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: In this paper, the authors construct an ideal type of Confucian actors, which is then applied to a survey of three Chinese communities, trying to formulate a new perspective in depicting the character of modern Chinese actors, measured in terms of their dynamic proximity to the Confucians ideal type.
Abstract: As a major source of social values in East Asia, Confucianism assumes especial significance amidst the proliferation of instrumental rationality in modern societies. This study attempts to answer the question: how Confucian are contemporary Chinese? By way of constructing an ideal type of Confucian actors, which is then applied to a survey of three Chinese communities, this study tries to formulate a new perspective in depicting the character of modern Confucian actors, measured in terms of their dynamic proximity to the Confucian ideal type. Our approach marks a shift of emphasis, both empirically and methodologically, compared with previous work on this topic. On the empirical side, our study breaks with the long-standing, classical distinction between the 'gentleman' and the 'commoner' prevalent in Confucian discourse. Degrees of proximity to Confucian values are viewed in representational—i.e. non-evaluative—terms. In constructing the ideal type of Confucian actors, we distinguish between formal and substantive values in Confucianism. This analytical distinction allows our study to demonstrate the continued relevance of Confucianism. While substantive values change over time, the formal, analytical core that captures the essence of Confucianism continues to survive in the face of the vicissitudes of modernity and the spread of instrumental rationality.
33 citations
TL;DR: The comment reconsiders Beckett’s approach to the selection problem, which, while creative, is open to multiple interpretations, as the entire framework for understanding mortality selection effects rests on a counter- factual foundation.
Abstract: Mortality Selection and Sample Selection: A Comment on Beckett* ANDREW NOYMER University of CaIifornia—BerkeIey Journal of Health and Social Behavior 2001, Vol 42 (Septmber): 326-327 In an interesting article, Megan Beckett (2000) examines the important question of converging health inequalities in later life. Many studies have shown that the differences in health across socioeconomic strata narrow at older ages. Using panel data from the National Health and Nutrition Examination Survey (NHANES), Beckett shows that the converging health inequality cannot be accounted for by mortality selection. The pre- sent comment reconsiders Beckett’s approach to the selection problem, which, while creative, is open to multiple interpretations. Consider the phenomenon that would cause converging health inequalities at later ages to be an “artifact,” as Beckett puts it, of mortality selection. At younger ages, persons with high- er socioeconomic status (SES) have lower lev- els of health problems than those with lower SES. At older ages, the prevalence of health problems in the two groups is closer to parity. If patterns in morbidity are mirrored in mortal- ity, then at older ages a lower SES cohort (higher morbidity and mortality) will be small- er compared to its starting size than a higher SES cohort (lower morbidity and mortality). Since the seminal work of Vaupel, Manton, and Stallard (1979) and Keyfitz and Littman (1979), many demographers have assumed that there are different rates of “frailty” within a population, which determine an individual’s deviation, at any age, from some baseline mor- tality risk. According to the frailty hypothesis, those who die at young ages tend to have high frailty, which skews the distribution of sur- vivors to be more robust. If this condition of nonrandom mortality risks is met, then the aged low SES cohort will be more robust than ‘Address correspondence to: Andrew Noymer, Departments of Sociology and Demography, University of Califomia-—Berkeley, 2232 Pied- mont Avenue, Berkeley, CA 94720; email: andrew@demog.berkeley.edu. when it started out. This reversal of fortune over the life course is called “cohort inversion” (Hobcraft, Menken, and Preston 1982). On the other hand, the low mortality, high SES cohort will have a much less-changed frailty distribu- tion, and will experience less cohort inversion. The greater cohort inversion of the low SES cohort could be enough to overcome the mor- tality disadvantage of being low SES. This problem must be analyzed cautiously, however, as the entire framework for understanding mortality selection effects rests on a counter- factual foundation. If we hold that convergence is a result of mortality selection, we imply that an intrinsic differential persists into older ages and that we would observe it were it not for the selection efiect. On the other hand, if we hold that the convergence is either intrinsic or the result of, for example, access to Medicare (Beckett 2000), we posit that even without selection we would see convergence. In both cases, there is the troubling verb “would.” In reality, we can only observe vital rates that do occur, not those that would occur if some con- dition is met. The general problem of sample selection is encountered frequently in the social sciences (cf. Stolzenberg and Relles 1997; Winship and Mare 1992), and as Beckett (2000) notes, dif- ferential mortality is just a special case of the more general problem. Although we cannot simply “control for” (i.e., condition on) selec- tion bias the same way we would a confound- ing variable, statistical techniques do exist that try to counteract the bias. However, mortality selection is a very special case of sample selec- tion, all the more so if the dependent variable in question is itself health-related. Because of cohort inversion, sample selection due to mor- tality has causal implications beyond nonran- dom missing data in panel followups. This is what makes Beckett’s approach problematic. Consider the statistical technique used by Beckett to set up the hypothetical of no mor- 326
29 citations
TL;DR: Among the available SES indicators, the level of education has most consistently been shown in both eastern and western population studies to be related to health and health change, and that self-perceived economic resource is also related to older people's health in Asian populations.
Abstract: The major purpose of this study was to examine the effects of socio-economic status (SES) on changes in functional abilities as measured by Activities of Daily Living (ADL) scales among older people in Taiwan. A prospective longitudinal study design was used. A panel of 874 community-dwelling older people were followed over four years (1994 to 1998). Three SES indicators education having extra money (more than required for basic necessities) and principal lifetime occupation were included in separate multiple logistic regression models of functional change in physical ADL (PADL) and in instrumental ADL (IADL). Over the four years the study cohort experienced greater decreases in IADL functioning than in PADL functioning. Having extra money was significantly and negatively associated with PADL decline while level of education had a strong positive relationship with IADL functioning. In addition to SES age was significantly associated with PADL and IADL functioning change. The paper also reports a comparison of similar findings from several eastern and western countries. This has established that among the available SES indicators the level of education has most consistently been shown in both eastern and western population studies to be related to health and health change and that self-perceived economic resource is also related to older peoples health in Asian populations. (authors)
29 citations
30 Nov 2007
26 citations