Jose Pagan
Jose Pagan
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Chair and Professor of the Department of Public Health Policy and Management
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Professional overview
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Dr. Pagán received his PhD in economics from the University of New Mexico and is a former Robert Wood Johnson Foundation Health & Society Scholar with expertise in health economics and population health. He has led research, implementation, and evaluation projects on the redesign of health care delivery and payment systems. He is interested in population health management, health care payment and delivery system reform, and the social determinants of health. Over the years his research has been funded through grants and contracts from the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the European Commission, and the Robert Wood Johnson Foundation, among others.
Dr. Pagán is Chair of the Board of Directors of NYC Health + Hospitals, the largest public healthcare system in the United States. He also served as Chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Health Policy Research Scholars and was a member of the Board of Directors of the Interdisciplinary Association for Population Health Science and the American Society of Health Economists.
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Areas of research and study
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Applied EconomicsHealth EconomicsPopulation HealthPublic Health Policy
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Publications
Publications
COVID-19 vaccine inequality : A global perspective
AbstractPagan, J., Tatar, M., Shoorekchali, J. M., Faraji, M. R., Seyyedkolaee, M. A., Pagán, J. A., & Wilson, F. A. (n.d.).Publication year
2022Journal title
Journal of Global HealthVolume
12Page(s)
3072Abstract~Cross-border utilization of health care : Evidence from a population-based study in South Texas
AbstractPagan, J., Su, D., Richardson, C., Wen, M., & Pagán, J. A. (n.d.).Publication year
2011Journal title
Health Services ResearchVolume
46Issue
3Page(s)
859-876AbstractObjective. To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods. This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings. Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions. The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.-Mexico border region.Decoding Nonadherence to Hypertensive Medication in New York City : A Population Segmentation Approach
AbstractPagan, J., Li, Y., Jasani, F., Su, D., Zhang, D., Shi, L., Yi, S. S., & Pagán, J. A. (n.d.).Publication year
2019Journal title
Journal of Primary Care and Community HealthVolume
10AbstractObjective: Nearly one-third of adults in New York City (NYC) have high blood pressure and many social, economic, and behavioral factors may influence nonadherence to antihypertensive medication. The objective of this study is to identify profiles of adults who are not taking antihypertensive medications despite being advised to do so. Methods: We used a machine learning–based population segmentation approach to identify population profiles related to nonadherence to antihypertensive medication. We used data from the 2016 NYC Community Health Survey to identify and segment adults into subgroups according to their level of nonadherence to antihypertensive medications. Results: We found that more than 10% of adults in NYC were not taking antihypertensive medications despite being advised to do so by their health care providers. We identified age, neighborhood poverty, diabetes, household income, health insurance coverage, and race/ethnicity as important characteristics that can be used to predict nonadherence behaviors as well as used to segment adults with hypertension into 10 subgroups. Conclusions: Identifying segments of adults who do not adhere to hypertensive medications has practical implications as this knowledge can be used to develop targeted interventions to address this population health management challenge and reduce health disparities.Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care
AbstractPagan, J., Howell, E. A., Padrón, N. A., Beane, S. J., Stone, J., Walther, V., Balbierz, A., Kumar, R., & Pagán, J. A. (n.d.).Publication year
2017Journal title
Maternal and Child Health JournalVolume
21Issue
3Page(s)
432-438AbstractPurpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk. The program includes a social work/care management component and a payment system redesign with a cost-sharing arrangement between the health system and the Medicaid managed care plan to cover the cost of staff, clinician education, performance feedback, and clinic/clinician financial incentives. The goal is to enroll 510 high-risk postpartum mothers. Assessment The primary outcome of interest is a timely postpartum visit in accordance with NCQA healthcare effectiveness data and information set guidelines. Secondary outcomes include care process measures for women with specific high-risk conditions, emergency room visits, postpartum readmissions, depression screens, and health care costs. Conclusion Our evidence-based program focuses on an important area of maternal health, targets racial/ethnic disparities in postpartum care, utilizes an innovative payment reform strategy, and brings together insurers, researchers, clinicians, and policy experts to work together to foster health and wellness for postpartum women and reduce disparities.Diabetes and employment productivity : Does diabetes management matter?
AbstractPagan, J., Brown, H. S., Peŕez, A., Yarnell, L. M., Pagán, J. A., Hanis, C. L., Fisher-Hoch, S. P., & McCormick, J. B. (n.d.).Publication year
2011Journal title
American Journal of Managed CareVolume
17Issue
8Page(s)
569-576AbstractObjective: To determine whether labor market effects were the result of diabetes per se or rather depended on the degree to which diabetes was controlled through management of blood sugar levels. Methods: This study utilized data from a recently completed survey of households in Brownsville, Texas, a largely Mexican American community with a high prevalence of diabetes that is located on the Texas-Mexico border. Diabetes management, or control, was measured by blood sugar levels, glycosylated hemoglobin (A1C) levels, and interaction terms. Methods used were probit and Heckman regression. Results: Management of diabetes did not appear to have a discernible impact on labor market outcomes in the short run. However, diabetes was negatively associated with male productivity, particularly in males' propensity to work. The new American Diabetes Association (ADA) definition of diabetes is based on having an A1C level ofDiabetes Management Through Remote Patient Monitoring : A Mixed-Methods Evaluation of Program Enrollment and Attrition
AbstractPagan, J., Su, D., Michaud, T. L., Ern, J., Li, J., Chen, L., Li, Y., Shi, L., Zhang, D., Andersen, J., & Pagán, J. A. (n.d.).Publication year
2025Journal title
Healthcare (Switzerland)Volume
13Issue
7AbstractBackground: Despite the growing use of remote patient monitoring (RPM) in diabetes management, few studies have assessed program enrollment and attrition. This study adopted a mixed-methods approach to examining factors linked to program enrollment and attrition amongst a large sample of patients who went through RPM in diabetes management. Methods: Based on quantitative data from the Remote Interventions Improving Specialty Complex Care program conducted in Nebraska from 2014 to 2018, chi-squared or t tests were used to compare three groups of patients with diabetes who had been contacted for program participation: those who completed the intervention, withdrew from the intervention, or declined to participate. Logistic regression was used to identify factors associated with program dropout. Inductive thematic analysis was conducted to assess patient feedback based on semi-structured interviews with patients from the three groups. Results: Out of the 1993 patients with diabetes invited for participation, 13% (n = 256) declined to participate, 16% (n = 317) withdrew before completion, and 71% (n = 1420) completed the intervention. Being younger or having poorer health (as indicated by higher blood glucose or blood pressure) at the baseline was associated with higher odds of program withdrawal. The top reason patients cited for declining participation or withdrawal from RPM was not having enough time to complete the intervention. Patients who declined to participate mentioned that an offer of incentives or more information at the beginning of the intervention may increase their motivation for participation. Conclusions: Being younger or having poorer health at the baseline was associated with higher odds of withdrawing from the RPM program. Future RPM programs can increase program retention by becoming more responsive to the health needs of vulnerable patients who struggle with managing their diabetes or related comorbidities at the baseline.Diabetes Management Through Remote Patient Monitoring : The Importance of Patient Activation and Engagement with the Technology
AbstractPagan, J., Su, D., Michaud, T. L., Estabrooks, P., Schwab, R. J., Eiland, L. A., Hansen, G., Devany, M., Zhang, D., Li, Y., Pagán, J. A., & Siahpush, M. (n.d.).Publication year
2019Journal title
Telemedicine and e-HealthVolume
25Issue
10Page(s)
952-959AbstractBackground: The documented efficacy and promise of telemedicine in diabetes management does not necessarily mean that it can be easily translated into clinical practice. An important barrier concerns patient activation and engagement with telemedicine technology. Objective: To assess the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among patients with type 2 diabetes. Methods: Ordinary least squares and logistic regression analyses were used to examine how patient activation and engagement with remote patient monitoring technology were related to changes in hemoglobin A1c (HbA1c) for 1,354 patients with type 2 diabetes monitored remotely for 3 months between 2015 and 2017. Results: Patients with more frequent and regular participation in remote monitoring had lower HbA1c levels at the end of the program. Compared to patients who uploaded their biometric data every 2 days or less frequently, patients who maintained an average frequency of one upload per day were less likely to have a postmonitoring HbA1c > 9% after adjusting for selected covariates on baseline demographics and health conditions. Conclusions: Higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes. Developing targeted interventions for different groups of patients to promote their activation and engagement levels would be important to improve the effectiveness of remote patient monitoring in diabetes management.Differences in access to health care services between insured and uninsured adults with diabetes in Mexico
AbstractPagan, J., & Puig, A. (n.d.).Publication year
2005Journal title
Diabetes CareVolume
28Issue
2Page(s)
425-6Abstract~Discrimination in Medical Settings across Populations : Evidence From the All of Us Research Program
AbstractPagan, J., Wang, V. H., Cuevas, A. G., Osokpo, O. H., Chang, J. E., Zhang, D., Hu, A., Yun, J., Lee, A., Du, S., Williams, D. R., & Pagán, J. A. (n.d.).Publication year
2024Journal title
American journal of preventive medicineAbstractIntroduction: Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. Methods: Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021–2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023–2024. Results: About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, pDo State Opioid Policies Influence Nonprofit Hospitals’ Decisions to Address Substance Abuse in Their Communities?
AbstractPagan, J., Franz, B., Cronin, C. E., Skinner, D., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Medical Care Research and ReviewVolume
78Issue
4Page(s)
371-380AbstractThe U.S. epidemic of opioid abuse calls for broad collaboration between a wide range of health care institutions and the various levels of government. Through the community benefit programs they provide, nonprofit hospitals are well positioned to be key partners in local efforts. Although substance abuse appears on approximately 90% of the most recent community health needs assessments completed by hospitals, many hospitals are not addressing substance abuse in their programmatic efforts. Given wide state variation in policies to combat opioid abuse, we assess whether state leadership to address the opioid crisis influences hospital decisions to invest in substance abuse programs. Our findings suggest that several key state policies are related to hospital investments in substance abuse initiatives. To capitalize on the community benefit responsibilities of local hospitals, policies that provide specific direction for and engagement with local hospitals may increase cooperation and investments to address substance abuse.Do You Speak My Language? When Patient Care Meets Cost- Effectiveness
AbstractSaloner, B., & Pagan, J. (n.d.).Publication year
2015Abstract~Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials
AbstractPagan, J., Su, D., Zhou, J., Kelley, M. S., Michaud, T. L., Siahpush, M., Kim, J., Wilson, F., Stimpson, J. P., & Pagán, J. A. (n.d.).Publication year
2016Journal title
Diabetes Research and Clinical PracticeVolume
116Page(s)
136-148AbstractAims: To assess the overall effect of telemedicine on diabetes management and to identify features of telemedicine interventions that are associated with better diabetes management outcomes. Methods: Hedges's g was estimated as the summary measure of mean difference in HbA1c between patients with diabetes who went through telemedicine care and those who went through conventional, non-telemedicine care using a random-effects model. Q statistics were calculated to assess if the effect of telemedicine on diabetes management differs by types of diabetes, age groups of patients, duration of intervention, and primary telemedicine approaches used. Results: The analysis included 55 randomized controlled trials with a total of 9258 patients with diabetes, out of which 4607 were randomized to telemedicine groups and 4651 to conventional, non-telemedicine care groups. The results favored telemedicine over conventional care (Hedges's g = -0.48, p < 0.001) in diabetes management. The beneficial effect of telemedicine were more pronounced among patients with type 2 diabetes (Hedges's g = -0.63, p < 0.001) than among those with type 1 diabetes (Hedges's g = -0.27, p = 0.027) (Q = 4.25, p = 0.04). Conclusions: Compared to conventional care, telemedicine is more effective in improving treatment outcomes for diabetes patients, especially for those with type 2 diabetes.Economic growth and interfactor/interfuel substitution in Korea
AbstractPagan, J., Cho, W. G., Nam, K., & Pagán, J. A. (n.d.).Publication year
2004Journal title
Energy EconomicsVolume
26Issue
1Page(s)
31-50AbstractThis paper investigates the impact of increases in oil consumption and changes in wage rates on the interfactor/interfuel substitution in Korea. A two-stage translog cost function is estimated to incorporate the feedback effect between the interfactor and interfuel substitution. Empirical results show that the substitutability/complementarity relationships among factors and fuels exhibit substantially different patterns before and after 1989.Effect of guidelines on primary care physician use of PSA screening : Results from the community tracking study physician survey
AbstractPagan, J., Guerra, C. E., Gimotty, P. A., Shea, J. A., Pagán, J. A., Schwartz, J. S., & Armstrong, K. (n.d.).Publication year
2008Journal title
Medical Decision MakingVolume
28Issue
5Page(s)
681-689AbstractBackground. Little is known about the effect of guidelines that recommend shared decision making on physician practice patterns. The objective of this study was to determine the association between physicians' perceived effect of guidelines on clinical practice and self-reported prostate-specific antigen (PSA) screening patterns. Methods. This was a cross-sectional study using a nationally representative sample of 3914 primary care physicians participating in the 1998-1999 Community Tracking Study Physician Survey. Responses to a case vignette that asked physicians what proportion of asymptomatic 60-year-old white men they would screen with a PSA were divided into 3 distinct groups: consistent PSA screeners (screen all), variable screeners (screen 1%- 99%), and consistent nonscreeners (screen none). Logistic regression was used to determine the association between PSA screening patterns and physician-reported effect of guidelines (no effect v. any magnitude effect). Results. Only 27% of physicians were variable PSA screeners; the rest were consistent screeners (60%) and consistent nonscreeners (13%). Only 8% of physicians perceived guidelines to have no effect on their practice. After adjustment for demographic and practice characteristics, variable screeners were more likely to report any magnitude effect of guidelines on their practice when compared with physicians in the other 2 groups (adjusted odds ratio= 1.73; 95% confidence interval=1:25-2:38;P= 0:001). Conclusions. Physicians who perceive an effect of guidelines on their practice are almost twice as likely to exhibit screening PSA practice variability, whereas physicians who do not perceive an effect of guidelines on their practice are more likely to be consistent PSA screeners or consistent PSA nonscreeners.Effects of New York’s Executive Order on Face Mask Use on COVID-19 Infections and Mortality : A Modeling Study
AbstractPagan, J., Shen, M., Zu, J., Fairley, C. K., Pagán, J. A., Ferket, B., Liu, B., Yi, S. S., Chambers, E., Li, G., Guo, Y., Rong, L., Xiao, Y., Zhuang, G., Zebrowski, A., Carr, B. G., Li, Y., & Zhang, L. (n.d.).Publication year
2021Journal title
Journal of Urban HealthVolume
98Issue
2Page(s)
197-204AbstractThere is growing evidence on the effect of face mask use in controlling the spread of COVID-19. However, few studies have examined the effect of local face mask policies on the pandemic. In this study, we developed a dynamic compartmental model of COVID-19 transmission in New York City (NYC), which was the epicenter of the COVID-19 pandemic in the USA. We used data on daily and cumulative COVID-19 infections and deaths from the NYC Department of Health and Mental Hygiene to calibrate and validate our model. We then used the model to assess the effect of the executive order on face mask use on infections and deaths due to COVID-19 in NYC. Our results showed that the executive order on face mask use was estimated to avert 99,517 (95% CIs 72,723–126,312) COVID-19 infections and 7978 (5692–10,265) deaths in NYC. If the executive order was implemented 1 week earlier (on April 10), the averted infections and deaths would be 111,475 (81,593–141,356) and 9017 (6446–11,589), respectively. If the executive order was implemented 2 weeks earlier (on April 3 when the Centers for Disease Control and Prevention recommended face mask use), the averted infections and deaths would be 128,598 (94,373–162,824) and 10,515 (7540–13,489), respectively. Our study provides public health practitioners and policymakers with evidence on the importance of implementing face mask policies in local areas as early as possible to control the spread of COVID-19 and reduce mortality.Employer sanctions on hiring illegal labor : An experimental analysis of firm compliance
AbstractPagan, J., & Pagán, J. A. (n.d.).Publication year
1998Journal title
Journal of Economic Behavior and OrganizationVolume
34Issue
1Page(s)
87-100AbstractThe employer sanctions provision of the 1986 Immigration Reform and Control Act penalizes employers who knowingly hire unauthorized workers. Under IRCA, employers are subject to civil and/or criminal penalties; however, given the widespread availability of counterfeit documentation, in some cases it becomes difficult to discern the employment eligibility status of some workers. Using experimental methods, this study provides some evidence that marginal increases in employer compliance rates are significantly higher when employers have perfect information on the employment eligibility status of its potential workers than when they do not. The experimental results suggest that increases in government spending for employer sanctions enforcement may be more effective if the informational asymmetry faced by employers is solved first. A possible solution to this problem may lie in the adoption of tamper-proof documentation such as a national identification card.Employment shifts, economic reform and the changes in public/private sector wages in Mexico : 1987-1997
AbstractPagan, J., Pagán, J. A., Gil, J. V., & Tijerina Guajardo, J. A. (n.d.).Publication year
2002Journal title
Empirical EconomicsVolume
27Issue
3Page(s)
447-460AbstractOver the last decade, the public sector in Mexico experienced substantial fiscal reform, divestiture of public enterprises, and the elimination of many regulations affecting pay and employment. This study analyzes the changes in the public/private sector differences in wages during the 1987-1997 period. The results from analyzing microdata from the Encuesta Nacional de Empleo Urbano show that relative public sector wages increased from 1987 to 1997. Most of the relative wage increase in the public sector can be explained by increases in the price of skills and by changes in sorting across sectors. The results have important public policy implications since they suggest that public sector workers earn more and their wages have grown faster than those of their private sector counterparts. As such, policies contemplating public sector reform should take into account the effect of these measures on the inter-sectoral income distribution and the overall economic growth.End-of-life medical treatment choices : Do survival chances and out-of-pocket costs matter?
AbstractPagan, J., Chao, L. W., Pagán, J. A., & Soldo, B. J. (n.d.).Publication year
2008Journal title
Medical Decision MakingVolume
28Issue
4Page(s)
511-523AbstractBackground. Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion. Objectives. To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs. Methods. Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s. Results. Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects. Conclusions. Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.Enrollment Patterns of Medicare Advantage Beneficiaries by Dental, Vision, and Hearing Benefits
AbstractPagan, J., Gupta, A., Silver, D. R., Meyers, D. J., Murray, G., Glied, S. A., & Pagán, J. A. (n.d.).Publication year
2024Journal title
JAMA Health ForumVolume
5Issue
1Page(s)
E234936AbstractImportance: Most Medicare beneficiaries now choose to enroll in Medicare Advantage (MA) plans. Racial and ethnic minority group and low-income beneficiaries are increasingly enrolling in MA plans. Objective: To examine whether dental, vision, and hearing supplemental benefits offered in MA plans are associated with the plan choices of traditionally underserved Medicare beneficiaries. Design, Setting, and Participants: This exploratory observational cross-sectional study used data from the 2018 to 2020 Medicare Current Beneficiary Survey linked to MA plan benefits. The nationally representative sample comprised primarily community-dwelling MA beneficiaries enrolled in general enrollment MA plans. Data analysis was performed between April and October 2023. Exposures: Beneficiary self-identified race and ethnicity and combined individual and spouse income and educational attainment. Main Outcomes and Measures: Binary indicators were developed to determine whether beneficiaries were enrolled in a plan offering any dental, comprehensive dental, any vision, eyewear, any hearing, or hearing aid benefit. Mixed-effects logistic regression models were estimated to report average marginal effects adjusted for beneficiary-level demographic and health characteristics, plan attributes, and plan availability. Results: This study included 8139 (weighted N = 31 million) eligible MA beneficiaries, with a mean (SD) age of 77.7 (7.5) years. More than half of beneficiaries (54.9%) were women; 9.8% self-identified as Black, 2.0% as Hispanic, 83.9% as White, and 4.2% as other or multiple races or ethnicities. Plan choices by dental benefits were examined among 7516 beneficiaries who were not enrolled in any dental standalone plan, by vision benefits for 8026 beneficiaries not enrolled in any vision standalone plan, and by hearing benefits for 8131 beneficiaries not enrolled in any hearing standalone plan. Black beneficiaries were more likely to enroll in plans with any dental benefit (9.0 percentage points [95% CI, 3.4-14.4]; PExamining Medicare’s Hospital Readmissions Reduction Program
AbstractPagan, J. (n.d.).Publication year
2014Abstract~Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017–2020
AbstractPagan, J., Lindenfeld, Z., Silver, D. R., Pagán, J. A., Zhang, D. S., & Chang, J. E. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5 MAYAbstractIntroduction Despite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017–2020. Methods This longitudinal analysis of 2,846 counties from 2017–2020 used bivariate and multivariate Generalized Estimating Equations models to estimate associations between county overdose mortality rates and SDOH characteristics, including the fines and forfeitures measure. Results In our multivariate model, higher per capita fine and forfeiture revenue (5.76; CI: 4.76, 6.78), households receiving food stamps (1.15; CI: 0.77, 1.53), residents that are veterans (1.07; CI: 0.52, 1.63), substance use treatment availability (4.69; CI: 3.03, 6.33) and lower population density (-0.002; CI: -0.004, -0.001) and percent of Black residents (-0.7‘; CI: -1.01, -0.42) were significantly associated with higher overdose death rates. There was a significant additive interaction between the fines and forfeitures measure (0.10; CI: 0.03, 0.17) and the percent of Black residents. Conclusions Our findings suggest that structural racism, along with other SDOH, is associated with overdose deaths. Future research should focus on connecting individual-level data on fines and forfeitures to overdose deaths and other health outcomes, include measures of justice-related fines, such as court fees, and assess whether interventions aimed at increasing economic vitality in disadvantaged communities impact overdose deaths in a meaningful way.Excess Deaths During the COVID-19 Economic Downturn
AbstractPagan, J., & Pagán, J. A. (n.d.).Publication year
2021Journal title
American journal of public healthVolume
111Issue
11Page(s)
1947-1949Abstract~Executive compensation and corporate production efficiency: a stochastic frontier approach
AbstractBaek, H., & Pagan, J. (n.d.).Publication year
2002Journal title
Quarterly Journal of Business and EconomicsVolume
41Issue
1-2Page(s)
27-42Abstract~Explaining Gender Differences in Earnings in the Microenterprise Sector
AbstractSánchez, S., & Pagan, J. (n.d.). (M. Correia & E. Katz, Eds.).Publication year
2001Abstract~Explaining the effects of changes in labor market structure on the relative wages of Puerto Rican workers: 1982-1992
AbstractPagan, J. (n.d.).Publication year
1995Journal title
Ceteris Paribus (Revista de Investigaciones Socio-Económicas, Universidad de Puerto Rico)Volume
5Issue
2Page(s)
61-73Abstract~