A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19

Carl Bonander; Debora Stranges; Johanna Gustavsson; Matilda Almgren; Malin Inghammar; Mahnaz Moghaddassi; Anton Nilsson; Joan Capdevila Pujol; Claire Steves; Paul W Franks; Maria F Gomez; Tove Fall; Jonas Björk; COVID Symptom Study Sweden

doi:10.1093/eurpub/ckac101

A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19

Carl Bonander, Debora Stranges, Johanna Gustavsson, Matilda Almgren, Malin Inghammar, Mahnaz Moghaddassi, Anton Nilsson, Joan Capdevila Pujol, Claire Steves, Paul W Franks, Maria F Gomez, Tove Fall, Jonas Björk, COVID Symptom Study Sweden

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: This paper investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviors and disease outcomes in Sweden during the first wave of the COVID-19 pandemic (March to July, 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household.

METHODS: We used a regression discontinuity design-in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96,053; age range: 39-79 years) and national register data (age range: 39-100+ years) on severe COVID-19 disease (hospitalization or death, n = 21,804) and confirmed cases (n = 48,984)-to estimate the effects of the policy.

RESULTS: Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (-13%) and severe COVID-19 cases (-16%) at the 70-year-threshold. These results imply that the age-specific recommendations prevented approximately 1,800 to 2,700 severe COVID-19 cases, depending on model specification.

CONCLUSION: It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.

SUPPLEMENTARY MATERIAL: Online appendix with figures, tables, extra methods and results.

Original language	English
Pages (from-to)	799-806
Journal	European Journal of Public Health
Volume	32
Issue number	5
Early online date	2022 Aug 13
DOIs	https://doi.org/10.1093/eurpub/ckac101
Publication status	Published - 2022

Subject classification (UKÄ)

Public Health, Global Health, Social Medicine and Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/eurpub/ckac101Licence: CC BY

PREPARE: Improved preparedness for future pandemics and other health crises through large-scale disease surveillance
Björk, J. (Researcher), Inghammar, M. (Researcher), Litins'ka, Y. (Researcher), Forsell, M. (Researcher), Ohlsson, M. (Researcher), Lingman, M. (Researcher), Wigren Byström, J. (Researcher), Almgren, M. (Researcher), Kahn, F. (Researcher), Rasmussen, M. (Researcher), Malmqvist, U. (Researcher), Mitchell, A. (Researcher), Neumann, A. (Researcher), Dietler, D. (Researcher), Bennet, L. (Researcher), Bonander, C. (Researcher), Eriksson, T. (Researcher), Björkelund, A. (Researcher), Vilhelmsson, A. (Researcher), Nilsson, A. (Researcher), Wetterberg, H. (Researcher), Hassan, M. (Research student) & Hashemi, A. S. (Researcher)
2021/01/01 → 2025/12/31
Project: Research

Cite this

Bonander, C., Stranges, D., Gustavsson, J., Almgren, M., Inghammar, M., Moghaddassi, M., Nilsson, A., Pujol, J. C., Steves, C., Franks, P. W., Gomez, M. F., Fall, T., Björk, J., & COVID Symptom Study Sweden (2022). A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19. European Journal of Public Health, 32(5), 799-806. https://doi.org/10.1093/eurpub/ckac101

@article{161d38a4ee00495092626dc3c0942894,

title = "A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19",

abstract = "BACKGROUND: This paper investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviors and disease outcomes in Sweden during the first wave of the COVID-19 pandemic (March to July, 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household.METHODS: We used a regression discontinuity design-in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96,053; age range: 39-79 years) and national register data (age range: 39-100+ years) on severe COVID-19 disease (hospitalization or death, n = 21,804) and confirmed cases (n = 48,984)-to estimate the effects of the policy.RESULTS: Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (-13%) and severe COVID-19 cases (-16%) at the 70-year-threshold. These results imply that the age-specific recommendations prevented approximately 1,800 to 2,700 severe COVID-19 cases, depending on model specification.CONCLUSION: It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.SUPPLEMENTARY MATERIAL: Online appendix with figures, tables, extra methods and results.",

author = "Carl Bonander and Debora Stranges and Johanna Gustavsson and Matilda Almgren and Malin Inghammar and Mahnaz Moghaddassi and Anton Nilsson and Pujol, {Joan Capdevila} and Claire Steves and Franks, {Paul W} and Gomez, {Maria F} and Tove Fall and Jonas Bj{\"o}rk and {COVID Symptom Study Sweden}",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.",

year = "2022",

doi = "10.1093/eurpub/ckac101",

language = "English",

volume = "32",

pages = "799--806",

journal = "European Journal of Public Health",

issn = "1101-1262",

publisher = "Oxford University Press",

number = "5",

}

Bonander, C, Stranges, D, Gustavsson, J, Almgren, M, Inghammar, M , Moghaddassi, M , Nilsson, A, Pujol, JC, Steves, C, Franks, PW , Gomez, MF, Fall, T, Björk, J & COVID Symptom Study Sweden 2022, 'A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19', European Journal of Public Health, vol. 32, no. 5, pp. 799-806. https://doi.org/10.1093/eurpub/ckac101

TY - JOUR

T1 - A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19

AU - Bonander, Carl

AU - Stranges, Debora

AU - Gustavsson, Johanna

AU - Almgren, Matilda

AU - Inghammar, Malin

AU - Moghaddassi, Mahnaz

AU - Nilsson, Anton

AU - Pujol, Joan Capdevila

AU - Steves, Claire

AU - Franks, Paul W

AU - Gomez, Maria F

AU - Fall, Tove

AU - Björk, Jonas

AU - COVID Symptom Study Sweden

PY - 2022

Y1 - 2022

N2 - BACKGROUND: This paper investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviors and disease outcomes in Sweden during the first wave of the COVID-19 pandemic (March to July, 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household.METHODS: We used a regression discontinuity design-in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96,053; age range: 39-79 years) and national register data (age range: 39-100+ years) on severe COVID-19 disease (hospitalization or death, n = 21,804) and confirmed cases (n = 48,984)-to estimate the effects of the policy.RESULTS: Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (-13%) and severe COVID-19 cases (-16%) at the 70-year-threshold. These results imply that the age-specific recommendations prevented approximately 1,800 to 2,700 severe COVID-19 cases, depending on model specification.CONCLUSION: It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.SUPPLEMENTARY MATERIAL: Online appendix with figures, tables, extra methods and results.

AB - BACKGROUND: This paper investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviors and disease outcomes in Sweden during the first wave of the COVID-19 pandemic (March to July, 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household.METHODS: We used a regression discontinuity design-in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96,053; age range: 39-79 years) and national register data (age range: 39-100+ years) on severe COVID-19 disease (hospitalization or death, n = 21,804) and confirmed cases (n = 48,984)-to estimate the effects of the policy.RESULTS: Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (-13%) and severe COVID-19 cases (-16%) at the 70-year-threshold. These results imply that the age-specific recommendations prevented approximately 1,800 to 2,700 severe COVID-19 cases, depending on model specification.CONCLUSION: It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.SUPPLEMENTARY MATERIAL: Online appendix with figures, tables, extra methods and results.

U2 - 10.1093/eurpub/ckac101

DO - 10.1093/eurpub/ckac101

M3 - Article

C2 - 35962987

SN - 1101-1262

VL - 32

SP - 799

EP - 806

JO - European Journal of Public Health

JF - European Journal of Public Health

IS - 5

ER -

A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19

Abstract

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PREPARE: Improved preparedness for future pandemics and other health crises through large-scale disease surveillance

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