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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
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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

Journal ArticleDOI
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)....

    [...]

Journal ArticleDOI
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)....

    [...]

Journal ArticleDOI
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....

    [...]

Journal ArticleDOI
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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Journal ArticleDOI
TL;DR: The effect of education strengthens across age, that this pattern is becoming stronger across cohorts, and that these patterns are suppressed when either effect is ignored.
Abstract: Recent medical sociological research has examined whether the relationship between education and health is dynamic across age, whereas recent demographic research has examined whether the relationship varies across cohorts. In this study, I examine how cohort structures the influence of education on life-course health trajectories. At the cohort level, changes in education and in the distribution of health and mortality make cohort differences in education’s effect probable. At the life-course level, the effect of education may vary across age because the mediators of the education-health relationship may vary in their relevance to health across the life course. Using basic regression analyses and random-effects models of two national data sets, I find that the effect of education strengthens across age, that this pattern is becoming stronger across cohorts, and that these patterns are suppressed when either effect is ignored.

493 citations

Journal ArticleDOI
TL;DR: In this article, education's positive effects extend beyond jobs and earnings, and they propose that education can improve health because it increases effective agency, and that education's benefits extend beyond job and earnings.
Abstract: The concept of human capital implies that education improves health because it increases effective agency. We propose that education's positive effects extend beyond jobs and earnings. Through educ...

480 citations

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

Journal ArticleDOI
TL;DR: In this paper, a three-wave panel survey of a representative upstate New York community is examined by lagged causal relationships among social, psychological, and physiological variables, showing that social resources play a buffering role relative to social and psychological stresses for physical well-being.
Abstract: In the life stress process social, psychological, and physiological environments simultaneously impinge on well-being. In this paper we focus on physical health as it is affected by two environmental elements: stress(or)es and resources. Data from a three-wave panel survey of a representative upstate New York community are examined by lagged causal relationships among these variables. The results show that (1) prior physiological conditions contribute directly to current physical symptoms, (2) stress and resource components of the psychological environment directly affect current physical symptoms, (3) social resources buffer both social stressors and psychological stress, whereas psychological resources buffer only psychological stress, and (4) psychological stress mediates the effects of prior social stressors and psychological resources. Clearly, stress is a complex process in which the three interacting environments affect well-being. Importantly, social resources play a buffering role relative to social and psychological stresses for physical well-being.

475 citations

Journal ArticleDOI
TL;DR: This paper developed a unified empirical framework for describing the relative contribution of rural-urban and inland-coastal inequality to overall regional inequality in China during the 1980's and 1990's.

475 citations