Estimating Causal Effects of Particulate Matter Regulation on Mortality.

BACKGROUND: Estimating the causal effect of pollution on human health is integral for evaluating returns to pollution regulation, yet separating out confounding factors remains a perennial challenge. METHODS: We use a quasi-experimental design to investigate the causal relationship between regulation of particulate matter smaller than 2.5 micrograms per cubic meter (PM2.5) and mortality among those 65 years of age and older. We exploit regulatory changes in the Clean Air Act Amendments (CAAA). Regulation in 2005 impacted areas of the United States differentially based on pre-regulation air quality levels for PM2.5. We use county-level mortality data, extracted from claims data managed by the Centers for Medicare & Medicaid Services, merged to county-level average PM2.5 readings and attainment status as classified by the Environmental Protection Agency. RESULTS: Based on estimates from log-linear difference-in-differences models, our results indicate after the CAAA designation for PM2.5 in 2005, PM2.5 levels decreased 1.59 micrograms per cubic meter (95% CI = 1.39, 1.80) and mortality rates among those 65 and older decreased by 0.93% (95% CI = 0.10%, 1.77%) in nonattainment counties, relative to attainment ones. Results are robust to a series of alternate models, including nearest-neighbor matching based on propensity score estimates. CONCLUSION: This analysis suggests large health returns to the 2005 PM2.5 designations, and provides evidence of a causal association between pollution and mortality among the Medicare population.

Where have all the young men gone? Using sex ratios to measure fetal death rates.

Fetal health is an important consideration in policy formation. Unfortunately, a complete census of fetal deaths, an important measure of overall fetal health, is infeasible, and available data are selectively observed. We consider this issue in the context of the Clean Air Act Amendments of 1970 (CAAA), one of the largest and most influential environmental regulations in the history of the United States. We discuss a model of potential bias in measuring observed fetal deaths, and present the sex ratio of live births as an alternative fetal health endpoint, taking advantage of the finding that males are more vulnerable to side effects of maternal stress in utero. We find the CAAA caused substantial improvements in fetal health, in addition to previously identified reductions in post-natal mortality.