About

José Pagán is a Professor and the Chair of the Department of Public Health Policy and Management at NYU School of Global Public Health. He received his PhD in economics from the University of New Mexico and is a former Robert Wood Johnson Foundation Health & Society Scholar. His expertise encompasses health economics and population health, with a focus on health care delivery and payment system redesign. Dr. Pagán has led research, implementation, and evaluation projects funded by various organizations including the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the European Commission, and the Robert Wood Johnson Foundation. He serves as Chair of the Board of Directors of NYC Health + Hospitals, the largest public healthcare system in the United States. His research interests include population health management, health care payment and delivery system reform, and the social determinants of health.

Research topics

• Sociology
• Environmental health
• Medicine
• Family medicine
• Computer Science
• Gerontology
• Political Science
• Geography
• Demography
• Telecommunications
• Demographic economics
• Virology
• Nursing
• Economic growth
• Socioeconomics
• Economics

Selected publications

• Association Between Hospital Participation in the Global Budget Revenue Model and Surgical Outcomes Among Traditional Medicare Beneficiaries Undergoing Cancer Surgery

  Annals of Surgery · 2026-04-17

  article

  OBJECTIVE: To evaluate the relationship between the Global Budget Revenue (GBR) model and surgical outcomes. SUMMARY BACKGROUND DATA: Medicare tested GBR in Maryland, wherein hospitals received a fixed annual revenue to cover healthcare delivery for their population. The relationship between GBR implementation and outcomes after cancer surgery is unclear. METHODS: Observational difference-in-differences analysis using 100% national Medicare data to compare changes in outcomes between GBR hospitals and matched control hospitals before (2011-2013) and after (2014-2018) policy implementation in Traditional Medicare beneficiaries undergoing cystectomy, prostatectomy, or nephrectomy for cancer. The primary outcome was achievement of a textbook outcome, defined as the absence of in-hospital and 30-day mortality, postoperative complications, a prolonged length of stay (i.e., above the 75th percentile by procedure and year) and readmission within 30 days of discharge. The secondary outcome was Medicare inpatient spending. RESULTS: This study included 23 Maryland hospitals with 4,910 beneficiaries and 371 control hospitals with 57,456 beneficiaries. Textbook outcomes increased from 72.8% to 76.1% in GBR hospitals and from 70.2% to 70.5% in matched controls, a differential increase of 2.9 percentage points (95% CI, 0.5 to 5.3; P=0.02). The greater improvement at GBR hospitals was a result of reducing complications (-1.5 percentage points; 95% CI, -2.9 to -0.1) and limiting prolonged lengths of stay (-1.8 percentage points; 95% CI, -2.9 to -0.7). Medicare inpatient spending declined by $771 (95% CI, -$1,275 to -$267) more at GBR hospitals. CONCLUSIONS: The GBR was associated with improved surgical outcomes and lower Medicare inpatient spending.

  PublisherDOI

• Overall and Avoidable Healthcare Utilization among Heterogeneous Hispanic/Latino Ethnic Groups with Cognitive Impairment in the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA)

  Journal of Racial and Ethnic Health Disparities · 2026-01-05

  articleOpen access
  PublisherOA PDFDOI

• Ghost gun recovery and firearm deaths in California, 2014–2023

  Journal of Epidemiology & Community Health · 2026-01-13 · 1 citations

  article

  BACKGROUND: We investigated whether ghost gun recovery rates are significantly associated with firearm mortality rates in the following year across California's 58 counties from 2014 to 2023. METHODS: We obtained yearly county-level data on ghost guns recovered in California from The Trace's Gun Violence Data Hub. County-level firearm death counts (total, suicide and homicide) were pulled from the Centers for Disease Control and Prevention's Restricted-Use Vital Statistics Data. Spatiotemporal models quantified the covariate-adjusted associations between ghost gun recoveries per capita and firearm death rates (total, suicide and homicide) in the following year. Secondary analyses examined suicide and homicide models stratified by sex and race/ethnicity. RESULTS : For every 20 ghost guns recovered per 100 000 population, there was an associated 6.4% increase in firearm suicide rate (adjusted incidence rate ratio (aIRR): 1.064, 95% credible interval (CrI) 1.019 to 1.111) in the following year. We found no evidence of a significant ghost gun recovery association with total firearm death rate (aIRR: 1.036, 95% CrI 0.999 to 1.075) and firearm homicide rates (aIRR: 1.002, 95% CrI 0.946 to 1.064). Stratified models for firearm suicide rates suggested variations across sex and racial/ethnic groups, with significant positive associations observed for male (6.5% increase; aIRR: 1.065, 95% CrI 1.017 to 1.115), non-Hispanic white (6.2% increase; aIRR: 1.062, 95% CrI 1.005 to 1.122) and Hispanic (12.6% increase; aIRR: 1.126, 95% CrI 1.031 to 1.230) individuals. A different pattern emerged for firearm homicide death rates, where associations across demographic groups were not statistically significant. CONCLUSIONS: Practitioners concentrating on suicide prevention efforts should be advised about the threat that ghost guns may present.

  PublisherDOI

• Association between subway iron particulate matter exposure and respiratory disease in New York City

  PLOS Global Public Health · 2026-01-07

  articleOpen access

  Particulate matter exposure is linked to increased morbidity and mortality. Iron-rich particulate matter (PM2.5), common in rapid transit systems, is a potential but understudied contributor to respiratory illness. Using electronic health records (EHR) from 452,272 patients in the INSIGHT Clinical Research Network in New York City (2020-2023), we examined whether local iron exposure is associated with asthma, chronic obstructive pulmonary disease (COPD), breathing difficulties, or respiratory inhaler use. Iron exposure was estimated using particulate matter measurements from New York City (NYC) subway stations, linked to each patients residential census block group. To account for potential non-linear relationships, we applied linear probability models and an adjacent block group estimator with paired fixed effects to assess respiratory outcomes across deciles of iron exposure. We found that the relative risk of developing asthma, COPD, or breathing difficulties increased by 6-15% between the lowest two exposure deciles. Beyond this range, there was no significant association between iron exposure and respiratory disease. This suggests that iron exposure from rapid transit is associated with respiratory disease primarily at lower exposure levels, with limited health benefits from marginal reductions in iron exposure at already high exposure levels.

  PublisherDOI

• Ghost Gun Recovery and Firearm Deaths in California, 2014-2023

  medRxiv · 2025-09-09

  preprintOpen access

  Abstract Background Ghost guns are untraceable firearms assembled from online parts kits without background checks or waiting periods. Police nationally recovered 17 times more ghost guns in 2023 than 2017, yet the relationship between ghost gun recovery and firearm mortality is understudied. We investigated whether ghost gun recovery rates are significantly associated with subsequent firearm mortality rates across California’s 58 counties from 2014 to 2023. Methods We obtained yearly county-level data on ghost guns recovered in California from The Trace’s Gun Violence Data Hub, which aggregated data from the California Department of Justice’s October 2024 report California’s Fight Against the Ghost Gun Crisis: Progress and New Challenges. County-level firearm death counts (total, suicide, homicide) were pulled from the Centers for Disease Control and Prevention’s Restricted-Use Vital Statistics Data. Covariates included (1) urbanicity measured using the Rural-Urban Continuum Codes from the U.S. Department of Agriculture and (2) economic/racial segregation assessed by the Index of Concentration at the Extremes for income and race/ethnicity. We employed a hierarchical Bayesian approach to quantify the associations between ghost gun recoveries per capita and total firearm death rates in the following year. Exploratory analyses examined whether urbanicity and economic/racial segregation were significantly related to ghost gun recovery rates from 2014 to 2023. Results Controlling for urbanicity and economic/racial segregation, spatiotemporal models indicated that for every 20 ghost guns recovered per 100,000 population, there was an associated 5% increase in total firearm death rate (IRR: 1.05, 95% CrI: 1.02-1.08) and a 5% increase in firearm suicide rate (IRR: 1.05, 95% CrI: 1.02-1.09) in the following year. Ghost gun recovery rates were 298% higher in urban versus rural counties (IRR: 3.98, 95% CrI: 2.37-6.94) and increased 113% per 0.25-unit increase in economic/racial segregation score (IRR: 2.13, 95% CrI: 1.11-4.19). Conclusions This study provides the first empirical evidence examining the relationship between ghost gun recovery rates and subsequent increases in firearm mortality, particularly firearm suicides, across California counties from 2014 to 2023. Practitioners concentrating on suicide prevention efforts should be advised about the threat that ghost guns may present.

  PublisherOA PDFDOI

• Adolescent utilization of school based mental health services in the United States

  International Journal of Mental Health Systems · 2025-08-20 · 1 citations

  articleOpen access

  BACKGROUND: Over 14 million adolescents have a diagnosable mental, behavioral, or emotional disorder yet only 20% receive adequate mental health services. There is a critical need to identify accessible and effective pathways to treatment. School based mental health services (SBMHS) are an optimal setting for timely identification, effective management, and convenient delivery of evidence-based mental health care. METHODS: Using data from the 2019 National Survey on Drug Use and Health, we employed structural equation modeling to examine the relationships between utilization of SBMHS and school and academic engagement, religiosity, self-reported depressive symptoms, and parental monitoring and support. RESULTS: Higher levels of parental monitoring and support (ß = -0.044, p < 0.05) and religiosity (ß = -0.027, p < 0.05) along with lower levels of school and academic engagement (ß = 0.069, p < 0.001) were associated with decreased adolescent utilization of SBMHS. Adolescents reporting a higher number of depressive symptoms on a scale of 1 to 9 (ß = 0.221, p < 0.001) were more likely to utilize SBMHS compared to their counterparts. Self-reported depressive symptoms mediated the relationship between all latent variables (parental monitoring and support [ß = -0.222, p < 0.001]; religiosity [ß = -0.051, p < 0.001]; school and academic engagement [ß = -0.067, p < 0.001]) and adolescent utilization of SBMHS. CONCLUSION: Findings from this study offer psychologists, teachers, counselors, school nurses, and administrators specific determinants of service use that can be used to develop strategies for adolescent mental health assessment, increase SBMHS utilization among those in need, and support overall emotional well-being.

  PublisherOA PDFDOI

• Remote work and mental health among employed US adults

  Occupational Medicine · 2025-06-17 · 5 citations

  article

  BACKGROUND: Existing research presents mixed findings regarding the effect of remote work on mental health, suggesting both beneficial and adverse outcomes. AIMS: To quantify the association between remote work status and depression/anxiety risk among employed US adults. METHODS: Repeated cross-sectional data (September 2022 to October 2023) from the Household Pulse Survey, a nationally representative sample of US adults. Depression risk (Cronbach's α 0.74) was measured using Patient Health Questionnaire-2, and anxiety risk (Cronbach's α 0.82) was assessed using the Generalized Anxiety Disorder-2. Weighted logistic regression models estimated covariate-adjusted associations between remote work status (0, 1-2, 3-4, 5+ days) and depression and anxiety risk. Covariates included race/ethnicity, gender identity, marital status, age, educational attainment, household income, number of children, employment sector, region, and survey cycle. RESULTS: Individuals who worked remotely for 1 to 2 days or 3 to 4 days per week (both adjusted OR [aOR]: 0.98, 95% CI 0.96-0.99) had slightly lower odds of depression risk than those who did not work remotely. Conversely, individuals who worked remotely for 5 or more days per week (aOR: 1.02, 95% CI 1.01-1.04) had slightly higher odds of anxiety risk compared to nonremote workers after controlling for the same covariates. CONCLUSIONS: Remote work status may be a social determinant of mental health. Our findings suggested that hybrid work may be a healthful working style. Longitudinal studies are needed to establish temporal relationships and potential causality between remote work arrangements and mental health risks.

  PublisherDOI

• Violent crime victimization and mental health among adolescents in Mexico

  Preventive Medicine Reports · 2025-04-07 · 2 citations

  articleOpen accessSenior author

  To understand the association between violent crime victimization and mental health outcomes among adolescents in Mexico, and to define the link between the nominal classification of violent crime and mental health outcomes. We used fixed-effects linear and logistic regressions and survey data from the 2018–2019, 2021, 2022, and 2023 National Health and Nutrition Survey ( n = 26,187). Survey waves were conducted in all 32 Mexican states during: July 2018–June 2019, July–December 2021, July–December 2022, and July–October 2023. Violent crime victimization was associated with higher scores of having depressive symptoms (CESD-7) (b = 1.93 points, ± 0.26), and greater likelihood of suicidal ideation (adjusted odds ratio (aOR) = 5.32, ± 0.86) and suicide attempts in the last twelve months (aOR = 6.87, ± 2.74). More serious classes of violent crime relate to worse mental health outcomes among adolescents. Specifically, kidnapping, the most serious class of violent crime in our data, correlates with worse mental health outcomes when compared to robbery or aggravated assault. Violent crime victimization is linked to increased depressive symptoms, suicidal ideation, and suicide attempts among adolescents. More serious classes of violent crime are associated with worse mental health outcomes in this population. • Does violent crime victimization affect mental health among the adolescent population? • Is there a link between the degree of violent crime and mental health outcomes? • Results indicate that crime victimization is associated with worse mental health. • The treated group showed more depressive symptoms and suicidal ideation and attempts. • The severity of violent crime correlates with worsening adolescent mental health.

  PublisherDOI

• Population, demographic and socioeconomic characteristics associated with state preemption laws in the United States, 2009–2018

  PLoS ONE · 2025-04-04

  articleOpen access1st authorCorresponding

  OBJECTIVE: In the United States, preemption laws enacted by state governments can remove local government authority to enact policy and undermine community self-determination and local democracy. No study to date has evaluated the population, demographic, and socioeconomic characteristics associated with state preemption of public health policies. Our study identifies state characteristics associated with preemption of local paid sick leave, food and nutrition, tobacco control, and firearm safety policies. METHODS: We conducted a Classification and Regression Tree (CART) analysis using state-level demographic, socioeconomic, and population health indicators from 2009 to 2018 to predict state ceiling preemption of local paid sick leave, food and nutrition, tobacco control, and firearm safety policies. RESULTS: Several demographic, economic, political, and health factors best distinguish states with and without preemption in each of the four domains. Total state population was an important characteristic in all four trees and the non-Hispanic Black population was important in three trees. All other age- and race/ethnicity-related demographic variables included were important characteristics in at least one tree. Additionally, adult obesity and flu vaccination were relevant in the paid sick leave tree and firearm-deaths, suicide-deaths, and the unemployment rate were relevant in the firearm safety tree. The relationship between specific factors and preemption in each of the four domains varied depending on the location of the factor within the trees. CONCLUSIONS AND RELEVANCE: Specific population, demographic and economic characteristics in a state are associated with the adoption of ceiling preemption of paid sick, food and nutrition, tobacco, and firearm safety laws, but these characteristics vary by domain. Our study identified which populations within groups of states may be affected by preemption. The findings can inform whether preemption laws considered or adopted in a state may also require protective measures for population groups that could be adversely affected by these laws.

  PublisherDOI

• Remote work and loneliness: Evidence from a nationally representative sample of employed U.S. adults

  Journal of Affective Disorders · 2025-10-13 · 3 citations

  article
  PublisherDOI

Frequent coauthors

• Yan Li

  Icahn School of Medicine at Mount Sinai

  96 shared

• Donglan Zhang

  New York University

  40 shared

• Carolyn C. Cannuscio

  University of Pennsylvania

  36 shared

• Dawn E. Alley

  Defense Advanced Research Projects Agency

  34 shared

• Christopher K. Fairley

  Melbourne Sexual Health Centre

  33 shared

• Erica L. Stockbridge

  32 shared

• David A. Asch

  32 shared

• Dejun Su

  University of Nebraska Medical Center

  30 shared

Awards & honors

• Delta Omega Honorary Society in Public Health
• Ellen C. Gstalder Memorial Scholarship