Socioeconomic Status and Health Differentials in China: Convergence Or Divergence at Older Ages?
01 Jan 2009-
About: The article was published on 2009-01-01 and is currently open access. It has received 34 citations till now. The article focuses on the topics: Divergence.
Citations
More filters
Posted Content•
01 Jan 2004
TL;DR: 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.
477 citations
01 Jan 2010
TL;DR: In this article, the authors provide a global assessment of the relationship between formal education and adult health, using sample data from 70 countries that participated in the World Health Survey and find that an increase in formal education is associated with lower levels of disability in both younger and older adults.
Abstract: Contemporary research primarily in the West offers a strong case for the relationship between formal education and adult health; more education, measured either by level completed or years of schooling, is associated, often in a stepwise fashion, with lower levels of mortality, morbidity and disability. In this study, we attempt to provide a global assessment of that relationship as it pertains to adult disability, using sample data from 70 countries that participated in the World Health Survey. In each of five regions and some of the largest countries outside the West we find that an increase in formal education is associated with lower levels of disability in both younger and older adults. Using the regional education-based differentials and several estimates of growth in education levels, we project levels of disability to 2050 to estimate the health and human capital benefits obtained from investments in education. We find that considering education in the population projection consistently shows lower prevalence of disability in the future, and that scenarios with better education attainment lead to lower prevalence. It is apparent that the educational dividend identified in our projection scenario should be an important policy goal, which, if anything, should be more speedily advanced in those countries and regions that have the greatest need.
64 citations
Cites background from "Socioeconomic Status and Health Dif..."
...…data from the 2005 Inter-Census Survey suggests adults with more education report higher levels of good health and that for both men and women and in both rural and urban areas, the disparity between the least educated and the rest of the population increases with age (Lowry and Xie 2009)....
[...]
TL;DR: Primary education has a stronger effect on mortality for men than for women and the effect of education is stronger for the young old than for the oldest old, which underscores the importance of national and subpopulation contexts in understanding the relationship between education and mortality.
46 citations
Cites background from "Socioeconomic Status and Health Dif..."
...Second, in a collective society like China, health behaviors and health care decisions tend to be a family affair rather than a personal matter and as the result, individual education levels may play a smaller role in determining health behaviors and health care decisions (Lowry and Xie, 2009)....
[...]
...…improves self-rated health, reduces mental distress, and reduces mortality among elderly Chinese (Beydoun and Popkin, 2005; Chen et al., 2010; Gu and Zeng, 2004; Liang et al., 2000; Lowry and Xie, 2009; Ross and Zhang, 2008; Zhu and Xie, 2007; Zimmer and Kwong, 2004; Zimmer et al., 2010)....
[...]
...Lowry and Xie (2009) suggest that the SES and health linkage may be weaker in China for two reasons....
[...]
...Other programs, such as the wide dissemination of health knowledge, the subsidized health care, and a government-sponsored medical insurance system, may have helped alleviate SES gradient in health (Lowry and Xie, 2009; World Bank, 1983)....
[...]
...There is evidence that education, and SES in general, reduces physical impairment, delays the onset of physical disability, improves self-rated health, reduces mental distress, and reduces mortality among elderly Chinese (Beydoun and Popkin, 2005; Chen et al., 2010; Gu and Zeng, 2004; Liang et al., 2000; Lowry and Xie, 2009; Ross and Zhang, 2008; Zhu and Xie, 2007; Zimmer and Kwong, 2004; Zimmer et al., 2010)....
[...]
TL;DR: The results show that older Chinese women, rural residents, those with an education level lower than high school, without individual income sources, who are ex-smokers, and those from poor economic status households are more likely to report disability and poor self-rated health.
39 citations
Cites background from "Socioeconomic Status and Health Dif..."
...Other research by Lowry and Xie (2009) has noted that although socioeconomic status is positively and strongly associated with health status for individuals at younger ages in China; such an association is weaker in the latter part of the life course....
[...]
TL;DR: The authors performed a meta-analysis of 4866 estimates gleaned from 99 published studies that examine the health effects of education and found that the overall effect size is practically zero, indicating that education generates no discernible benefits to health.
Abstract: While numerous studies assess the relationship between education and health, no consensus has been reached on whether education really improves health. We perform a meta‐analysis of 4866 estimates gleaned from 99 published studies that examine the health effects of education. We find that the current literature suffers from moderate publication bias towards the positive effects of education on health. After correcting for publication bias with an array of sophisticated methods, we find that the overall effect size is practically zero, indicating that education generates no discernible benefits to health. The heterogeneity analysis by Bayesian Model Averaging (BMA) and Frequentist Model Averaging (FMA) reveals that the reported estimates can be largely explained by whether the econometric models control for endogeneity of education, the types of data and the differences in health measurements. Our results also suggest that education may not be an effective policy option for promoting population health.
34 citations
References
More filters
TL;DR: Education, being determined early in life and influencing psychosocial mechanisms throughout life, may have a greater impact on prevention of activity and functional disorders.
Abstract: Background Although a robust association between socioeconomic status and health has been shown in past research, the processes that explain the connection are not well understood. This paper seeks to advance such understanding in two ways, first by attending to the distinction between onset of a functional health problem and its progression, and second by addressing whether and how education and income relate differently to the onset versus progression of functional health problems. Methods Data come from the Americans' Changing Lives survey (n = 3617). The baseline was conducted in 1986 and outcome status measured in 1994. Activity limitations are categorized into none, mild, moderate, severe. Onset is defined as having no limitation at origin and a limitation at outcome. Progression is defined as limitation of a particular severity at origin and improving, staying the same, or getting worse with respect to the severity. Multinomial regressions determine transition probabilities related to onset and progression. Results Those with higher income and education are less likely to experience an onset. Only income associates with progression. Those with the highest income are most likely to improve and least likely to get worse in comparison to those with the lowest income. Conclusions Education, being determined early in life and influencing psychosocial mechanisms throughout life, may have a greater impact on prevention of activity and functional disorders. Income's role may be both as a prevention factor and as a mechanism for management of health problems.
160 citations
TL;DR: For example, this article found that the large socioeconomic differences in health among older Americans mostly accrue earlier in adulthood on gradients set by educational attainment, and that a low sense of control over one's own life accelerates physical impairment, which in turn decreases the sense of personal control.
Abstract: Education’s positive effect on health gets larger as people age. The large socioeconomic differences in health among older Americans mostly accrue earlier in adulthood on gradients set by educational attainment. Education develops abilities that help individuals gain control of their own lives, encouraging and enabling a healthy life. The health-related consequences of education cumulate on many levels, from the socioeconomic (including work and income) and behavioral (including health behaviors like exercising) to the physiological and intracellular. Some accumulations influence each other. In particular, a low sense of control over one’s own life accelerates physical impairment, which in turn decreases the sense of control. That feedback progressively concentrates good physical functioning and a firm sense of personal control together in the better educated while concentrating physical impairment and a sense of powerlessness together in the less well educated, creating large differences in health in old age.
157 citations
TL;DR: This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China, from the 1960s to 2000, and shows a spectacular improvement in life expectancy.
Abstract: This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China from the 1960s to 2000 We use the General Growth Balance method to evaluate the completeness of death reporting above the youngest ages in three censuses of the People's Republic of China from 1982 to 2000, concluding that reporting quality is quite high, and revisit the completeness of death recording in the 1973-75 Cancer Epidemiology Survey Estimates of child mortality from a variety of direct and indirect sources are reviewed, and best estimates arrived at Our estimates show a spectacular improvement in life expectancy in China: from about 60 years in the period 1964-82 to nearly 70 years in the period 1990-2000, with a further improvement to over 71 years by 2000 We discuss why survival rates continue improving in China despite reduced government involvement in and increasing privatization of health services, with little insurance coverage
157 citations
TL;DR: It is found that the use of self-rated ill-health has face validity as assessed via its relationship to SES, and a less dismissive and pessimistic view of health data obtained through self-reports seems warranted.
145 citations