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.
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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)....
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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)....
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...…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)....
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...Lowry and Xie (2009) suggest that the SES and health linkage may be weaker in China for two reasons....
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...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)....
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...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)....
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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....
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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
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TL;DR: Results from multilevel logistic regression models indicate that exposure to deteriorated housing conditions and perceptions of low social cohesion in the neighborhood significantly elevate the odds of asthma.
Abstract: This article examines the prevalence of asthma among New York City households from 10 racial/ethnic groups, and it explores whether differential exposure to potentially adverse housing and neighborhood conditions helps to mediate observed disparities. After adjusting for household size, Puerto Rican households exhibit the highest levels of asthma, followed by other Hispanic and black households. Mexican, Chinese, and Asian Indian households exhibit the lowest levels of asthma. Results from multilevel logistic regression models indicate that exposure to deteriorated housing conditions and perceptions of low social cohesion in the neighborhood significantly elevate the odds of asthma. Controlling for these conditions along with household characteristics reduces the disproportionately high levels of asthma among Puerto Rican and black households, although they remain significantly higher than the level among white households.
81 citations
Posted Content•
01 Jan 2007
TL;DR: In this paper, the authors test two competing hypotheses on the relationship between age, SES, and health inequality at the cohort/population level and find that the accumulation hypothesis predicts that levels of SES based health inequality and consequently overall health inequality within a cohort progressively increase as it ages.
Abstract: This paper tests two competing hypotheses on the relationship between age, SES, and health inequality at the cohort/population level. The accumulation hypothesis predicts that levels of SES- based health inequality and consequently overall health inequality within a cohort progressively increase as it ages. The divergence-convergence hypothesis predicts that these inequalities increase only up to early-old age then decrease. Data from a Canadian national health survey are used in this study, and are adjusted for SES-biases in mortality. Bootstrap methods are employed to assess the statistical precision and significance of the results. The Gini coefficient is used to estimate change in the overall level of health inequality with age and the Concentration coefficient estimates the contribution of SES- based health inequalities to this change. Health is measured using the Health Utilities Index and income and education provide the measure of SES. First, the findings show that the Gini coefficient progressively increases from 0.048 (95% CI: 0.045, 0.051) at ages 15-29 to 0.147 (95% CI: 0.131, 0.163) at ages 80+. Second, the data reveal that health inequalities between SES groups (Concentration coefficients for income and education) tend to follow a similar pattern of divergence. Together these findings provide support for the accumulation hypothesis. A notable implication of the study's findings is that the level of health inequality increases when compensating for age-specific socio- economic differences in mortality. These selective effects of mortality should be considered in future research on health inequalities and the life course.
78 citations
TL;DR: The study's findings show that the level of health inequality increases when compensating for age-specific socio-economic differences in mortality, and health inequalities between SES groups tend to follow a similar pattern of divergence.
Abstract: This paper tests two competing hypotheses on the relationship between age, SES, and health inequality at the cohort/population level. The accumulation hypothesis predicts that the level of SES-based health inequality, and consequently the overall level of health inequality, within a cohort progressively increases as it ages. The divergence-convergence hypothesis predicts that these inequalities increase only up to early-old age then decrease. Data from a Canadian national health survey are used in this study, and are adjusted for SES-biases in mortality. Bootstrap methods are employed to assess the statistical precision and significance of the results. The Gini coefficient is used to estimate change in the overall level of health inequality with age, and the Concentration coefficient estimates the contribution of SES-based health inequalities to this change. Health is measured using the Health Utilities Index, and income and education provide the measure of SES. First, the findings show that the Gini coefficient progressively increases from 0.048 (95% CI: 0.045, 0.051) at ages 15-29 to 0.147 (95% CI: 0.131, 0.163) at ages 80+. Second, the data reveal that health inequalities between SES groups (Concentration coefficients for income and education) tend to follow a similar pattern of divergence. Together these findings provide support for the accumulation hypothesis. A notable implication of the study's findings is that the level of health inequality increases when compensating for age-specific socio-economic differences in mortality. These selective effects of mortality should be considered in future research on health inequalities and the lifecourse.
71 citations
TL;DR: In this paper, the authors investigated determinants of China's mortality levels and trends since 1981 and found that both economic development and social policies matter to survival outcomes, but in different magnitudes for various mortality measures.
69 citations
TL;DR: Zhang et al. as mentioned in this paper examined the relationship between socioeconomic status (SES) and mortality among the oldest old (80 years and older) population in China using data from the 1998, 2000, and 2002 waves of the Chinese Longitudinal Healthy Longevity Survey.
Abstract: Although an inverse relationship between socioeconomic status (SES) and mortality has been well documented for many populations throughout the world, it remains unclear whether this relationship holds true for the oldest old. Most notably, some scholars have suggested that the relationship may disappear at the oldest ages. Using data from the 1998, 2000, and 2002 waves of the Chinese Longitudinal Healthy Longevity Survey, this study examined the relationship between SES and mortality among the oldest old (80 years and older) population in China. The results show the continuing prevalence of SES differentials in mortality—higher SES is significantly associated with lower mortality risks—among the oldest old in China. The authors further show that the relationship holds regardless of how the oldest old are operationalized (as 80 years and older, 90 years and older, or 100 years and older).
64 citations