Background: Precise future projection of population health distribution is imperative for designing an efficient healthcare system in rapidly aging countries. Multistate-transition microsimulation models such as the US Future Elderly Model have been developed based on panel data collection, but these data may not be always available. We proposed a pseudopanel method using repeated cross-sectional representative surveys as a complementary approach, and specifically applied the model to Japan's population.

Methods: We calculated birth-cohort and sex-specific prevalence for all combinations of 14 health statuses using microdata from five waves of the Comprehensive Survey of People's Living Conditions. Combining obtained prevalences with vital statistics data, we determined transition probabilities of statuses over time using contingency tables. Assuming that state transition and mortality-exit follow the first-order Markov process, we then designed a virtual Japanese population aged older than 60 years as of 2013 and performed a microsimulation to project disease distributions to 2046 with forward, backward, and external validation tests. Following validation, we compared our projection results with those based on traditional stativ models.

Results: Our calculated morbidity and mortality rates successfully replicated governmental projections of population pyramids and matched cardiovascular and cancer incidences reported in existing epidemiological studies, supporting the validity of our estimation. Our future projection of stroke and heart disease indicated lower prevalences than expected from static models, presumably because of recent declining trends in disease incidence and fatality.

Conclusions: Our pseudopanel approach provides a valid alternative microsimulation frame for future health projection in aging societies.

Keywords: Pseudopanel approach; microsimulation; forecasting; aging; comorbidities; Japan

JEL No. C53, I1, I12, J11, J14

Cardiovascular diseases (CVDs), which are disorders of the heart and blood vessels, are the world’s leading cause of death (WHO, 2016). The transition from infectious diseases to non-communicable diseases (NCDs), primarily CVDs, as the primary cause of mortality and morbidity worldwide— combined with the economic burden associated with heart-related diseases—prompted the World Health Organization (WHO) and its regional offices to identify CVDs’ risk factors (WHO, 2016). This paper examines these risk factors with a focus on the fetal environment and its interaction with adult body mass index (BMI), using longitudinal data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS).

Using a Cox proportional hazards model to estimate hazard ratios adjusted for age and risk factors in adulthood, such as cigarette smoking, the results suggest that there is a positive association between birth weight and heart disease. In addition, when birth weight is interacted with BMI, raised blood pressure is found to be higher among those who were bigger infants at birth and grew to be lighter adults, suggesting centile crossing. Probit models are also used for sensitivity analysis, and the results are consistent with those of the hazards model. Other factors such as adult obesity and a smoking habit are also positively associated with hypertension and CVD.

Keywords: Fetal origins hypothesis, CLHNS, hazards model, CVD, adult risk factors

This paper shows that, for mothers in Cebu, Philippines, access to electricity and the type of cooking fuel used at home affect both health outcomes and also how time is allocated, including for paid work. First, the use of fuelwood for cooking adversely affects the health of mothers, who are traditionally responsible for cooking and are often at home, taking care of their families. This result is consistent across different econometric specifications. Second, shifting to a more efficient source of energy allows women more time to be engaged in the labor force, including in micro enterprises. It also enables them to reallocate their time and efforts away from household chores (cooking, tending animals, and childcare) toward caring for themselves (improved personal hygiene and rest). Drafting and strengthening existing gender-sensitive energy policies and programs can, therefore, help the welfare of mothers in the Philippines, where 54% of households rely on fuelwood, and where the resulting indoor air pollution has a particularly adverse impact on women. The analysis relies on a longitudinal data set (CLHNS 1994-2005).

Keywords: Energy access; time allocation; health of mothers; labor participation of mothers; Philippines; CLHNS

Risky health behaviors such as illicit drug use, smoking, overconsumption of alcohol, violence, and early sexual activity have contemporaneous and intertemporal adverse health and economic outcomes. The health-related and economic costs to individuals and to society overall are particularly pronounced when adolescents are the ones engaging in one or more of such behaviors.

This paper uses longitudinal data from the Philippines (from the Cebu Longitudinal Health and Nutrition Survey) to examine the long-term impact of adolescents’ risky behaviors in 2002 (related to sex, tobacco, alcohol, and violence, but not drugs) on their economic outcomes in 2009 (related to participation in the labor force, educational attainment, and family formation). The results reveal that risky behaviors are most likely to affect educational outcomes. Teenagers who smoked at least one cigarette a day were 21% less likely to be in college several years later, and this difference was 17% for those who had an early sexual initiation, and 7% for those who consumed alcohol at least once a week. Labor outcomes were also adversely affected.

The growing literature on environmental migration presents conflicting results. While some find that natural disasters induce international migration, others discover a dampening effect. We aim to reconcile these differences by using a comprehensive list of weather shocks from the Philippines, a country prone to natural disasters and a major exporter of labor. We constructed a longitudinal provincial dataset (2005–2015) from an assemblage of administrative and survey datasets and tested linear, quadratic, and lagged models.

Our fixed-effects results are consistent with both strands in the literature with caveats. First, Filipinos are more likely to work abroad when they experience less-intense tropical cyclones and storm warning signal but are more likely to stay with a more damaging storm warning signal. Second, differential effects of weather shocks on international migration contingent on agriculture exists. Third, non-environmental factors such as economic (unemployment rate) and infrastructure (number of high schools) also push Filipinos abroad.

Keywords: Migration, Natural Disaster, Panel Dataset, Agriculture, OFWs

JEL classification: C33, C36, F22

Forthcoming, Journal of Population Economics.