A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19
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Abstract
Background
This article investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviours and disease outcomes in Sweden during the first wave of the coronavirus disease 2019 (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 1800–2700 severe COVID-19 cases, depending on model specification.
Conclusions
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.
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SciScore for 10.1101/2021.07.22.21260973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: Our study relied on an RD design, which allows for causal effect estimation in observational data under relatively weak assumptions.10 Other policies that use the same threshold may, however, bias the results.11 Sweden had no other relevant policies using a 70-year threshold during the COVID-19 pandemic. The …
SciScore for 10.1101/2021.07.22.21260973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: Our study relied on an RD design, which allows for causal effect estimation in observational data under relatively weak assumptions.10 Other policies that use the same threshold may, however, bias the results.11 Sweden had no other relevant policies using a 70-year threshold during the COVID-19 pandemic. The observed discontinuities were also isolated to the expected outcome variables, suggesting causality. The validity of our estimates also depends on appropriate modeling of the age-outcome relationship. We followed the current best practice recommendations, which is to fit simple models (linear or quadratic) within a data-driven bandwidth (age window) around the threshold.21,22 In this modeling framework, the typical concern is that the conclusions may depend heavily on the selected bandwidth.10 The Supplementary material shows that the main results are robust to other reasonable bandwidth choices. A limitation is that RDD can only be used to estimate effects for persons who are exactly 70 years old. The estimates may not generalize to older parts of the targeted age group, and the calculations in Box 1 should, therefore, be interpreted with caution. A key strength of our study was the availability of detailed and complete register data for severe COVID-19 disease, which most likely limited the extent of outcome misclassification, together with repeated assessment of social distancing during the study period. However, participants in the app study...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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