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The Spanish Flu 1918–1920 saw a high degree of excess mortality among young and healthy adults. The purpose of this paper is a further exploration of the hypothesis that high mortality risk during The Spanish Flu in Copenhagen was associated with early life exposure to The Russian Flu 1889–1892.

Based on 37,000 individual-level death records in a new unique database from The Copenhagen City Archives combined with approximate cohort-specific population totals interpolated from official censuses of population, the author compiles monthly time series on all-cause mortality rates 1916–1922 in Copenhagen by gender and one-year birth cohorts. The author then analyses birth cohort effects on mortality risk during The Spanish Flu using regression analysis.

The author finds support for hypotheses relating early life exposure to The Russian Flu to mortality risk during The Spanish Flu. Some indications of possible gender heterogeneity during the first wave of The Spanish Flu – not found in previous studies – should be a topic for future research based on data from other countries.

Due to lack of individual-level death records with exact dates of birth and death, previous studies on The Spanish Flu in Denmark and many other countries have relied on data with lower birth cohort resolutions than the one-year birth cohorts used in this study. The analysis in this paper illustrates how archival Big Data can be used to gain new insights in studies on historical pandemics.

In the public debate, immigration is often viewed as a threat to the access and the quality of health care services. The health needs of immigrants and refugees pose new challenges to health care systems. This chapter reviews the recent economic literature on immigration and health. We discuss the main methods used to study the health immigrant trajectories and the effects of immigration on demand and supply of health care in both destination and sending countries.

Hepatitis A is a prevalent disease that is largely preventable by vaccine usage. The vaccine for this illness is highly underused in most regions. In an attempt to find the strategies that are most beneficial in regard to quality-adjusted life years (QALYs) and cost in current environments, the purpose of this paper is to conduct cost-effectiveness analyses to investigate vaccination strategies in a more economically developed country (MEDC), generally known as a “developed” area: the USA, and a less economically developed country (LEDC), generally known as a “developing” area: the state of Rio de Janeiro, Brazil.

This study used a dynamic transmission model for comparative effectiveness analyses. The model ran two different scenarios. The two regions studied have different policies and strategies for Hepatitis A vaccination currently, and also used different strategies in 2009. In the USA, a universal vaccination policy was modeled, along with a scenario in which it was removed. In Rio de Janeiro, a no vaccination policy was modeled, along with a scenario in which a universal vaccination policy was effected.

The comparison of resulting incremental cost-effectiveness ratio values to accepted threshold values showed universal vaccination to be cost-effective in both the USA and Rio de Janeiro as compared to no vaccination. When episode and vaccination costs and vaccination efficacy were varied, this still remained true. Universal vaccination was found to result in lower incidence of Hepatitis A in both the USA and Rio de Janeiro. Over the twenty-year time horizon, universal vaccination is projected to prevent 506,945 cases of symptomatic Hepatitis A in the USA and 42,318 cases of Hepatitis A in Rio de Janeiro. Other benefits include a projected increase in cumulative QALYs through the use of universal vaccination.

This analysis showed universal vaccination to be cost-effective as compared to no vaccination, and portions of the study’s approach had not previously been applied in tandem to investigate Hepatitis A interventions. The results may help foster higher compliance rates for Hepatitis A vaccination and even greater per-person economic benefits of universal vaccination, particularly in the USA. The purpose of this study is also to encourage elevated levels of surveillance on age of infection in developing regions and consistent reevaluation utilizing dynamic transmission models in both the USA and Brazil, as well as other rapidly developing regions, in order to prevent future epidemics and costs associated with the disease.

Social participation (SP) has been shown to have a favorable impact on health status, particularly among elders in developed countries. However, empirical study is scarce for China. This study explores the relation between social participation (SP) and health status among middle-aged adults and elders in China when controlled socioeconomic characteristics of individuals.

This paper employs an empirical study based on the data from a three-wave national longitudinal survey: the Chinese Health and Retirement Longitudinal Study (CHARLS) from 2011, 2013 to 2015. It collects data from 28,895 individuals aged 45–84. It uses lagged variable method (LV) to address the reverse causality problem, and the random-effects model or fixed-effect model to address the heterogeneity problem.

The paper finds the social participation positively affect self-reported health statistically. The influence of social participation on self-reported health flows through two channels: the improved mental health effect (SP-MH-SRH channel) and the increased income effect (SP-income-SRH channel). In comparison with the SAP-income-SRH channel, the influence of the SP-MH-SRH channel l is greater.

First, the absence of other measures of volunteering, such as hours of social participation that are not available in the employed dataset. Second, even though the LV model and FE model are used in the paper, there may remain the endogeneity problem in the results. Third, the influences of formal and informal social participation should be distinguished in the future research.

Social participation may improve the self-reported health status. The influence of SP on health may be due to the improved mental health effect (SP-MH-SRH channel). In order to improve the mental and physical health status of middle-aged adults and elders the government should consider even more promotion of social participation.

First, this paper focuses on the correlation between social participation and well-being (self-reported health) of middle-aged adults and elderly in China, the previous studies on the issue for China are scarce. Second, this paper uses the lagged variable method (LV) to address the reverse causal relation problem, and the fixed-effects model or the random-effects model to address the heterogeneity problem. Third, the two channels (the improved mental health effect and the increased income effect) are firstly investigated in this study.

The purpose of this paper is to investigate the relationship between occupational degree requirement and mortality between ethnic groups in a cohort of urban workers.

The study included 118,606 health-insured full-time workers from the New York City Health and Hospitals Corporation (HHC). Mortality rates (MR) and mortality rate ratios (MRR) were calculated for major ethnic categories. Estimates were adjusted for age, sex, and occupational degree requirement.

Prior to adjustment for degree requirement, mortality rates (MRs) by ethnic groups in the Health and Hospitals Corporation were in line with national estimates: highest for blacks, followed by whites, Hispanics, and Asian/Pacific Islander (APIs). After adjustment, the MR for blacks became comparable to whites (mortality rate ratio (MRR)=1.02). The low-Hispanic MR did not change; the Hispanic advantage persisted (MRR=0.66), as did the API advantage (MRR=0.50).

Higher education may not substantially change the MR for Hispanics, and it may only account for a portion of the survival advantage among APIs. The findings also suggest that without reducing the disparity in higher education attainment between blacks and whites, equality in other socioeconomic factors may not abolish the disparity in mortality between these groups.

This study bypassed common limitations of ethnic mortality studies, with intrinsic parity for certain socio-economic status factors (full-time employment and health care access) across cohort members and consistent ethnic classification across time-points. This includes a cohort of API workers with complete self-identification of ethnicity, which has not been accomplished by previous investigations.

This paper addresses revolutionary changes in the education, fertility and market work of U.S. families formed in the 1870s–1920s: Fertility fell from 5.3 to 2.6; the graduation rate of their children increased from 7% to 50%; and the fraction of adulthood wives devoted to market-oriented work increased from 7% to 23% (by one measure).

These trends are addressed within a unified framework to examine the ability of several proposed mechanisms to quantitatively replicate these changes. Based on careful calibration, the choices of successive generations of representative husband-and-wife households over the quantity and quality of their children, household production, and the extent of mother’s involvement in market-oriented production are simulated.

Rising wages, declining mortality, a declining gender wage gap, and increased efficiency and public provision of schooling cannot, individually or in combination, reduce fertility or increase stocks of human capital to levels seen in the data. The best fit of the model to the data also involves: (1) a decreased tendency among parents to view potential earnings of children as the property of parents and (2) rising consumption shares per dependent child.

Greater attention should be given the determinants of parental control of the work and earnings of children for this period.

One contribution is the gathering of information and strategies necessary to establish an initial baseline, and the time paths for parameters and targets for this period beset with data limitations. A second contribution is identifying the contributions of various mechanisms toward reaching those calibration targets.

To determine the mortality of drug users after release from prison in Denmark, a cohort of drug users was identified from two national registers during 1996‐2001: the drug treatment register (T) and the register of viral hepatitis (H). Incarcerations were extracted from the national penal register, vital status from the civil register, and causes of death from the death certificate register and the police register of drug‐related deaths. We identified 15,885 drug users (T: 15,735, H: 896), 62% of the estimated drug‐using population in Denmark. There were 1000 observed deaths, of which 51% were classified as overdose deaths. Mortality in the treatment cohort was 2.4/100 person years (py) (95% C.I. 2.2‐2.5/100 py) compared to the general population expectation of 0.2/100 py. Within the first 2 weeks after release from prison, 26 deaths were observed among 6019 released drug users corresponding to 13/100 py (95% CI 8‐19/100 py). Overdose deaths accounted for 24/26 deaths (92%) in the first two weeks compared to 121/179 (68%) hereafter (p <0.001). We conclude that drug users released from prison are at high risk of overdose death. We suggest that methadone treatment should be evaluated as a way to decrease mortality after release from prison.

Using data from the Survey of Income and Program Participation (SIPP) matched to administrative records, we examine mortality risk and participation in the Disability Insurance (DI) and Supplemental Security Income (SSI) disability programs from a long-term perspective. Over a period of 14 years, we analyze the effect of self-reported health and disability on the probability of death and disability program entry among individuals aged 18–48 in 1984. We also assess DI and SSI programs from a life-cycle perspective. Self-reported poor health and severe disability at baseline are strongly correlated with death over the 14-year follow-up period. These variables also are strong predictors of disability program participation over the follow-up period among non-participants at baseline or before, with increasing marginal probabilities in the out-years. Our cross-sectional models are consistent with recent studies that find that the work-prevented measure is useful in modeling DI entry. However, once self-reported health and functional limitations are accounted for, the longitudinal entry models provide conflicting DI results for the work-prevented measure, suggesting that, contrary to claims based on cross-sectional or short-time horizon application models, the work-prevented measure is an unreliable indicator of severity. The risk of SSI and DI participation is significantly greater for individuals who die, suggesting that future mortality captures the effect of case severity and deterioration of health during the follow-up period. From a life-cycle perspective, a substantially greater proportion of individuals participate in SSI or DI at some point in their lives compared to typical cross-sectional estimates of participation, especially among minorities, people with less than a high school education, and those with early onset of poor health and/or disabilities. Cross-sectional estimates for the Social Security area population indicate SSI and DI participation rates of no more than 5% combined in 2000. In contrast, for individuals aged 43–48 in 1984, we observe a cumulative lifetime SSI and/or DI participation rate of 14%. The corresponding figure is 32% for individuals in that age group who did not graduate from high school, suggesting the need for human capital investments and/or improved work incentives.

This paper aims to measure the financial impact on social security system of a recently proposed indexation mechanism for retirement age by considering the Italian longevity experience. The analysis is motivated by the progressive increase in life expectancy at advanced age, which is rapidly bringing to the fore noticeable socio-economic consequences in most industrialized countries. Among those, the impact on National Social Security systems is particularly relevant if people live longer than expected; this will lead to greater financial exposure for pension providers.

Referring to the Italian population for illustrative purposes, the authors contemplate different scenarios for mortality projection methods and for the implementation of pension age shift while accounting for gender and cohort gaps and model risk. Synthetic indicators to measure the impact of the indexation mechanism on social security system are introduced on the basis of pension cash flows.

An indexation policy that manages gender gap while adjusting retirement age for varying life expectancy is proposed. As a result, sustainability of public retirement expenditure is improved.

The paper is a concise scenario analysis of the reduction of costs and risks that pension providers would have if the system resorted to link retirement age to life expectancy. The ideas fostered by the paper follow a recent proposal of the Authors on a flexible retirement scheme that deals with model risk for mortality projection and accounts for gender gap in mortality rates.