When the economy is good, more people die, which seems odd — and contrary to most of human history. A new study finds that many of the extra deaths in good times come from elderly women in nursing homes:
A growing literature documents cyclical movements in mortality and health. We examine this pattern more closely and attempt to identify the mechanisms behind it. Specifically, we distinguish between mechanisms that rely on fluctuations in own employment or time use and those involving factors that are external to the individual.
Our investigation suggests that changes in individuals’ own behavior contribute very little to pro-cyclical mortality. Looking across broad age and gender groups, we find that own-group employment rates are not systematically related to own-group mortality.
In addition, we find that most of the additional deaths that occur during times of economic growth are among the elderly, particularly elderly women, who have limited labor force attachment. Focusing on mortality among the elderly, we show that cyclicality is especially strong for deaths occurring in nursing homes, and is stronger in states where a higher fraction of the elderly reside in nursing homes. We also demonstrate that staffing in skilled nursing facilities moves counter-cyclically. Taken together, these findings suggest that cyclical fluctuations in the mortality rate may be largely driven by fluctuations in the quality of health care.
Robin Hanson finds it inexcusable that we don’t spend the tiny amount necessary to keep nursing-home care at high enough levels.
I think we should address the point that the death rate doesn’t differentiate between nursing home patients who die one year early because of sub-optimal care and young adults who die decades early because of a car crash.
Addendum: Gwern, who comments here, had this to say:
So? You really think looking at QALYs is going to change much? We already spend a ton on automotive safety, the impact of another dollar on the margin is epsilon. On the other hand, it’s very easy to raise nurse/aid salary.
Yes, the additional costs are small, but so are the benefits:
Moving from deaths, or persons lost, to person-years of life lost changes things by a factor of, say, 30.
Moving to quality-adjusted life years could change things by many, many orders of magnitude, depending on how low we rate the quality of life of those who might die a year early from sub-optimal nursing care. That quality could be close to zero or even negative — especially when we take into account the tendency to show that we care, rather than to let people go.