Open AccessPosted Content
Can Patient Self-Management Help Explain the SES Health Gradient?
Dana P. Goldman,James P. Smith +1 more
TLDR
Differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, are examined, and the subsequent impact of differential adherence on health status is assessed.Abstract:
There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation - better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys - one cohort study and one randomized clinical trial - that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.read more
Citations
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Journal ArticleDOI
Understanding Differences in Health Behaviors by Education
TL;DR: This paper examined possible explanations for the relationship between education and health behaviors, known as the education gradient, and found that income, health insurance, and family background can account for about 30 percent of the gradient, while knowledge and measures of cognitive ability explain an additional 30 percent.
Journal ArticleDOI
Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States
Christopher J L Murray,Sandeep C. Kulkarni,Sandeep C. Kulkarni,Catherine M. Michaud,Catherine M. Michaud,Niels Tomijima,Maria T. Bulzacchelli,Terrell J. Iandiorio,Majid Ezzati +8 more
TL;DR: Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards and will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.
Book
Critical Perspectives on Racial and Ethnic Differences in Health in Late Life
TL;DR: This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life, and considers possible explanations.
Journal ArticleDOI
Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice
TL;DR: Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension although correlated, they measure different phenomena and tap into different causal mechanisms.
Journal ArticleDOI
Differences in life expectancy due to race and educational differences are widening, and many may not catch up.
S. Jay Olshansky,Toni C. Antonucci,Lisa F. Berkman,Robert H. Binstock,Axel H. Boersch-Supan,John T. Cacioppo,Bruce A. Carnes,Laura L. Carstensen,Linda P. Fried,Dana P. Goldman,James S. Jackson,Martin Kohli,John Rother,Yuhui Zheng,John W. Rowe +14 more
TL;DR: Estimates of the impact of race and education on past and present life expectancy are updated, trends in disparities from 1990 through 2008 are examined, and observed disparities are placed in the context of a rapidly aging society that is emerging at a time of optimism about the next revolution in longevity.
References
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Understanding Differences in Health Behaviors by Education
TL;DR: This paper examined possible explanations for the relationship between education and health behaviors, known as the education gradient, and found that income, health insurance, and family background can account for about 30 percent of the gradient, while knowledge and measures of cognitive ability explain an additional 30 percent.
Journal ArticleDOI
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Preventable hospitalizations and access to health care
Andrew B. Bindman,Kevin Grumbach,Dennis Osmond,Miriam Komaromy,Karen Vranizan,Nicole Lurie,John Billings,Anita L. Stewart +7 more
TL;DR: Communities where people perceive poor access to medical care have higher rates of hospitalization for chronic diseases, and improving access to care is more likely than changing patients' propensity to seek health care or eliminating variation in physician practice style to reduce hospitalization rates for chronic conditions.
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