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Preventive Care Disruptions and Emergency Hospitalizations: Evidence from COVID-19 and SHARE

Moslem Rashidi, Luke B. Connelly, Gianluca Fiorentini

TL;DR

Estimates imply that mammography reduces emergency overnight hospitalization by about six percentage points, and this effect appears among women aged 70 and above, the target group for organized breast cancer screening.

Abstract

We study whether disruptions to preventive care during the first wave of the coronavirus disease 2019 pandemic affected subsequent acute hospital use. Using the Survey of Health, Ageing and Retirement in Europe from eight countries, we focus on women aged 50-69, the target group for organized breast cancer screening. The outcome is an indicator for any all-cause emergency overnight hospitalization in the prior twelve months. To address selection into screening, we use an instrumental variables design based on six interview-month cohorts in Wave 9 (March-August 2022) interacted with country indicators. Because mammography is reported over a two-year recall window anchored to the interview month, these cohort-by-country interactions shift how much of the March-August 2020 restriction period falls inside the recall window, generating variation in mammography uptake across cohorts within countries. The estimates imply that mammography reduces emergency overnight hospitalization by about six percentage points. No effect appears among women aged 70 and above. Results are robust to controls, disruption measures, and falsification tests.

Preventive Care Disruptions and Emergency Hospitalizations: Evidence from COVID-19 and SHARE

TL;DR

Estimates imply that mammography reduces emergency overnight hospitalization by about six percentage points, and this effect appears among women aged 70 and above, the target group for organized breast cancer screening.

Abstract

We study whether disruptions to preventive care during the first wave of the coronavirus disease 2019 pandemic affected subsequent acute hospital use. Using the Survey of Health, Ageing and Retirement in Europe from eight countries, we focus on women aged 50-69, the target group for organized breast cancer screening. The outcome is an indicator for any all-cause emergency overnight hospitalization in the prior twelve months. To address selection into screening, we use an instrumental variables design based on six interview-month cohorts in Wave 9 (March-August 2022) interacted with country indicators. Because mammography is reported over a two-year recall window anchored to the interview month, these cohort-by-country interactions shift how much of the March-August 2020 restriction period falls inside the recall window, generating variation in mammography uptake across cohorts within countries. The estimates imply that mammography reduces emergency overnight hospitalization by about six percentage points. No effect appears among women aged 70 and above. Results are robust to controls, disruption measures, and falsification tests.

Paper Structure

This paper contains 15 sections, 6 equations, 3 figures, 12 tables.

Table of Contents

  1. Introduction
  2. Data
  3. Choice of Predictors
  4. Instrumental Variable Strategy
  5. Empirical method
  6. Results
  7. Local Average Treatment Effects (LATEs)
  8. Conclusion
  9. Outcome construction and charts
  10. Descriptive statistics
  11. Additional figures
  12. Interview cohorts by country and NUTS1 region
  13. Falsification tests
  14. Negative controls and alternative-path variables (APVs)
  15. Placebo IV analysis using pre-pandemic Wave 8

Figures (3)

  • Figure A.1: Construction of the outcome R_ER_only (“only emergency hospital stays”) in the analysis sample
  • Figure C.1: Average mammography rates by month of interview from March 2022 to August 2022
  • Figure C.2: Country-level mean restriction instrument $Z_c$ and mammography screening rates, Wave 9 vs. Wave 8