
Atheendar S VenkataramaniUniversity of Pennsylvania | UP · Department of Medical Ethics and Health Policy
Atheendar S Venkataramani
MD, PhD
About
181
Publications
27,915
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
4,672
Citations
Introduction
My research investigates the origins of health and socioeconomic inequality. I am particularly interested in the roles of early life investments, social policies, and economic opportunity in shaping health behaviors and outcomes.
Please message me if you want copies of gated papers.
Additional affiliations
May 2014 - present
Southern Africa Labour and Development Research Institute, University of Cape Town
Position
- Research Affiliate
June 2011 - July 2015
June 2011 - present
Education
August 2005 - June 2009
Yale University
Field of study
- Health Policy/Economics
August 2003 - June 2011
August 1998 - August 2002
Publications
Publications (181)
Growing evidence from evolutionary biology demonstrates how early life shocks trigger physiological changes designed to be adaptive in challenging environments. We examine the implications of one type of physiological adaptation-immunity formation-for human capital accumulation. Using variation in early life malaria risk generated by an interrupted...
The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to ‘deaths of despair’. Increasing automation—the use of industrial robots to perform tasks previously done by human workers—is one major structural force driving the decline of manufacturing jobs a...
Importance
People with disabilities experience pervasive health disparities driven by adverse social determinants of health, such as unemployment. Section 14(c) of the 1938 Fair Labor Standards Act has been a controversial policy that allows people with disabilities to be paid below the prevailing minimum wage, but its impact on employment remains...
A common practice in evidence-based decision-making uses estimates of conditional probabilities P(y|x) obtained from research studies to predict outcomes y on the basis of observed covariates x. Given this information, decisions are then based on the predicted outcomes. Researchers commonly assume that the predictors used in the generation of the e...
We investigate women’s fertility, labor and marriage market responses to a health innovation that led to reductions in mortality from treatable causes, and especially large declines in child mortality. We find delayed childbearing, with lower intensive and extensive margin fertility, a decline in the chances of ever having married, increased labor...
Cost-effectiveness analyses are commonly used to inform health care and public health policy decisions. However, standard approaches may systematically disadvantage marginalized groups by incorporating assumptions of persisting health inequities. We examined how competing risks, baseline health care costs, and indirect costs can differentially affe...
We hypothesize that deepening resource scarcity results in rationing on the basis of group identity in settings with underlying discrimination. We provide evidence of such race-based rationing in a high-stakes setting: health care. Using detailed, time-stamped data on 107,000 patient admissions to a large health system, we find that in-hospital mor...
Our previously published work (Bor, Venkataramani, Williams, and Tsai, 2018) showed that officer-involved killings of unarmed Black people have adverse mental health spillover effects on Black people in the general U.S. population. In a recent preprint, McCrain, Adams, Nix, and Del Pozo (2024) raised concerns about our methods, findings, and the in...
Importance
The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known.
Objective
To assess the association between state adoption of the Affordable Care Act’s Medicaid expansion—which led to substantial improvements in health care organization finance...
Importance
Racial disparities in sleep health may mediate the broader health outcomes of structural racism.
Objective
To assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism.
Design, Setting, and Participants
Two distinct difference-in-diffe...
Importance
The US is unique among wealthy countries in its degree of wealth inequality and its poor health outcomes. Wealth is known to be positively associated with longevity, but little is known about whether wealth redistribution might extend longevity.
Objective
To examine the association between wealth and longevity and estimate the changes i...
This cross-sectional study uses American Community Survey data to assess disability earnings gaps for physicians between 2005 and 2019.
An estimated 17.6% of blue-collar, manufacturing jobs were lost in the United States between 1970 and 2016. These jobs, often union-represented, provided relatively generous pay and benefits, creating a path to the middle class for individuals without a four-year college degree. Evidence suggests the closure of manufacturing facilities and resultin...
Importance
Federal and state policymakers continue to pursue work requirements and premiums as conditions of Medicaid participation. Opinion polling should distinguish between general policy preferences and specific views on quotas, penalties, and other elements.
Objective
To identify views of adults in Kentucky regarding the design of Medicaid wo...
This cross-sectional study examines the association between labor unions and health care staff turnover in the US using data from 2021.
All US nursing homes are required to report workplace injury and illness data to the Occupational Safety And Health Administration (OSHA). Nevertheless, the compliance rate for US nursing homes during the period 2016-21 was only 40 percent. We examined whether unionization increases the probability that nursing homes will comply with that requireme...
The use of race measures in clinical prediction models is contentious. We seek to inform the discourse by evaluating the inclusion of race in probabilistic predictions of illness that support clinical decision making. Adopting a static utilitarian framework to formalize social welfare, we show that patients of all races benefit when clinical decisi...
We examined children's Medicaid participation during 2019-21 and found that as of March 2021, states newly adopting continuous Medicaid coverage for children during the COVID-19 pandemic experienced a 4.62 percent relative increase in children's Medicaid participation compared to states with previous continuous eligibility policies.
We assessed how many U.S. deaths would have been averted each year, 1933-2021, if U.S. age-specific mortality rates had equaled those of other wealthy nations. We refer to these excess U.S. deaths as “missing Americans”. The U.S. had lower mortality rates than peer countries in the 1930s-50s and similar mortality in the 1960s and 70s. However, begi...
Background:
The federal Earned Income Tax Credit (EITC) is the primary income support program for low-income workers in the U.S., but its design may hinder its effectiveness when poor health limits, but does not preclude, work.
Methods:
Cross-sectional analysis of nationally-representative U.S. Census Current Population Survey (CPS) data coverin...
Importance:
Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies.
Objective:
To investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which pro...
Objectives:
In the United States, caregivers of children and youth with special healthcare needs (CYSHCN) must navigate complex, inefficient health care and insurance systems to access medical care. We assessed for sociodemographic inequities in time spent coordinating care for CYSHCN and examined the association between time spent coordinating ca...
Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota legislation across developing countries, we identify sharp sustained reductions of 7–12 percent in ma...
Abstract
Importance In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. The role of wealth inequality in mediating racial health inequities is unclear.
Objective To assess the contribution of wealth inequities to the longevi...
Background
Violent crime has recently increased in many major metropolitan cities in the United States. Prior studies suggest an association between neighborhood crime levels and cardiovascular disease, but many have been limited by cross‐sectional designs. We investigated whether longitudinal changes in violent crime rates are associated with chan...
We assessed how many U.S. deaths would have been averted each year, 1933-2021, if U.S. age-specific mortality rates had equaled those of other wealthy nations. The annual number of excess deaths in the U.S. increased steadily beginning in the late 1970s, reaching 626,353 in 2019. Excess deaths surged during the COVID-19 pandemic. In 2021, there wer...
Since the start of the COVID-19 pandemic, nursing home residents have accounted for roughly one of every six COVID-19 deaths in the United States. Nursing homes have also been very dangerous places for workers, with more than one million nursing home workers testing positive for COVID-19 as of April 2022. Labor unions may play an important role in...
Objective:
The objective of this study is to assess changes in local economic outcomes before and after rural hospital closures.
Data sources:
Rural hospital closures from January 1, 2005, to December 31, 2018, were obtained from the Sheps Center for Health Services Research. Economic outcomes from this same period were obtained from the Bureau...
The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to “deaths of despair.” Increasing automation—the use of industrial robots to perform tasks previously done by human workers—is one structural force driving the decline of manufacturing jobs and wag...
Background
Greater US local public health department (LPHD) spending has been associated with decreases in population-wide mortality. We examined the association between changes in LPHD spending between 2008 and 2016 and county-level sociodemographic indicators of public health need.
Methods
Multivariable linear regression was used to estimate the...
Historically, improvements in municipal water quality led to substantial mortality decline in today’s wealthy countries. However, water disinfection has not consistently produced large benefits in lower-income countries. We study this issue by analyzing a large-scale municipal water disinfection program in Mexico that increased water chlorination c...
Background
Greater US local public health department (LPHD) spending has been associated with decreases in population-wide mortality. We examined the association between changes in LPHD spending between 2008 and 2016 and county-level sociodemographic indicators of public health need.
Methods
Multivariable linear regression was used to estimate the...
Deindustrialization has fundamentally reshaped the economic geography of the United States. Between 1993 and 2007 alone, increasing automation—the use of industrial robots to perform tasks done by human workers—led to the loss of upwards of 750,000 jobs, primarily in the industrial Midwest and Northeast. Prior research demonstrates the social conse...
The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including increased mortality due to rising ‘deaths of despair’. Increasing automation—the use of industrial robots to perform tasks previously done by human workers—is one major structural force driving the decline of manufactur...
Background
Oral health care use remains low among adult Medicaid recipients, despite the Patient Protection and Affordable Care Act’s expansion increasing access to care in many states. It remains unclear the extent to which low use reflects either low demand for care or barriers to accessing care. The authors aimed to examine factors associated wi...
Significance
Poverty confers many costs on individuals, primarily through constraining material resources. Poverty may also worsen welfare by reducing the utility (or enjoyment) individuals may get from whatever little they are able to consume by constraining cognitive resources—conferring a “double tax” on the wellbeing of the poor. However, the i...
Importance
Housing insecurity induced by evictions may increase the risk of contracting COVID-19.
Objective
To estimate the association of lifting state-level eviction moratoria, which increased housing insecurity during the COVID-19 pandemic, with the risk of being diagnosed with COVID-19.
Design, Setting, and Participants
This retrospective coh...
During the COVID-19 pandemic, safely reopening schools has been one of the most pressing public health challenges in the United States. At the beginning of the 2020-21 school year, the Centers for Disease Control and Prevention strongly encouraged schools to require mask wearing. Although teachers unions frequently supported such policies, the adop...
Objectives. To evaluate changes in mortality in US counties along the US–Mexico border in which there was substantial new border wall construction after the Secure Fence Act of 2006 relative to border counties in which there was no such border wall construction.
Methods. Using complete 1990 to 2017 mortality microdata and a quasi-experimental diffe...
Restrictive immigration policies are important social determinants of health, but less is known about the health implications and health-related content of protective immigration policies, which may also represent critical determinants of health. We conducted a content analysis of types, themes, and health-related language in 328 "sanctuary" polici...
Aggressive deportation policy enforcement in the US may make undocumented immigrants and those close to them reluctant to seek medical care. With 68 percent of undocumented immigrants coming from Mexico or Central America, US deportation policies particularly affect Hispanic residents. To examine how deportation enforcement relates to health care u...
Objectives
Multiple states have passed legislation permitting marijuana use. The impact of legalization on trends in hospital encounters for marijuana exposures in young children across states remains unknown. We aimed to describe trends in marijuana-related hospital encounters over time in children <6 years and assess the association of state-leve...
Introduction:
This paper describes the methodology of partial identification and its applicability to empirical research in preventive medicine and public health.
Methods:
The authors summarize findings from the methodologic literature on partial identification. The analysis was conducted in 2020-2021.
Results:
The applicability of partial ide...
This cross-sectional study assesses inquiries to a child distress hotline during the COVID-19 pandemic compared with inquiries during the same period the previous year.
Importance
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that st...
Introduction
In response to the coronavirus disease 2019 (COVID-19) pandemic, governments have implemented social distancing measures to slow viral transmission. This work aims to determine the extent to which socioeconomic and political conditions have shaped community-level distancing behaviors during the COVID-19 pandemic, especially how these d...
Even before the coronavirus disease 2019 (COVID-19) pandemic occurred, the US was mired in a 40-year population health crisis. Since 1980, life expectancy in the US has increasingly fallen behind that of peer countries, culminating in an unprecedented decline in longevity since 2014.¹ Life expectancy at birth in the US in 1980 was 73.6 years, in 20...
Importance:
After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear.
Objective:
To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-ag...
Importance
More than 50 million US residents have lost work during the coronavirus disease 2019 (COVID-19) pandemic, and food insecurity has increased.
Objective
To evaluate the association between receipt of unemployment insurance, including a $600/wk federal supplement between April and July, and food insecurity among people who lost their jobs...
Introduction: Prior analyses suggest a link between food insecurity and cardiovascular (CV) health but are limited by cross-sectional designs. We investigated whether longitudinal changes in food insecurity are independently associated with CV mortality.
Methods: Using National Center for Health Statistics data, we determined annual U.S. county-lev...
Section 1115 demonstration waivers provide a mechanism for states to implement changes to their Medicaid programs. While such waivers are mandated to include evaluations of their impact, randomization – the gold standard for assessing causality – has not typically been a consideration. In a critical departure, the Commonwealth of Kentucky opted to...
[This corrects the article DOI: 10.1371/journal.pmed.1003244.].
More than 40% of all reported coronavirus disease 2019 (COVID-19) deaths in the United States have occurred in nursing homes. As a result, health care worker access to personal protective equipment (PPE) and infection control policies in nursing homes have received increased attention. However, it is not known if the presence of health care worker...
• The United States is in the midst of a 40-year-long population health crisis. Life expectancy has declined since 2014, an unprecedented event that has followed on the heels of a decades-long slowing in secular gains in longevity in the US relative to peer countries. These adverse population health trends appear to be primarily driven by worsening...
Background
Social distancing measures to address the US coronavirus disease 2019 (COVID-19) epidemic may have notable health and social impacts.
Methods and findings
We conducted a longitudinal pretest–posttest comparison group study to estimate the change in COVID-19 case growth before versus after implementation of statewide social distancing me...
More than a dozen states have sought federal approval for Section 1115 Medicaid waivers to make premiums and work requirements (ie, requirements to work, volunteer, or engage in education, or caretaking), a condition of Medicaid eligibility for adults deemed able‐bodied. Support for these waivers may differ among adults based on Medicaid participat...
Forty million U.S. residents lost their jobs in the first two months of the coronavirus disease 2019 (COVID-19) pandemic. In response, the Federal Government expanded unemployment insurance benefits in both size ($600/week supplement) and scope (to include caregivers and self-employed workers). We assessed the relationship between unemployment insu...
Background:
Social distancing is encouraged to mitigate viral spreading during outbreaks. However, the association between distancing and patient-centered outcomes in Covid-19 has not been demonstrated. In the United States social distancing orders are implemented at the state level with variable timing of onset. Emergency declarations and school...
This cohort study examines the association of implementation of Medicaid sanctions in the Temporary Assistance for Needy Families program with Medicaid coverage rates among low-income adults.
The U.S. is the epicenter of the coronavirus disease 2019 (COVID-19) pandemic. In response, governments have implemented measures to slow transmission through "social distancing." However, the practice of social distancing may depend on prevailing socioeconomic conditions and beliefs. Using 15-17 million anonymized cell phone records, we find that...
In this study, we introduce the ‘racial opportunity gap’ as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial vari...
Early antiretroviral therapy (ART) initiation is essential, but linkage to care following community-based services is often poor, and inadequately understood. This study examined factors influencing linkage to care following home-based HIV-testing services (HBHTS) in a hyper-endemic setting in South Africa. HBHTS was offered to participants (N = 10...
Nix and Lozada (2020) provide a critique of our 2018 paper, “Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study.” They take issue to our use of crowdsourced data from the Mapping Police Violence project database on whether or not a given victim was unarmed, our main expo...
Importance
Despite substantial research, the drivers of the widening gap in life expectancy between rich and poor individuals in the United States—known as the longevity gap—remain unknown. The hypothesis of this study is that social mobility may play an important role in explaining the longevity gap.
Objective
To assess whether social mobility is...
Medicare has reinforced its commitment to voluntary bundled payment by building upon the Bundled Payments for Care Improvement (BPCI) initiative via an ongoing successor program, the BPCI Advanced Model. Although lower extremity joint replacement (LEJR) is the highest-volume episode in both BPCI and BPCI Advanced, there is a paucity of independent...
Importance:
Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities.
Objective:
To estimate the extent to which automotive assembly plant closures were assoc...
Background. Dental utilization remains low among adults on Medicaid, despite the ACA expansion increasing access to care in many states. It remains unclear whether low utilization reflects low demand or other barriers. Our objective was to examine factors associated with poor perceived dental health and low dental utilization among adults on Medica...
Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis.
Public and private sector organizations are continuously developing new policies and interventions to improve health behaviors, health outcomes, and health care delivery. Examples include payment reforms (such as pay for performance or bundled payments), incentives for healthy behaviors, workplace wellness programs, and changing benefit packages an...
Importance
An increasing number of hospitals have participated in Medicare’s bundled payment and accountable care organization (ACO) programs. Although participation in bundled payments has been associated with savings for lower-extremity joint replacement (LEJR) surgery, simultaneous participation in ACOs may be associated with different outcomes...