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The economic underpinnings of the drug epidemic.

ABSTRACT: U.S. labor markets have experienced transformative change over the past half century. Spurred on by global economic change, robotization, and the decline of labor unions, state labor markets have shifted away from an occupational regime dominated by the production of goods to one characterized by the provision of services. Prior studies have proposed that the deterioration of employment opportunities may be associated with the rise of substance use disorders and drug overdose deaths, yet no clear link between changes in labor market dynamics in the U.S. manufacturing sector and drug overdose deaths has been established. Using restricted-use vital registration records between 1999 and 2017 that comprise over 700,000 drug deaths, I test two questions: First, what is the association between manufacturing decline and drug and opioid overdose mortality rates? Second, how much of the increase in these drug-related outcomes can be predicted by manufacturing decline? The findings provide strong evidence that the restructuring of the U.S. labor market has played an important upstream role in the current drug crisis. Up to 92,000 overdose deaths for men and up to 44,000 overdose deaths for women are predicted by the decline of state-level manufacturing over this nearly two-decade period. These results persist in models that adjust for other social, economic, and policy trends changing at the same time. Critically, the findings signal the value of policy interventions that aim to reduce persistent economic precarity experienced by individuals and communities, especially the economic strain placed upon the middle class.

SUBMITTER: Seltzer N

PROVIDER: S-EPMC7725949 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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The economic underpinnings of the drug epidemic.

Seltzer Nathan N

SSM - population health 20201017

U.S. labor markets have experienced transformative change over the past half century. Spurred on by global economic change, robotization, and the decline of labor unions, state labor markets have shifted away from an occupational regime dominated by the production of goods to one characterized by the provision of services. Prior studies have proposed that the deterioration of employment opportunities may be associated with the rise of substance use disorders and drug overdose deaths, yet no clea ...[more]

PMID: 33319025

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Project description:Background and Objectives: Germany was affected by Bluetongue virus serotype 8 (BTV-8) from 2006 to 2009 and recorded new cases since December 2018. We assessed the economic impact of the epidemic from the first cases in 2006 until 2018. Direct costs include production losses, animal deaths, and veterinary treatment. Indirect costs include surveillance, additional measures for animal export, disease control (preventive vaccination and treatment with insecticides), vector monitoring, and administration. Methodology: To estimate the financial impact of BTV-8 on different species and production types at the animal level, we performed a gross margin analysis (GMA) for dairy and beef cattle, and sheep. To estimate the impact on the national level, we used a modified framework described by Rushton et al. (1) and applied a methodology described by Bennett (2). Both the GMA and the economic model on national level were implemented in Excel and the Excel Add-in @Risk. The tools, which are widely applicable, also for other diseases, are made available here. Results: The financial impact of a BTV-8 infection at the animal level was estimated at 119-136 Euros in dairy cattle, at 27 Euros in beef cattle, and at 74 Euros in sheep. At the national level, the impact of the BTV-8 epidemic ranged between 157 and 203 million Euros (mean 180 million Euros). This figure consisted of 132 (73%) and 48 (27%) million Euros for indirect and direct costs. Indirect costs included 89 million Euros (67%) for vaccination, 18 million Euros (14%) for insecticide treatment, 15 million Euros (11%) for diagnostic testing of animals dispatched for trade, 8 million Euros (6%) for monitoring and surveillance, and 3 million Euros (2%) for administration. The highest costs were induced by a compulsory vaccination campaign in 2008 (51 million Euros; 28% of the total costs) and the disease impact on cattle in 2007 (30 million Euros; 17%). Discussion: We compare the outcome of our study with economic analyses of Bluetongue disease in other countries, and discuss the suitability of GMA and the developed tools for a wider application in veterinary economics.

Project description:BACKGROUND:The HIV epidemic in the USA is a collection of diverse local microepidemics. We aimed to identify optimal combination implementation strategies of evidence-based interventions to reach 90% reduction of incidence in 10 years, in six US cities that comprise 24·1% of people living with HIV in the USA. METHODS:In this economic modelling study, we used a dynamic HIV transmission model calibrated with the best available evidence on epidemiological and structural conditions for six US cities: Atlanta (GA), Baltimore (MD), Los Angeles (CA), Miami (FL), New York City (NY), and Seattle (WA). We assessed 23 040 combinations of 16 evidence-based interventions (ie, HIV prevention, testing, treatment, engagement, and re-engagement) to identify combination strategies providing the greatest health benefit while remaining cost-effective. Main outcomes included averted HIV infections, quality-adjusted life-years (QALYs), total cost (in 2018 US$), and incremental cost-effectiveness ratio (ICER; from the health-care sector perspective, 3% annual discount rate). Interventions were implemented at previously documented and ideal (90% coverage or adoption) scale-up, and sustained from 2020 to 2030, with outcomes evaluated until 2040. FINDINGS:Optimal combination strategies providing health benefit and cost-effectiveness contained between nine (Seattle) and 13 (Miami) individual interventions. If implemented at previously documented scale-up, these strategies could reduce incidence by between 30·7% (95% credible interval 19·1-43·7; Seattle) and 50·1% (41·5-58·0; New York City) by 2030, at ICERs ranging from cost-saving in Atlanta, Baltimore, and Miami, to $95 416 per QALY in Seattle. Incidence reductions reached between 39·5% (26·3-53·8) in Seattle and 83·6% (70·8-87·0) in Baltimore at ideal implementation. Total costs of implementing strategies across the cities at previously documented scale-up reached $559 million per year in 2024; however, costs were offset by long-term reductions in new infections and delayed disease progression, with Atlanta, Baltimore, and Miami projecting cost savings over the 20 year study period. INTERPRETATION:Evidence-based interventions can deliver substantial public health and economic value; however, complementary strategies to overcome social and structural barriers to HIV care will be required to reach national targets of the ending the HIV epidemic initiative by 2030. FUNDING:National Institutes of Health.

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The economic underpinnings of the drug epidemic.

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The economic underpinnings of the drug epidemic.

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