New IZA DPs -- Health
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IZA DP Alerts
Jun 3, 2026, 9:09:15 AM (11 days ago) Jun 3
to it...@umich.edu
New IZA Discussion Papers brought to you by IZA@LISER
Dear Italo Gutierrez,
These new IZA Discussion Papers are now available online.
DP 18494 - Lin/Sun/Ross/Lau/Stumpf/Chen:
Long-Term Trends in Racial and Ethnic Reporting and Representation in US Alzheimer’s Clinical Trials
DP 18495 - Brenøe/Stearns/Martin:
Causal Effects of Breastfeeding Promotion on Child Health: Understanding the Role of Nutrition
DP 18556 - Qian/Gettel/I-Shin Su/Grogan/Cohen/Rothenberg/Chen/Hwang:
Geriatric Emergency Care, Hospitalization, and Mortality Among Older Adults in the United States
DP 18562 - Kucera/Scavette/Porreca:
The Post-Fentanyl Urbanization of the Opioid Epidemic
DP 18581 - Yu/Wang/Gill/Chen:
Neighborhood Disorder and Dementia Risk in U.S. Older Adults: The Role of Cardiometabolic Risk
Please find the abstracts and download links below.
IZA DP No. 18494
Zhuoer Lin, Ruochen Sun, Joseph R. Ross, Kien Lau, Sofia Stumpf, Xi Chen:
Long-Term Trends in Racial and Ethnic Reporting and Representation in US Alzheimer’s Clinical Trials
(published in: JAMA Network Open. 2026;9(3):e262427. doi:10.1001/jamanetworkopen.2026.2427)
Abstract:
Alzheimer's disease (AD) disproportionately burdens racial and ethnic minority populations, yet the extent to which clinical trials reflect this burden remains poorly understood. We review all US-based Phase III AD drug trials (1997-2023), using a multi-source approach that integrates the Trialtrove clinical trial database with PubMed, ClinicalTrials.gov, pharmaceutical reports, and conference abstracts. We document three main findings. First, nearly half of published trials reported no data on patient race or ethnicity. Among trials that did report, practices were highly inconsistent in terminology, categorization, and analytical depth. Second, White patients constituted shares of enrollment that are grossly disproportionate to AD prevalence rates. Third, almost no trials conducted any subgroup analyses by race or ethnicity. Critically, there is no evidence of improvement in reporting or representation. These patterns limit the generalizability of AD treatment evidence. Our findings support strengthening mandatory reporting standards, broadening eligibility criteria, and diversifying trial site selection to ensure emerging AD treatments are evaluated equitably across the populations most affected.
https://docs.iza.org/dp18494.pdf
IZA DP No. 18495
Anne Ardila Brenøe, Jenna Stearns, Richard M. Martin:
Causal Effects of Breastfeeding Promotion on Child Health: Understanding the Role of Nutrition
Abstract:
Using data from the only large-scale randomized controlled trial promoting prolonged exclusive breastfeeding, we study how the intervention affected child health and why. The intervention increased weight-for-age in infancy, with effects persisting through adolescence. We show that treated infants were breastfed more and received less water, juice, and other liquids, resulting in a more calorie-dense diet. A mediation analysis indicates that increased caloric intake explains a large share of the early weight gain, while reduced illness explains little. These findings suggest that, in this setting, the main benefits of breastfeeding promotion for physical growth came from improved nutrition. More broadly, the results highlight that the effects of breastfeeding promotion depend on the local alternatives to breast milk and may differ in settings where infant formula or other more nutritious substitutes are the main alternative.
https://docs.iza.org/dp18495.pdf
IZA DP No. 18556
Yuting Qian, Cameron Gettel, Jasmine I-Shin Su, Elyssa F.L. Grogan, Inessa Cohen, Craig Rothenberg, Xi Chen, Ula Hwang:
Geriatric Emergency Care, Hospitalization, and Mortality Among Older Adults in the United States
(Journal of the American Geriatrics Society (2026): 1–11, https://doi.org/10.1111/jgs.70421.)
Abstract:
Geriatric Emergency Departments (GEDs) -- accredited units that integrate geriatric-trained staff, age-friendly protocols, and post-visit care coordination -- have expanded rapidly across the United States. This paper provides the first nationally representative estimates of GED effects on hospitalization and mortality among Medicare beneficiaries. Linking data from the Health and Retirement Study to Medicare claims, we find that older adults treated at a GED were 9.7 percentage points less likely to be hospitalized and 6.1 percentage points less likely to die within 30 days, compared to those treated at a non-GED emergency department. Placebo tests and sensitivity analyses support causal interpretation. However, treatment effect heterogeneity analysis reveals that gains are concentrated among non-Hispanic white patients and adults under age 80; Black and Hispanic older adults exhibit no statistically significant benefit, consistent with persistent disparities in post-discharge care access and social support. These findings suggest that GED accreditation improves downstream health outcomes at scale, but that structural inequities outside the emergency department attenuate benefits for minority patients.
https://docs.iza.org/dp18556.pdf
IZA DP No. 18562
Alexander Kucera, Adam Scavette, Zachary Porreca:
The Post-Fentanyl Urbanization of the Opioid Epidemic
Abstract:
The geography of the U.S. opioid epidemic has shifted across successive waves. After a period in which overdose mortality increasingly burdened rural and suburban communities, the fentanyl era appears to have redirected harm toward dense urban cores. We document this post-2015 urbanization using national mortality microdata from CDC WONDER and inpatient discharge records from Pennsylvania. We show three patterns. First, urban overdose mortality rises sharply after fentanyl becomes the dominant illicit opioid. Second, within large metropolitan areas, overdose rates diverge between core counties and suburban peripheries, with especially large gaps in eastern metros, where fentanyl diffused earlier and more intensely. Third, within the Philadelphia region, overdose-related inpatient admissions become increasingly concentrated in a small number of central-city ZIP codes, especially near longstanding drug-market hotspots. We argue that this shift reflects both supply- and demand-side changes associated with fentanyl. If overdose risk is becoming more spatially concentrated, then naloxone distribution, outreach, enforcement, and emergency response may be more effective when targeted to a narrower set of urban locations.
https://docs.iza.org/dp18562.pdf
IZA DP No. 18581
Jiao Yu, Yi Wang, Thomas M. Gill, Xi Chen:
Neighborhood Disorder and Dementia Risk in U.S. Older Adults: The Role of Cardiometabolic Risk
Abstract:
We estimate the effect of neighborhood disorder on dementia risk and identify cardiometabolic dysregulation as a mediating biological pathway. Using Health and Retirement Study (2006–2020), we show that exposure to visible neighborhood disorder is associated with higher risk of dementia (Hazard Ratio: 1.37; 95% CI: 1.08–1.74) and higher risk of cognitive impairment no dementia (CIND; HR: 1.50; 95% CI: 1.22–1.85) over a 14-year follow-up. Mediation analysis reveals that a composite cardiometabolic risk score - aggregating seven biomarkers spanning inflammatory, cardiovascular, and metabolic systems - accounts for approximately 16% of the total neighborhood disorder–dementia association and 19% of the neighborhood disorder–CIND association. These findings are robust to competing-risk regression for mortality, restriction to non-movers, age-at-onset restrictions, and exclusion of pandemic-year data. The findings suggest that community interventions that simultaneously reduce visible signs of neighborhood decay and address cardiometabolic risk may yield dementia-prevention dividends beyond what individual-level clinical strategies alone can achieve.
https://docs.iza.org/dp18581.pdf
These new IZA Discussion Papers are now available online.
DP 18494 - Lin/Sun/Ross/Lau/Stumpf/Chen:
Long-Term Trends in Racial and Ethnic Reporting and Representation in US Alzheimer’s Clinical Trials
DP 18495 - Brenøe/Stearns/Martin:
Causal Effects of Breastfeeding Promotion on Child Health: Understanding the Role of Nutrition
DP 18556 - Qian/Gettel/I-Shin Su/Grogan/Cohen/Rothenberg/Chen/Hwang:
Geriatric Emergency Care, Hospitalization, and Mortality Among Older Adults in the United States
DP 18562 - Kucera/Scavette/Porreca:
The Post-Fentanyl Urbanization of the Opioid Epidemic
DP 18581 - Yu/Wang/Gill/Chen:
Neighborhood Disorder and Dementia Risk in U.S. Older Adults: The Role of Cardiometabolic Risk
Please find the abstracts and download links below.
IZA DP No. 18494
Zhuoer Lin, Ruochen Sun, Joseph R. Ross, Kien Lau, Sofia Stumpf, Xi Chen:
Long-Term Trends in Racial and Ethnic Reporting and Representation in US Alzheimer’s Clinical Trials
(published in: JAMA Network Open. 2026;9(3):e262427. doi:10.1001/jamanetworkopen.2026.2427)
Abstract:
Alzheimer's disease (AD) disproportionately burdens racial and ethnic minority populations, yet the extent to which clinical trials reflect this burden remains poorly understood. We review all US-based Phase III AD drug trials (1997-2023), using a multi-source approach that integrates the Trialtrove clinical trial database with PubMed, ClinicalTrials.gov, pharmaceutical reports, and conference abstracts. We document three main findings. First, nearly half of published trials reported no data on patient race or ethnicity. Among trials that did report, practices were highly inconsistent in terminology, categorization, and analytical depth. Second, White patients constituted shares of enrollment that are grossly disproportionate to AD prevalence rates. Third, almost no trials conducted any subgroup analyses by race or ethnicity. Critically, there is no evidence of improvement in reporting or representation. These patterns limit the generalizability of AD treatment evidence. Our findings support strengthening mandatory reporting standards, broadening eligibility criteria, and diversifying trial site selection to ensure emerging AD treatments are evaluated equitably across the populations most affected.
https://docs.iza.org/dp18494.pdf
IZA DP No. 18495
Anne Ardila Brenøe, Jenna Stearns, Richard M. Martin:
Causal Effects of Breastfeeding Promotion on Child Health: Understanding the Role of Nutrition
Abstract:
Using data from the only large-scale randomized controlled trial promoting prolonged exclusive breastfeeding, we study how the intervention affected child health and why. The intervention increased weight-for-age in infancy, with effects persisting through adolescence. We show that treated infants were breastfed more and received less water, juice, and other liquids, resulting in a more calorie-dense diet. A mediation analysis indicates that increased caloric intake explains a large share of the early weight gain, while reduced illness explains little. These findings suggest that, in this setting, the main benefits of breastfeeding promotion for physical growth came from improved nutrition. More broadly, the results highlight that the effects of breastfeeding promotion depend on the local alternatives to breast milk and may differ in settings where infant formula or other more nutritious substitutes are the main alternative.
https://docs.iza.org/dp18495.pdf
IZA DP No. 18556
Yuting Qian, Cameron Gettel, Jasmine I-Shin Su, Elyssa F.L. Grogan, Inessa Cohen, Craig Rothenberg, Xi Chen, Ula Hwang:
Geriatric Emergency Care, Hospitalization, and Mortality Among Older Adults in the United States
(Journal of the American Geriatrics Society (2026): 1–11, https://doi.org/10.1111/jgs.70421.)
Abstract:
Geriatric Emergency Departments (GEDs) -- accredited units that integrate geriatric-trained staff, age-friendly protocols, and post-visit care coordination -- have expanded rapidly across the United States. This paper provides the first nationally representative estimates of GED effects on hospitalization and mortality among Medicare beneficiaries. Linking data from the Health and Retirement Study to Medicare claims, we find that older adults treated at a GED were 9.7 percentage points less likely to be hospitalized and 6.1 percentage points less likely to die within 30 days, compared to those treated at a non-GED emergency department. Placebo tests and sensitivity analyses support causal interpretation. However, treatment effect heterogeneity analysis reveals that gains are concentrated among non-Hispanic white patients and adults under age 80; Black and Hispanic older adults exhibit no statistically significant benefit, consistent with persistent disparities in post-discharge care access and social support. These findings suggest that GED accreditation improves downstream health outcomes at scale, but that structural inequities outside the emergency department attenuate benefits for minority patients.
https://docs.iza.org/dp18556.pdf
IZA DP No. 18562
Alexander Kucera, Adam Scavette, Zachary Porreca:
The Post-Fentanyl Urbanization of the Opioid Epidemic
Abstract:
The geography of the U.S. opioid epidemic has shifted across successive waves. After a period in which overdose mortality increasingly burdened rural and suburban communities, the fentanyl era appears to have redirected harm toward dense urban cores. We document this post-2015 urbanization using national mortality microdata from CDC WONDER and inpatient discharge records from Pennsylvania. We show three patterns. First, urban overdose mortality rises sharply after fentanyl becomes the dominant illicit opioid. Second, within large metropolitan areas, overdose rates diverge between core counties and suburban peripheries, with especially large gaps in eastern metros, where fentanyl diffused earlier and more intensely. Third, within the Philadelphia region, overdose-related inpatient admissions become increasingly concentrated in a small number of central-city ZIP codes, especially near longstanding drug-market hotspots. We argue that this shift reflects both supply- and demand-side changes associated with fentanyl. If overdose risk is becoming more spatially concentrated, then naloxone distribution, outreach, enforcement, and emergency response may be more effective when targeted to a narrower set of urban locations.
https://docs.iza.org/dp18562.pdf
IZA DP No. 18581
Jiao Yu, Yi Wang, Thomas M. Gill, Xi Chen:
Neighborhood Disorder and Dementia Risk in U.S. Older Adults: The Role of Cardiometabolic Risk
Abstract:
We estimate the effect of neighborhood disorder on dementia risk and identify cardiometabolic dysregulation as a mediating biological pathway. Using Health and Retirement Study (2006–2020), we show that exposure to visible neighborhood disorder is associated with higher risk of dementia (Hazard Ratio: 1.37; 95% CI: 1.08–1.74) and higher risk of cognitive impairment no dementia (CIND; HR: 1.50; 95% CI: 1.22–1.85) over a 14-year follow-up. Mediation analysis reveals that a composite cardiometabolic risk score - aggregating seven biomarkers spanning inflammatory, cardiovascular, and metabolic systems - accounts for approximately 16% of the total neighborhood disorder–dementia association and 19% of the neighborhood disorder–CIND association. These findings are robust to competing-risk regression for mortality, restriction to non-movers, age-at-onset restrictions, and exclusion of pandemic-year data. The findings suggest that community interventions that simultaneously reduce visible signs of neighborhood decay and address cardiometabolic risk may yield dementia-prevention dividends beyond what individual-level clinical strategies alone can achieve.
https://docs.iza.org/dp18581.pdf
IZA DP Alerts | www.iza.org
If you have trouble downloading the papers, or for any other questions regarding the IZA Discussion Paper Series, please contact iza...@liser.lu.
IZA@LISER Network
Luxembourg Institute of Socio-Economic Research (LISER)
11, Porte des Sciences, L-4366 Esch-sur-Alzette / Belval
Privacy Policy | Manage your subscriptions
If you have trouble downloading the papers, or for any other questions regarding the IZA Discussion Paper Series, please contact iza...@liser.lu.
IZA@LISER Network
Luxembourg Institute of Socio-Economic Research (LISER)
11, Porte des Sciences, L-4366 Esch-sur-Alzette / Belval
Privacy Policy | Manage your subscriptions
IZA DP Alerts
Jun 3, 2026, 9:11:08 AM (11 days ago) Jun 3
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