I’ve come. I’m usually skeptical of economists trying to simulate non-economic issues, but this seems to be a definite study designed to examine the impact of childhood respiratory infections. Please note that the diseases in question are “only” respiratory diseases, as they do not affect other organs like Covid.

Considering that severe cases (including hospitalization) of Omicron, especially in children under 9 years old, are much higher than the earlier variants, these conclusions themselves and their impact on Covid are worrying. This study found that babies are two to three times more likely to be hospitalized than older children, and their hospitalization impairs their education and job prospects without developing greater resistance to subsequent childhood respiratory infections .

Authors: N. Meltem Daysal, Associate Professor of Economics at the University of Copenhagen, Hui Ding, PhD student in Economics at Stanford University, Maya Rossin-Slater, Associate Professor of Health Policy at Stanford University School of Medicine, Hannes Schwandt, Assistant Professor at Northwestern University, School of Education and Social Policy (SESP).Originally published on Voice of Europe

Epidemics have a major impact on families and the economy. However, how common endemic viruses affect long-term population human capital and economic outcomes remains unclear. This column uses data from Denmark to explore the mechanisms and consequences of children’s early exposure to respiratory diseases. Compared with older siblings, younger siblings are two to three times more likely to be hospitalized for respiratory diseases in the first year after birth. The family unit plays a central role in the spread of the virus, and the birth order can affect the long-term outcome of the child.

The COVID-19 pandemic has rekindled interest in understanding the social costs of infectious diseases, which are usually measured in terms of their direct and direct impact on public health and economic activities (Adda 2016). Although a large number of studies have focused on the impact of epidemics on families and the economy (e.g. Janke et al. 2020, Moroni et al. 2020, Alon et al. 2020, Conti 2020, Baldwin 2020), the parallel question is how endemic the epidemic is The impact of the virus on society is still poorly understood.In addition, there is even less attention to potential long The impact of these viruses on population human capital and economic results.

Respiratory diseases: the role and long-term effects of birth order

In our paper (Daysal et al. 2021), we use population-level administrative data from 35 birth cohorts in Denmark to comprehensively analyze the mechanism of infants infected with respiratory viruses and the consequences of early exposure to respiratory diseases and their subsequent results.

We first recorded significant differences in the likelihood of severe respiratory disease in early childhood in order of birth. Using data on all first and second siblings born in Denmark between 1980 and 2015, we found that compared with older siblings, younger siblings suffered from breathing in the first year after birth. The rate of hospitalization for systemic diseases is two to three times higher at the same age. This gap is especially large when hospitalization is measured in the first three months of life.

If the younger siblings were born in autumn or winter, when the respiratory virus spreads more frequently, the difference in hospitalization is even greater. The gap between siblings with shorter birth intervals is also greater, and they may be more likely to have close contact, thereby promoting the spread of the virus.

These patterns highlight the core position of family units in the spread of the virus, and the mechanism by which birth order may affect the long-term outcome of children that has not been fully studied so far: older children “bring home” common viruses (e.g. from collective childcare settings) ), to “bring home” their younger children, siblings are at higher risk of severe respiratory disease in the first few months of life.

Causal long-term impact

To determine the long-term causal effects of early respiratory disease exposure, we combined changes in the birth order of the likelihood of severe respiratory infections with changes in the local disease prevalence. The prevalence of local respiratory diseases in children is mainly driven by highly contagious diseases, such as respiratory syncytial virus or RSV, which spread to different locations in irregular waves (Pitzer et al., 2015).

We constructed a city-level index to obtain the respiratory disease exposure of each child in the first year after birth from the older children in the community. Specifically, we calculate the number of people hospitalized with respiratory diseases for every 100 children between 13 and 71 months (excluding siblings) in each city, and then assign each child the cumulative children of the first 12 months of their city Hospitalization rate. Then, we used our sample of siblings to estimate the different effects of respiratory disease index on younger siblings and older siblings.

Our regression model controls for time-invariant differences between different cities, which may lead to differences in disease exposure, overall and seasonal trends in respiratory diseases, and a large number of observable personal and family characteristics.

We show that the local respiratory disease index strongly predicts the likelihood that a child will be hospitalized for respiratory disease in the first year after birth. Compared with older brothers and sisters, this influence is much greater for young people. Moving from the 25th percentile to the 75th percentile of the disease index distribution, compared with older children, the difference in the number of hospitalizations for respiratory diseases among younger children in the first year after birth has increased 0.021, which represents an additional 30.9% increase in the sample average. This effect is partly due to the increase in the difference in the number of RSV hospitalizations. RSV is a mild disease for most older children, but it may be affected in infants. Very serious.

In the long run, the increased risk of second-born babies being exposed to severe respiratory diseases during infancy will lead to worse outcomes in their education and labor market. We found that for younger siblings, moving from the 25th percentile to the 75th percentile of the disease index distribution is associated with a 0.4 percentage point (0.5%) decrease in the probability of graduation from high school and an additional 1.3% decrease in income. At 30 years old.

We also studied the impact of exposure to respiratory diseases in the first year of life on hospitalizations for respiratory diseases in children. We found that exposure to higher respiratory diseases before one year of age is associated with a lower likelihood of hospitalization for all respiratory diseases at the age of three to four, which is consistent with the hypothesis of immune formation.

However, we did not observe the protective effect of RSV exposure in the first year of life on the possibility of RSV hospitalization in later childhood. This result is consistent with that RSV is not an immune disease—that is, RSV infection does not provide immunity to future diseases. The lack of immune formation, coupled with RSV accounting for a large proportion of all respiratory hospitalizations in infancy (30% in the second child), suggests that RSV may play a particularly important role in promoting long-term adverse effects on children . Educational and economic achievements.

Fill in important gaps in existing literature

A wealth of empirical evidence associates disadvantages (including health shocks) in early childhood with poor long-term socioeconomic outcomes (Barker 1990, Currie 2008, Almond and Currie 2011, Almond et al., 2018). Consistent with this extensive literature, current research on the impact of infectious viruses shows that it has a long-term negative impact on health and economic outcomes.

However, these studies are mainly based on serious infectious diseases such as malaria and polio (e.g. Bleakley 2010, Barreca 2010, Venkataramani 2012, Gensowski 2019, Fink et al. 2021) or pandemic influenza outbreaks, including the Spanish flu of 1918 and 1957 Asian flu in the year (e.g. Almond 2006, Almond and Mazumder 2005, Lin and Liu 2014, Kelly 2011). Severe infectious diseases such as malaria and polio continue to plague developing countries, but they have been basically eliminated in high-income countries.

In addition, the evidence of epidemics may not be suitable for understanding the long-term effects of endemic viruses, and individuals may be exposed to these viruses multiple times during their lifetime. Studies in evolutionary biology have emphasized the importance of physiological adaptation (Bateson et al., 2014, Gluckman and Hanson 2006), and determined that the immune system has a high learning rate in the first year of life (Holt and Jones 2000, M’Rabet) Et al., 2006). In 2008, Cote et al., 2010). Therefore, if individuals are exposed to the same virus at an older age, exposure to infectious diseases during infancy may increase their immunity, indicating a potentially non-linear relationship between early exposure and long-term outcomes (Fink et al., 2021) ).

On the other hand, new evidence on the long-term effects of endemic influenza is concentrated in the womb (Schwandt 2018). Our research contributes to this document on endemic diseases by focusing on the first year of life and analyzing the transmission mechanism.

COVID-19 and the way forward

Currently, the COVID-19 pandemic is still going on and there is no sign of its end. Although children are not considered high-risk groups for the SARS-CoV-2 virus to a large extent (Schwandt 2020), the pandemic may have a lasting and dynamic impact on children through its impact on other infectious diseases .

Policies implemented during the pandemic—including travel restrictions and school closures—reduced the spread of other respiratory viruses, including RSV (Leung et al., 2020, Cowling et al., 2020). Epidemiological models predict that after a pandemic period when common infectious diseases spread slowly (Baker et al., 2020).

Because the risk of severe childhood illness cases is particularly high in the first year of life, the pandemic may have the most severe long-term impact on babies born at the end of the pandemic, who are subsequently exposed to more serious childhood illness outbreaks. Finish.

In general, our research emphasizes the importance of family units in the spread of infancy diseases and provides new information that can inform the cost-benefit assessment of policies aimed at curbing the spread of endemic viruses, including vaccination. Requirements, drug distribution plan and sick pay regulations (Bhalotra and Venkataramani 2015, White 2019, Pichler and Ziebarth 2020, Bütikofer and Salvanes 2020, Marie and Castello 2020).

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