Medicine, University of Perugia, Italy
| | - L Pieroni
- Department of Political Science, University of Perugia, Italy.
| | - L Salmasi
- Department of Political Science, University of Perugia, Italy
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Salmasi L, Celidoni M. Investigating the poverty-obesity paradox in Europe. Econ Hum Biol 2017; 26:70-85. [PMID: 28334657 DOI: 10.1016/j.ehb.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 06/06/2023]
Abstract
This paper investigates the effect of income- and wealth-based poverty on the probability of being obese for the elderly in Europe by analysing data drawn from the Survey of Health, Ageing and Retirement (SHARE) and the English Longitudinal Study of Ageing (ELSA). We use early-life economic conditions and regional circumstances as instruments for poverty later in life to account for endogeneity issues. After controlling for a large set of covariates at the individual, household, regional and country level, the results show that poverty significantly increases the probability of being obese and the Body Mass Index (BMI), for men and women. The results show that, accounting for endogeneity with a bivariate probit model, poor individuals are from 10 to 20% points more likely to be obese than non-poor individuals. The effect on BMI ranges from 0.295 points (2.39 kg) to 0.395 points (2.75 kg). These results are robust to a series of checks and suggest that anti-poverty interventions might have positive side effects in terms of reducing food-related health inequalities.
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Affiliation(s)
- Luca Salmasi
- University of Perugia Via Pascoli 20, 06123 Perugia, Italy.
| | - Martina Celidoni
- University of Perugia Via Pascoli 20, 06123 Perugia, Italy; University of Padova Via Del Santo 33, 35123 Padova, Italy.
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Pieroni L, Salmasi L. The Economic Impact of Smoke-Free Policies on Restaurants, Cafés, and Bars: Panel Data Estimates From European Countries. J Policy Anal Manage 2017; 36:853-879. [PMID: 28991425 DOI: 10.1002/pam.22016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, we investigate the extent to which the economic outcomes of restaurants, bars, and cafés have been affected by the introduction of anti-smoking regulations in Europe. We use an unexploited panel database to collect a comprehensive set of information on financial indicators regarding the balance sheets of private and public companies in various economic sectors. The results show that smoke-free policies did not significantly affect the firms' economic performance, irrespective of the balance sheet indicators analyzed. Moreover, the results are robust to various econometric specifications and suggest that the recent enforcement of anti-smoking legislation in Europe has improved public health without a corresponding negative impact on revenues and employment in the hospitality industry.
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Abstract
Precision medicine presents various methodological challenges whose assessment requires the consideration of multiple factors. In particular, the data multitude in the Electronic Health Records poses interoperability issues and requires novel inference strategies. A problem, though apparently a paradox, is that highly specific treatments and a variety of outcomes may hardly match with consistent observations (i.e., large samples). Why is it the case? Owing to the heterogeneity of Electronic Health Records, models for the evaluation of treatment effects need to be selected, and in some cases, the use of instrumental variables might be necessary. We studied the recently defined person-centered treatment effects in cancer and C-section contexts from Electronic Health Record sources and identified as an instrument the distance of patients from hospitals. We present first the rationale for using such instrument and then its model implementation. While for cancer patients consideration of distance turns out to be a penalty, implying a negative effect on the probability of receiving surgery, a positive effect is instead found in C-section due to higher propensity of scheduling delivery. Overall, the estimated person-centered treatment effects reveal a high degree of heterogeneity, whose interpretation remains context-dependent. With regard to the use of instruments in light of our two case studies, our suggestion is that this process requires ad hoc variable selection for both covariates and instruments and additional testing to ensure validity.
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Affiliation(s)
- Luca Salmasi
- 1 Department of Political Science, University of Perugia, Perugia, Italy
| | - Enrico Capobianco
- 2 Center for Computational Science, University of Miami, Coral Gables, Florida, USA.,3 Laboratory of Integrative Systems Medicine, Institute of Clinical Physiology, CNR, Pisa, IT
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Pieroni L, Salmasi L. The effect of smoking habit changes on body weight: Evidence from the UK. Econ Hum Biol 2016; 20:1-13. [PMID: 26650917 DOI: 10.1016/j.ehb.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/10/2015] [Accepted: 11/03/2015] [Indexed: 06/05/2023]
Abstract
This paper evaluates the causal relationship between smoking and body weight through two waves (2004-2006) of the British Household Panel Survey. We model the effect of changes in smoking habits, such as quitting or reducing, and account for the heterogeneous responses of individuals located at different points of the body mass distribution by quantile regression. We test our results by means of a large set of control groups and investigate their robustness by using the changes-in-changes estimator and accounting for different thresholds to define smoking reductions. Our results reveal the positive effect of quitting smoking on weight changes, which is also found to increase in the highest quantiles, whereas the decision to reduce smoking does not affect body weight.
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Affiliation(s)
| | - Luca Salmasi
- Department of Political Science, Perugia, Italy.
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Abstract
OBJECTIVES We addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable characteristics bias results. SETTING This study is on primary care and especially on adequate access to prenatal healthcare services by immigrant mothers. PARTICIPANTS Approximately 37,000 mothers of both Italian and foreign nationality were studied. Data were obtained from the Standard Certificate of Live Birth between 2005 and 2010 in Umbria. RESULTS Estimates from the bivariate probit model indicate that immigrant mothers are three times more likely to make fewer than four prenatal visits (OR=3.35) and 1.66 times more likely to make a late first visit (OR=1.66). The effect is found to be strongest for Asian women. CONCLUSIONS Standard probit models lead to underestimation of the probability of inadequate use of prenatal care services by immigrant women, whereas bivariate probit models, which allow us to consider immigrant status as an endogenous variable, estimated ORs to be three times larger than those obtained with univariate models.
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Affiliation(s)
- Manuela Chiavarini
- Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Donatella Lanari
- Department of Medicine, University of Perugia, Piazzale Lucio Severi, Perugia, Italy
| | - Liliana Minelli
- Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Luca Pieroni
- Department of Political Science, University of Perugia, Perugia, Italy
| | - Luca Salmasi
- Department of Political Science, University of Perugia, Perugia, Italy
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15
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Pasqualini M, Chiavarini M, Lanari D, Minelli L, Pieroni L, Salmasi L. The role of circumstances in explaining health and income related inequalities in European countries. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Chiavarini M, Minelli L, Nucci D, Salmasi L. The effect of weight increases during pregnancy on birth weight and preterm delivery. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Salmasi L, Pieroni L. Immigration policy and birth weight: Positive externalities in Italian law. J Health Econ 2015; 43:128-139. [PMID: 26245767 DOI: 10.1016/j.jhealeco.2015.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/14/2015] [Accepted: 06/30/2015] [Indexed: 06/04/2023]
Abstract
A decade ago, the political party of the Italian center-right voted a law restricting immigration. The law became effective in early 2005, when the Italian parliament approved the decree for its application, but one of its articles, granting amnesty for illegal immigrant workers, became immediately effective in July 2002. As a result, 650,000 immigrants were granted the status of foreign nationals in Italy. In this paper, we examine whether the increase in the prevalence of "regular immigrants" has led to an improvement in health outcomes of babies born to migrant women, measured in terms of birth weight. Two hitherto unexploited birth sample surveys published by Italian Institute of Statistics were used for this study. Our estimates show that regularized immigration reduced the probability of low birth weight.
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Affiliation(s)
- Luca Salmasi
- Department of Political Science, University of Perugia, Italy
| | - Luca Pieroni
- Department of Political Science, University of Perugia, Italy
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18
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Pieroni L, Minelli L, Salmasi L. Economic Evaluation of the effect of Quitting Smoking on Weight Gains: Evidence from the United Kingdom. Value Health 2015; 18:791-799. [PMID: 26409606 DOI: 10.1016/j.jval.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This article estimated the causal effect of quitting smoking on body weight gains in the United Kingdom to evaluate whether savings in health costs deriving from smoking prevention and its related diseases are greater than the costs associated with increased obesity. METHODS We used a longitudinal data set extracted from two waves (2004-2006) of the British Household Panel Survey, which includes information on smoking and a large number of sociodemographic variables. We modeled the effect of quitting smoking on body weight accounting for heterogeneous responses from individuals belonging to different clinical classes of body mass index (BMI) (i.e., overweight and obese individuals). National Health Service costs associated with smoking were then used to implement a cost-benefit analysis, comparing the advantages of smoking reductions with the costs associated with increased obesity. RESULTS The BMI was found to increase by 0.26 points for quitters compared with those who continued to smoke. The estimated BMI increase was larger for overweight (0.49 points) and obese (0.76 points) people. This result does not change when different control groups are examined. From an economic perspective, the National Health Service cost reductions attributable to quitting smoking were £156.81 million whereas the lost benefit for unintended increases in body weight was £24.07 million. CONCLUSIONS This article found that the health benefits associated with quitting smoking are greater than the costs associated with increased overweight and obesity.
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Affiliation(s)
- Luca Pieroni
- Department of Political Science, University of Perugia, Perugia, Italy.
| | - L Minelli
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| | - L Salmasi
- Department of Political Science, University of Perugia, Perugia, Italy
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Chiavarini M, Minelli L, Pieroni L, Salmasi L. Decomposition of health inequalities at birth: a Shapley Value approach. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku162.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Chiavarini M, Cicognola L, Salmasi L, Angeli G, Minelli L. [Knowledge about sexual health in Italian adolescents girls and women: the need for intergenerational communication]. Ig Sanita Pubbl 2014; 70:363-380. [PMID: 25353267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study, performed between September to November 2010, was to provide insight into Italian girls' and women's knowledge of sexual health and sexuality, in particular regarding the physiology of human reproduction, contraception, sexuality, cervical cancer screening and abortion. The data used were obtained through face-to-face interviews with two groups of women, performed by a trained interviewer using a structured multiple-choice questionnaire. The first group was composed of young women aged 17 to 20 years, randomly selected from five high-school institutes in the inner-city area of Perugia (Italy), while the second group was made up of women aged 30 to 43 years, recruited amongst women undergoing postpartum checks at a regional hospital. The number of correct answers for each group of questions and the total number of correct answers in the questionnaire were calculated. A Poisson regression model was used to identify the main determinants of answering correctly. Adult women gave a higher rate of correct answers for each topic, except for those related to abortion, contraception, and HPV. Characteristics of adult women associated with a better knowledge about sexuality were: discussing about sexuality with friends or partner, being Italy-born and having an open and relaxed attitude toward sex. For younger women, better knowledge was associated with being Italy-born, having attended affectivity education courses and having an open and relaxed attitude towards sex. Results suggest that no sex education or information source by itself is effective but what is needed is a combination of various information sources, both formal and informal, including parent-adolescent communication.
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Affiliation(s)
- Manuela Chiavarini
- Public Health Section, Department of Experimental Medicine, University of Perugia
| | - Lucrezia Cicognola
- Public Health Section, Department of Experimental Medicine, University of Perugia
| | - Luca Salmasi
- Public Health Section, Department of Experimental Medicine, University of Perugia
| | - Giuseppe Angeli
- Public Health Section, Department of Experimental Medicine, University of Perugia
| | - Liliana Minelli
- Public Health Section, Department of Experimental Medicine, University of Perugia
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21
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Chiavarini M, Lanari D, Minelli L, Salmasi L. Socio-demographic determinants and access to prenatal care in Italy. BMC Health Serv Res 2014; 14:174. [PMID: 24735757 PMCID: PMC3991890 DOI: 10.1186/1472-6963-14-174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/11/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many governments have made commitments to examine inequalities in healthcare access based on studies assessing the association between several socio-demographic factors and late initiation or fewer prenatal examinations. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in prenatal care in one administrative region of Italy, Umbria. METHODS Data were obtained from the administrative source of the regional Standard Certificate of Live Births between 2005 and 2010, and were merged with Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyze the magnitude of various individual-level maternal characteristics and socio-demographic indicators, such as nationality, employment status, education with respect to late access to the first examination, and low number of medical visits. RESULTS The study involved approximately 37,000 women. The heterogeneous effects of socio-demographic variables were documented on the prenatal care indicators analyzed. A multivariate model showed that women born outside Italy had a higher probability of making their first visit later than the 12th week of pregnancy and low numbers of prenatal medical visits; the estimated odds ratio for the analyzed indicators range from 2.25 to 3.05. Inadequate prenatal healthcare use was also observed in younger and pluriparous women and those with low education; in addition, having a job improved the use of services, possibly through transmission of information of negative consequences due to delayed or few prenatal visits. Interestingly, this study found a substantial reduction in the number of pregnant women who do not use prenatal healthcare services properly. CONCLUSIONS The aim of this research is to provide more accurate knowledge about the inadequate use of prenatal healthcare in Italy. Results highlight the existence of differences in healthcare use during pregnancy, especially for women from less advantaged social classes (i.e., unemployed or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for their use.
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Affiliation(s)
- Manuela Chiavarini
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| | - Donatella Lanari
- Department of Economics, Statistics and Finance, University of Perugia, Perugia, Italy
| | - Liliana Minelli
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| | - Luca Salmasi
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
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22
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Chiavarini M, Salmasi L, Pieroni L, Lanari D, Minelli L. Access equality to prenatal care in Italy: the effects of socio-demographic determinants. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt124.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Pieroni L, Chiavarini M, Minelli L, Salmasi L. The role of anti-smoking legislation on cigarette and alcohol consumption habits in Italy. Health Policy 2013; 111:116-26. [PMID: 23642788 DOI: 10.1016/j.healthpol.2013.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 03/30/2013] [Accepted: 04/02/2013] [Indexed: 11/18/2022]
Abstract
The short-term effects of public smoking bans on individual smoking and drinking habits were investigated in this paper. In 2005, a smoking ban was introduced in Italy, and we exploited this exogenous variation to measure the effect on both smoking participation and intensity and the indirect effect on alcohol consumption. Using data from the Everyday Life Aspects survey, for the period 2001-2007, we show that the introduction of smoke-free legislation in Italy significantly affected smoking behavior. We also document significant indirect effects on alcohol consumption for the main alcoholic beverage categories. A robustness analysis is also performed, to test the extent to which unobservable variables may bias our estimated parameters. Our results are then used to perform a cost-effectiveness analysis of the anti-smoking legislation in Italy.
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Affiliation(s)
- Luca Pieroni
- Department of Economics, Finance and Statistics, University of Perugia, via Pascoli 20, 06123 Perugia, Italy.
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Abstract
In this paper, we examine the role of relative food prices in determining the recent increase in body weight in Italy. Cross-price elasticities of unhealthy and healthy foods estimated by a demand system provide a consistent framework to evaluate substitution effects, when a close association is assumed between unhealthy (healthy) foods and more (less) energy-dense foods. We used a dataset constructed from a series of cross-sections of the Italian Household Budget Survey (1997-2005) to obtain the variables of the demand system, which accounts for regional price variability. The relative increase in healthy food prices was found to produce nontrivial elasticities of substitution towards higher relative consumption of unhealthy foods, with effects on weight outcomes. In addition, these changes were unevenly distributed among individuals and were particularly significant for those who were poorer and had less education.
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Affiliation(s)
- L Pieroni
- Department of Economics, Finance and Statistics, University of Perugia, Via Pascoli 20, 06123 Perugia, Italy.
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