追溯英国国家卫生服务的遗传足迹
Tracing the Genetic Footprints of the UK National Health Service
AI总结：
本文研究了英国国家卫生服务对早期生命死亡率的影响，发现其通过降低先天性疾病和腹泻死亡率，改变了人口构成并产生长期生存偏差。
摘要：
英国国家卫生服务（NHS）于1948年7月建立，是20世纪最具影响力的卫生政策干预之一，提供了普遍免费的医疗服务，并显著扩大了产前和婴儿健康服务。在本文中，我们估计了NHS引入对早期生命死亡率的因果效应，并测试了生存是否具有选择性。我们采用局部随机化下的回归不连续设计，比较出生在1948年7月前后的人群。利用新数字化的每周死亡记录，我们发现NHS引入后，仍出生率和婴儿死亡率显著下降，后者主要由先天性疾病和腹泻死亡率的减少驱动。我们随后使用多基因指数（PGIs），在受孕时固定，来追踪人口构成的变化，显示出生在NHS引入后的人群表现出与情境不利特征（如抑郁、COPD和早产）相关的更高PGI，以及与情境有利特征（如教育水平、自评健康和怀孕持续时间）相关的较低PGI，效应规模可达标准差的7.5%。这些基于英国生物库数据的结果在家庭设计下稳健，并在英国老龄化纵向研究和英国家庭纵向研究中得到复制。效果在经济和社会地位不利地区和男性中最强。这些关于选择性生存存在和规模的新型证据突显了大规模公共政策如何在人口构成上留下持久印记，并产生长期生存偏差。
英文摘要：
The establishment of the UK National Health Service (NHS) in July 1948 was one of the most consequential health policy interventions of the twentieth century, providing universal and free access to medical care and substantially expanding maternal and infant health services. In this paper, we estimate the causal effect of the NHS introduction on early-life mortality and we test whether survival is selective. We adopt a regression discontinuity design under local randomization, comparing individuals born just before and just after July 1948. Leveraging newly digitized weekly death records, we document a significant decline in stillbirths and infant mortality following the introduction of the NHS, the latter driven primarily by reductions in deaths from congenital conditions and diarrhea. We then use polygenic indexes (PGIs), fixed at conception, to track changes in population composition, showing that cohorts born at or after the NHS introduction exhibit higher PGIs associated with contextually-adverse traits (e.g., depression, COPD, and preterm birth) and lower PGIs associated with contextually-valued traits (e.g., educational attainment, self-rated health, and pregnancy length), with effect sizes as large as 7.5% of a standard deviation. These results based on the UK Biobank data are robust to family-based designs and replicate in the English Longitudinal Study of Ageing and the UK Household Longitudinal Study. Effects are strongest in socioeconomically disadvantaged areas and among males. This novel evidence on the existence and magnitude of selective survival highlights how large-scale public policies can leave a persistent imprint on population composition and generate long-term survival biases.
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