Selected Working Papers:
Misdated at Birth: The Consequences of a Slow Clinical Clock (Job Market Paper - JMP)
The latest version is available here!
Many healthcare decisions depend on measurements that determine when patients receive different types of care. This paper studies whether improving such measurements can also change treatment and health outcomes in unexpected ways. I examine the introduction of routine ultrasound for pregnancy dating in Sweden. Ultrasound estimates how long a pregnancy has lasted based on the size of the fetus. Before ultrasound became widely used, pregnancy duration was mainly calculated from the date of the mother's last menstrual period. Because the estimated duration of a pregnancy determines whether a birth is considered early, on time, or late, changing how pregnancy duration is measured can also change the timing of medical monitoring and care. Using linked Swedish administrative data from 1977 to 1987, I exploit differences in how quickly hospitals adopted ultrasound dating in an instrumental variables design. I find that ultrasound shifted births across the thresholds used to classify them as early, on time, or late. These changes affected early-life health and healthcare use after birth. For longer pregnancies, I also find evidence of effects on educational outcomes later in life for females. The results show that even a technology that improves medical measurement can have unintended effects when the resulting measurements determine how and when patients receive care.
Shifting Access to Care: Evidence from Hospital Closures and Openings in Brazil (Work in progress)
With: Valdemar Neto and Soraya Roman.
This paper studies how changes in hospital access affect newborn health outcomes in Brazil. Using administrative data on births and hospital availability, I identify municipality-level access shocks based on the loss or gain of important hospital routes and estimate their effects using a staggered difference-in-differences design with event-study specifications. The results suggest that hospital closures worsen newborn health, while hospital openings partly offset these effects. The project contributes to the literature on service delivery, spatial inequality, and human capital in developing countries.
Do Pregnancy Complications Shape Sisters’ Fertility Decisions? Evidence from Within-Family Exposure (Work in progress)
With: Mikael Elinder and Oscar Erixson.
This paper studies whether pregnancy complications affect not only the fertility decisions of the woman who directly experiences the complication, but also the subsequent fertility behavior of her sisters. Using linked family data, the analysis compares sibships in which the first pregnancy among sisters involved a complication with sibships in which the first pregnancy did not. The empirical strategy uses difference-in-differences models to separate the direct effect of experiencing a complication from the indirect effect of being exposed to a sister’s complicated pregnancy.
Selected Publications and Policy Reports:
Can maternal characteristics improve due date prediction without ultrasound? Development and internal validation of a machine-learning prediction model in 600 000 pregnancies in Sweden (BMJ Open)
With: Mikael Elinder and Oscar Erixson. (Link to the article!)
Inequalities in the geographic access to delivery services in Brazil (BMC Health Services Research)
With: Valdemar Pinho Neto, Cecilia Machado, Felipe Lima, and Soraya Roman. (Link to the article!)
Evaluation of data on deaths due to COVID-19 from the databases of the Civil Registry (RC-Arpen), SIVEP-Gripe, and SIM in Brazil in 2020 (Cadernos de Saúde Pública)
With: Ricardo Guedes, Cecilia Machado, and Marina Aguiar Palma (Link to the article!)
The Relationship Between Disarmament and Crime Rates in the State of São Paulo (In Portuguese)
With: Lucas Adriano Silva, Pedro Rodrigues Oliveira, and Viviani Silva Lírio (Link to the report!)
The Occurrence of Crimes During the COVID-19 Pandemic: Initial Investigations for the State of Rio Grande do Sul (In Portuguese)
With: Ana Cecília de Almeida, Felipe Nathan Ferreira dos Santos, and Bruno Truzzi (Link to the report!)
Gender and Racial Inequalities in the Health Sector: An Intersectional Analysis (In Portuguese)
With: Marcos Duarte, Alexandre Almeida, Davi Costa, Soraya Roman, and Valdemar Pinho Neto (Brazilian Public Call No. 22/2023)