The United States is embroiled in a debate about whether to protect or deport its estimated 11 million unauthorized immigrants, but the fact that these immigrants are also parents to more than 4 million U.S.-born children is often overlooked. We provide causal evidence of the impact of parents’ unauthorized immigration status on the health of their U.S. citizen children. The Deferred Action for Childhood Arrivals (DACA) program granted temporary protection from deportation to more than 780,000 unauthorized immigrants. We used Medicaid claims data from Oregon and exploited the quasi-random assignment of DACA eligibility among mothers with birthdates close to the DACA age qualification cutoff. Mothers’ DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children. Parents’ unauthorized status is thus a substantial barrier to normal child development and perpetuates health inequalities through the intergenerational transmission of disadvantage.

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Credible causal inference in accounting and finance research often comes from natural experiments. These experiments can be exploited using several shock-based research designs, including difference in differences (DID), shock-based instrumental variable (shock-IV), and regression discontinuity. We study here shock-IV designs using panel data. We identify all shock-IV papers in two broad data sets and reexamine three of the apparently strongest papers—Desai and Dharmapala [Desai M, Dharmapala D (2009) Corporate tax avoidance and firm value. Rev. Econom. Statist. 91:537–546.], Duchin et al. [Duchin R, Matsusaka J, Ozbas O (2010) When are outside directors effective? J. Financial Econom. 95:195–214.], and Iliev [Iliev P (2010) The effect of SOX Section 404: Costs, earnings quality, and stock prices. J. Finance 65:1163–1196.]. After we enforce covariate balance and common support for treated and control firms, the instruments in all three papers are unusable—they are no longer significant in the first stage. All three papers also show nonparallel pretreatment trends on outcomes or core covariates. The problems with these papers generalize to our full sample and to other papers exploiting the same shocks as Duchin et al. A core conclusion of our reexamination is that pretreatment balance (common support, covariate balance, and parallel pretreatment trends) is necessary for credible shock-IV designs. We provide a good-practice checklist for shock-IV design with panel data, much of which also applies to DID designs. This paper was accepted by Shiva Rajgopal, accounting.

COVID-19 vaccines have saved millions of lives; however, understanding the long-term effectiveness of these vaccines is imperative to developing recommendations for booster doses and other precautions. Comparisons of mortality rates between more and less vaccinated groups may be misleading due to selection bias, as these groups may differ in underlying health status. We studied all adult deaths during the period of 1 April 2021–30 June 2022 in Milwaukee County, Wisconsin, linked to vaccination records, and we used mortality from other natural causes to proxy for underlying health. We report relative COVID-19 mortality risk (RMR) for those vaccinated with two and three doses versus the unvaccinated, using a novel outcome measure that controls for selection effects. This measure, COVID Excess Mortality Percentage (CEMP), uses the non-COVID natural mortality rate (Non-COVID-NMR) as a measure of population risk of COVID mortality without vaccination. We validate this measure during the pre-vaccine period (Pearson correlation coefficient = 0.97) and demonstrate that selection effects are large, with non-COVID-NMRs for two-dose vaccinees often less than half those for the unvaccinated, and non-COVID NMRs often still lower for three-dose (booster) recipients. Progressive waning of two-dose effectiveness is observed, with an RMR of 10.6% for two-dose vaccinees aged 60+ versus the unvaccinated during April–June 2021, rising steadily to 36.2% during the Omicron period (January–June, 2022). A booster dose reduced RMR to 9.5% and 10.8% for ages 60+ during the two periods when boosters were available (October–December, 2021; January–June, 2022). Boosters thus provide important additional protection against mortality.

ObjectiveWe describe how the coronavirus (COVID-19) pandemic impacted emergency department (ED) economics, acuity, and staffing.MethodsWe conducted an observational study of visits during January to September 2020 compared to 2019 in 136 EDs staffed by a national emergency medicine group. We created ratios of three-week moving averages for 2020 visits, acuity, costs divided by 2019 moving averages, by age and ED size. We tabulated reductions in clinician hours and FTEs compared to early 2020 staffing.Results2020-2019 ED visit ratios declined in March nadiring mid-April for both adults (to 0.60) and children (to 0.30) and rose thereafter but remained below 2019 levels through September 2020. The ratio of adult RVUs/visit rose to 1.1 for adults and 1.2 for children in the early pandemic, falling to 1.04 and 1.1 through September. The ratio of direct salary expenses in freestanding (FSED) and small EDs declined less dramatically than in medium and large EDs. Clinical revenues in medium and large EDs declined more sharply and recovered slowly but plateaued well below 2019 levels. By September 2020, expenses were still higher than revenues for small EDs, similar for FSEDs, and somewhat higher for medium and large EDs. During the pandemic, physician hours fell 15% and APP hours 27% during COVID-19 translating to 174 lost physician and 193 lost APP FTEs.ConclusionThe COVID-19 pandemic reduced ED visits and increased acuity in the first 7 months of the pandemic, leading to a contraction of the ED workforce, and threatening ED economics, more so in small and FSEDs.

Background Advances in technology and care quality have transformed the care of acute myocardial infarction (AMI), but little is known about trends in mortality rates across separate time periods after hospitalization. Methods and Results We identified all Medicare fee‐for‐service beneficiaries hospitalized with incident AMI from 2008 to 2018. We calculated unadjusted mortality rates by dividing the number of all‐cause deaths by the number of patients with incident AMI for the following time periods: acute (in hospital), post acute (0–30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1–2 years after discharge), and long term (2–3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Using logistic regression to account for differences in patient characteristics, we calculated annual risk standardized mortality ratios defined as observed over expected mortality based on 2008 rates. Among 768 084 patients with incident AMI (mean age 81 years, 48% male, 87% White), declines in observed‐to‐expected mortality ratios were observed for each time period: acute (0.68 [95% CI, 0.66–0.71]), postacute (0.72 [95% CI, 0.71–0.75]), short term (0.77 [95% CI, 0.75–0.78]), intermediate term (0.79 [95% CI, 0.77–0.81]), and long term (0.77 [95% CI, 0.75–0.79]). Declines were observed both for patients with and without ST‐segment–elevation AMI. Conclusions For patients with incident AMI, there have been improvements in mortality rates across periods spanning the hospital stay through 3 years after discharge, reflecting advances in AMI care from hospitalization through long‐term outpatient follow‐up.

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