Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemAssociation between COVID-19 vaccination rates and the Australian 'Million Dollar Vax' competition: an observational study(BMJ PUBLISHING GROUP, 2022-08-01)OBJECTIVE: To examine the association between financial incentives from entry into a vaccine competition with the probability of vaccination for COVID-19. DESIGN: A cross-sectional study with adjustment for covariates using logistic regression. SETTING: October and November 2021, Australia. PARTICIPANTS: 2375 respondents of the Taking the Pulse of the Nation survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The proportion of respondents who had any vaccination, a first dose only, or second dose after the competition opened. RESULTS: Those who entered the competition were 2.27 (95% CI 1.73 to 2.99) times more likely to be vaccinated after the competition opened on 1 October than those who did not enter-an increase in the probability of having any dose of 0.16 (95 % CI 0.10 to 0.21) percentage points. This increase was mostly driven by those receiving second doses. Entrants were 2.39 (95% CI 1.80 to 3.17) times more likely to receive their second dose after the competition opened. CONCLUSIONS: Those who entered the Million Dollar Vax competition were more likely to have a vaccination after the competition opened compared with those who did not enter the competition, with this effect dominated by those receiving second doses.
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ItemJobless parents, unhealthy children? How past exposure to parental joblessness influences children's future health(ELSEVIER SCI LTD, 2022-09-01)Rationale: Despite a growing body of work investigating the combined effects of maternal and paternal joblessness for children's outcomes, very little is known about the long-term effects of parental joblessness on children's health, and especially health during adulthood. Objective: The primary objective of this study is to directly test whether exposure to parental joblessness during childhood and early adulthood has adverse consequences for health in later years. This study also explores whether family resources, time inputs and family harmony mediate this relationship. Methods: Multilevel generalized structural equation models describing processes influencing child health outcomes in later life are estimated using longitudinal data from 19 waves of the Household, Income and Labour Dynamics in Australia Survey (N = 2875 individuals and 22,942 person-year observations). Results: Parental joblessness, especially when experienced over a protracted period, is found to impose a penalty on children's mental health in later life, which is mostly not mediated by other variables. A significant negative association with general health is also found, but in this case family income and family harmony play a more important mediating role. Conclusion: The results suggest that it is not parental job loss per se that matters, but parents not being able to quickly find alternative employment. It is only children in families where joblessness is protracted and long-lasting who are at serious risk of long-term health problems. In sum, our results imply that the parental outcome that is most important for children's later health, and especially their mental health, is continuous paid employment. Such findings provide support for a jobs-first policy emphasis.
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ItemPopulation level impact of the NHS Diabetes Prevention Programme on incidence of type 2 diabetes in England: An observational study.(Elsevier BV, 2022-08)Background: The NHS Diabetes Prevention Programme (DPP) is the first nationwide type 2 diabetes prevention programme targeting people with prediabetes. It was rolled out across England from 2016 in three waves. We evaluate the population level impact of the NHS DPP on incidence rates of type 2 diabetes. Methods: We use data from the National Diabetes Audit, which records all individuals across England who have been diagnosed with type 2 diabetes by 2019. We use difference-in-differences regression models to estimate the impact of the phased introduction of the DPP on type 2 diabetes incidence. We compare patients registered with the 3,282 general practices enrolled from 2016 (wave 1) and the 1,610 practices enrolled from 2017 (wave 2) to those registered with the 1,584 practices enrolled from 2018 (final wave). Findings: Incidence rates of type 2 diabetes in wave 1 practices in 2018 and 2019 were significantly lower than would have been expected in the absence of the DPP (difference-in-differences Incident Rate Ratio (IRR) = 0·938 (95% CI 0·905 to 0·972)). Incidence rates were also significantly lower than expected for wave 2 practices in 2019 (difference-in-differences IRR = 0·927 (95% CI 0·885 to 0·972)). These results remained consistent across several robustness checks. Interpretation: Introduction of the NHS DPP reduced population incidence of type 2 diabetes. Longer follow-up is required to explore whether these effects are maintained or if diabetes onset is delayed. Funding: This research was funded by the National Institute for Health and Care Research (Health Services and Delivery Research, 16/48/07 - Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the DIPLOMA research programme (Diabetes Prevention - Long Term Multimethod Assessment)). The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health and Care Research or the Department of Health and Social Care.
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ItemConnecting Healthcare with Income Maximisation Services: A Systematic Review on the Health, Wellbeing and Financial Impacts for Families with Young Children(MDPI, 2022-06-01)Financial counselling and income-maximisation services have the potential to reduce financial hardship and its associated burdens on health and wellbeing in High Income Countries. However, referrals to financial counselling services are not systematically integrated into existing health service platforms, thus limiting our ability to identify and link families who might be experiencing financial hardship. Review evidence on this is scarce. The purpose of this study is to review "healthcare-income maximisation" models of care in high-income countries for families of children aged between 0 and 5 years experiencing financial difficulties, and their impacts on family finances and the health and wellbeing of parent(s)/caregiver(s) or children. A systematic review of the MEDLINE, EMBase, PsycInfo, CINAHL, ProQuest, Family & Society Studies Worldwide, Cochrane Library, and Informit Online databases was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement. A total of six studies (five unique samples) met inclusion criteria, which reported a total of 11,603 families exposed to a healthcare-income maximisation model. An average annual gain per person of £1661 and £1919 was reported in two studies reporting one Scottish before-after study, whereby health visitors/midwives referred 4805 clients to money advice services. In another UK before-after study, financial counsellors were attached to urban primary healthcare centres and reported an average annual gain per person of £1058. The randomized controlled trial included in the review reported no evidence of impacts on financial or non-financial outcomes, or maternal health outcomes, but did observe small to moderate effects on child health and well-being. Small to moderate benefits were seen in areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. There was a high level of bias in most studies, and insufficient evidence to evaluate the effectiveness of healthcare-income maximisation models of care. Rigorous (RCT-level) studies with clear evaluations are needed to assess efficacy and effectiveness.
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ItemVocational and psychosocial predictors of medical negligence claims among Australian doctors: a prospective cohort analysis of the MABEL survey(BMJ PUBLISHING GROUP, 2022-06-01)OBJECTIVE: To understand the association between medical negligence claims and doctors' sex, age, specialty, working hours, work location, personality, social supports, family circumstances, self-rated health, self-rated life satisfaction and presence of recent injury or illness. DESIGN AND SETTING: Prospective cohort study of Australian doctors. PARTICIPANTS: 12 134 doctors who completed the Medicine in Australia: Balancing Employment and Life survey between 2013 and 2019. PRIMARY OUTCOME MEASURE: Doctors named as a defendant in a medical negligence claim in the preceding 12 months. RESULTS: 649 (5.35%) doctors reported being named in a medical negligence claim during the study period. In addition to previously identified demographic factors (sex, age and specialty), we identified the following vocational and psychosocial risk factors for claims: working full time (OR=1.48, 95% CI 1.13 to 1.94) or overtime hours (OR 1.70, 95% CI 1.29 to 2.23), working in a regional centre (OR 1.69, 95% CI 1.37 to 2.08), increasing job demands (OR 1.16, 95% CI 1.04 to 1.30), low self-rated life satisfaction (OR 1.43, 95% CI 1.08 to 1.91) and recent serious personal injury or illness (OR 1.40, 95% CI 1.13 to 1.72). Having an agreeable personality was mildly protective (OR 0.91, 95% CI 0.83 to 1.00). When stratified according to sex, we found that working in a regional area, low self-rated life satisfaction and not achieving work-life balance predicted medical negligence claims in male, but not female, doctors. However, working more than part-time hours and having a recent personal injury or illness predicted medical negligence claims in female, but not male, doctors. Increasing age predicted claims more strongly in male doctors. Personality type predicted claims in both male and female doctors. CONCLUSIONS: Modifiable risk factors contribute to an increased risk of medical negligence claims among doctors in Australia. Creating more supportive work environments and targeting interventions that improve doctors' health and well-being could reduce the risk of medical negligence claims and contribute to improved patient safety.
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ItemMedical negligence claims and the health and life satisfaction of Australian doctors: a prospective cohort analysis of the MABEL survey(BMJ PUBLISHING GROUP, 2022-05-01)OBJECTIVE: To assess the association between medical negligence claims and doctors' self-rated health and life satisfaction. DESIGN: Prospective cohort study. PARTICIPANTS: Registered doctors practising in Australia who participated in waves 4 to 11 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey between 2011 and 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-rated health and self-rated life satisfaction. RESULTS: Of the 15 105 doctors in the study, 885 reported being named in a medical negligence claim. Fixed-effects linear regression analysis showed that both self-rated health and self-rated life satisfaction declined for all doctors over the course of the MABEL survey, with no association between wave and being sued. However, being sued was not associated with any additional declines in self-rated health (coef.=-0.02, 95% CI -0.06 to 0.02, p=0.39) or self-rated life satisfaction (coef.=-0.01, 95% CI -0.08 to 0.07, p=0.91) after controlling for a range of job factors. Instead, we found that working conditions and job satisfaction were the strongest predictors of self-rated health and self-rated life satisfaction in sued doctors. In analyses restricted to doctors who were sued, we observed no changes in self-rated health (p=0.99) or self-rated life satisfaction (p=0.59) in the years immediately following a claim. CONCLUSIONS: In contrast to prior overseas cross-sectional survey studies, we show that medical negligence claims do not adversely affect the well-being of doctors in Australia when adjusting for time trends and previously established covariates. This may be because: (1) prior studies failed to adequately address issues of causation and confounding; or (2) legal processes governing medical negligence claims in Australia cause less distress compared with those in other jurisdictions. Our findings suggest that the interaction between medical negligence claims and poor doctors' health is more complex than revealed through previous studies.
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ItemCorrection: Ethnic inequalities in COVID-19 vaccine uptake and comparison to seasonal influenza vaccine uptake in Greater Manchester, UK: A cohort study.(Public Library of Science (PLoS), 2022-04)[This corrects the article DOI: 10.1371/journal.pmed.1003932.].
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ItemA Comparison of Methods for Identifying Informal Carers: Self-Declaration Versus a Time Diary(ADIS INT LTD, 2022-04-08)OBJECTIVES: Two main methods for identifying whether an individual is an informal carer are self-declaration and the use of a time diary. We analysed the level and predictors of agreement between these two methods among co-residential informal carers of adult recipients. METHODS: We used the 2014/15 UK Time Use Survey, which is a large-scale household survey for those aged 8 years old and over. It contains an individual questionnaire for self-declaration and a time diary for activity-based identification that records all activity in 10-min slots for two 24-h periods. Our analysis: (i) assesses the degree of overlap across approaches; (ii) explores the differences in characteristics between carers identified via one approach relative to non-carers using a bivariate probit estimator; and (iii) shows what factors are associated with being identified by both approaches using two independent probit estimators. RESULTS: Out of 6301 individuals, we identified 545 carers (8.6%) by at least one method and only 104 (19.1% of 545 carers) by both methods. We found similar factors predicted caregiving using either method but the magnitudes of the effects of these factors were larger for self-declared carers. Activity-based carers who provided more activities to a dependent adult and spent more time caregiving were more likely to also self-declare. CONCLUSIONS: Our results show low levels of agreement between the two main methods used to identify informal carers. Any assessment of current caregiving research or future means to collect caregiving information should pay particular attention to the identification method as it may only relate to certain carer groups.
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ItemEvaluation of the mental health impacts of Universal Credit: protocol for a mixed methods study.(BMJ, 2022-04-08)INTRODUCTION: The UK social security system is being transformed by the implementation of Universal Credit (UC), which combines six existing benefits and tax credits into a single payment for low-income households. Despite extensive reports of hardship associated with the introduction of UC, no previous studies have comprehensively evaluated its impact on mental health. Because payments are targeted at low-income households, impacts on mental health will have important consequences for health inequalities. METHODS AND ANALYSIS: We will conduct a mixed methods study. Work package (WP) 1 will compare health outcomes for new recipients of UC with outcomes for legacy benefit recipients in two large population surveys, using the phased rollout of UC as a natural experiment. We will also analyse the relationship between the proportion of UC claimants in small areas and a composite measure of mental health. WP2 will use data collected by Citizen's Advice to explore the sociodemographic and health characteristics of people who seek advice when claiming UC and identify features of the claim process that prompt advice-seeking. WP3 will conduct longitudinal in-depth interviews with up to 80 UC claimants in England and Scotland to explore reasons for claiming and experiences of the claim process. Up to 30 staff supporting claimants will also be interviewed. WP4 will use a dynamic microsimulation model to simulate the long-term health impacts of different implementation scenarios. WP5 will undertake cost-consequence analysis of the potential costs and outcomes of introducing UC and cost-benefit analyses of mitigating actions. ETHICS AND DISSEMINATION: We obtained ethical approval for the primary data gathering from the University of Glasgow, College of Social Sciences Research Ethics Committee, application number 400200244. We will use our networks to actively disseminate findings to UC claimants, the public, practitioners and policy-makers, using a range of methods and formats. TRIAL REGISTRATION NUMBER: The study is registered with the Research Registry: researchregistry6697.
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ItemSocial Isolation, Social Support, and Loneliness Profiles Before and After Spousal Death and the Buffering Role of Financial Resources(OXFORD UNIV PRESS INC, 2022-04-04)OBJECTIVES: We provide new evidence on the profiles of social isolation, social support, and loneliness before and after spousal death for older widows. We also examine the moderating effects of gender and financial resources on changes in social health before and after widowhood. METHODS: We use 19 waves of data from the Household, Income and Labour Dynamics in Australia Survey, including 749 widowed individuals and a comparison group of around 8,000 married individuals. We apply coarsened exact matching weights and control for age and time trends. Local polynomial smoothed plots show the profiles of social health from 3 years pre- to 3 years postspousal death. All analyses were stratified by gender. RESULTS: Spousal death was strongly associated with increased loneliness for women and men, but also an increase in interactions with friends and family not living with the bereaved. For men, financial resources (both income and asset wealth) provided some protection against loneliness. Spousal death was not associated with changes in social support or participation in community activities. DISCUSSION: We demonstrate that loneliness is a greater challenge of widowhood than social isolation or a lack of social support. Our findings suggest that interventions focusing only on increasing social interactions are unlikely to alleviate loneliness following spousal death. Moreover, policies that reduce the cost of formal social participation may have limited effectiveness in tackling loneliness, particularly for women. Alternative strategies, such as helping the bereaved form a new sense of identity and screening for loneliness around widowhood by health care workers, could be beneficial.