arXiv subjects

Sarika Aggarwal

Publications and source records attributed to Sarika Aggarwal.

3 recordsLinked to original sources

arXiv2026

Evaluating the effects of policy interventions subject to early adoption: A case study of prescription drug monitoring programs and opioid dispensing

Policies that require organizations to use new systems, such as prescription drug monitoring programs (PDMPs), are often implemented in phases, with an initial period of voluntary access followed by mandated compliance. This allows the policy intervention to be adopted before compliance is required (early adoption), causing outcomes to change before the mandate takes effect. When early adoption is present, the no-anticipation assumption underlying synthetic control methods (SCM) is violated, leading to biased policy effect estimates. We formalize early adoption in a potential outcomes framework for staggered policy implementation and decompose the total policy effect into early adoption and mandate components. We then propose a two-stage, early adoption-aware SCM procedure that first estimates early adoption effects using an interactive fixed effects model fit to pre-mandate data and then residualizes outcomes before applying SCM variants to estimate mandate and total policy effects. Simulations, including settings with correlation between early adoption and latent factors, show reduced bias and improved uncertainty quantification relative to conventional SCM estimators. We apply the framework to state-level PDMP policies and per-capita opioid dispensing. After accounting for early adoption, estimates suggest reductions in opioid dispensing following PDMP availability and mandates; however, the estimates are imprecise and not statistically significant.

stat.ME↗

arXiv2026

A varying-coefficient model for characterizing duration-driven heterogeneity in flood-related health impacts

Previous work revealed associations between flood exposure and adverse health outcomes during and in the aftermath of flood events. Floods are highly heterogeneous events, largely owing to vast differences in flood durations, i.e., flash-floods versus slow-moving floods. However, little to no work has incorporated exposure duration into the modeling of flood-related health impacts or has investigated duration-driven effect heterogeneity. To address this gap, we propose an exposure duration varying coefficient modeling (EDVCM) framework for estimating exposure day-specific health effects of consecutive-day environmental exposures that vary in duration. We develop the EDVCM within an area-level self-matched study design to eliminate time-invariant confounding followed by conditional Poisson regression modeling for exposure effect estimation and adjustment of time-varying confounders. Using a Bayesian framework, we introduce duration- and exposure day-specific exposure coefficients within the conditional Poisson model and assign them a two-dimensional Gaussian process prior to allow for sharing of information across both duration and exposure day. This approach enables highly-resolved insights into duration-driven effect heterogeneity while ensuring model stability through information sharing. Through simulations, we demonstrate that the EDVCM out-performs conventional approaches in terms of both effect estimation and uncertainty quantification. We apply the EDVCM to nationwide, multi-decade Medicare claims data linked with high-resolution flood exposure measures to investigate duration-driven heterogeneity in flood effects on musculoskeletal system disease hospitalizations.

stat.AP↗

arXiv2023

Severe flooding and cause-specific hospitalization in the United States

Flooding is one of the most disruptive and costliest climate-related disasters and presents an escalating threat to population health due to climate change and urbanization patterns. Previous studies have investigated the consequences of flood exposures on only a handful of health outcomes and focus on a single flood event or affected region. To address this gap, we conducted a nationwide, multi-decade analysis of the impacts of severe floods on a wide range of health outcomes in the United States by linking a novel satellite-based high-resolution flood exposure database with Medicare cause-specific hospitalization records over the period 2000- 2016. Using a self-matched study design with a distributed lag model, we examined how cause-specific hospitalization rates deviate from expected rates during and up to four weeks after severe flood exposure. Our results revealed that risk of hospitalization was consistently elevated during and for at least four weeks following severe flood exposure for nervous system diseases (3.5 %; 95 % confidence interval [CI]: 0.6 %, 6.4 %), skin and subcutaneous tissue diseases (3.4 %; 95 % CI: 0.3 %, 6.7 %), and injury and poisoning (1.5 %; 95 % CI: -0.07 %, 3.2 %). Increases in hospitalization rate for these causes, musculoskeletal system diseases, and mental health-related impacts varied based on proportion of Black residents in each ZIP Code. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after severe flooding.

stat.AP↗