View
21
Download
1
Category
Tags:
Preview:
DESCRIPTION
Health, Aging and Socio-Economic Status in Mexico. Sonia Laszlo (McGill) Franque Grimard (McGill) Wilfredo Lim (Columbia). Motivation – Research questions. What are the long-term health effects of socio-economic status (SES) during childhood? - PowerPoint PPT Presentation
Citation preview
1
Health, Aging and Socio-Economic Status in Mexico
Sonia Laszlo (McGill)
Franque Grimard (McGill)
Wilfredo Lim (Columbia)
2
Motivation – Research questions What are the long-term health effects of
socio-economic status (SES) during childhood?
How much persists beyond its effect on human capital investment and earnings capacity?
Long term effects of education?
3
Motivation - Literature
Income gradient: health outcomes positively affected by income or SES Via child health: Case et al. AER ’02; Currie & Stabile AER
’03 Child health education (Glewwe & Miguel, HDE ’08) Child health & education income (large literature)
But: income and health jointly determined Recently: in utero or childhood SES
Maccini & Yang (AER forthcoming), Almond (JPE ’06): long term health effects of conditions prevailing in utero
Akresh & Verwimp (’07): conditions prevailing in early childhood have long run health outcomes
Review: Strauss and Thomas (HDE ’08)
4
Motivation – Aging population We focus on the aging population (50+) in Mexico Developing countries:
Changing burden of disease Pressures on medical resources and financing Yet little literature in economics on these countries
Contribution: Build on Case et al. (JHE ’05) and Buckley et al. (JHE ’04) Long-term effects of childhood SES on health of the elderly
5
Why aging in a developing country? Epidemiological transition :
Demographic transition shift in disease burden from infectious to non-communicable diseases.
Demographic transition:
Total fertility rate Life expectancy
Years 55-60 75-80 95-00 55-60 75-80 95-00
Mexico 6.80 5.25 2.67 55.2 65.0 73.7
Centr Am 6.31 4.90 2.90 54.5 64.1 71.9
South Am 5.74 4.27 2.65 55.1 62.9 70.3
North Am 3.72 1.78 1.95 69.7 73.4 76.7
Gap w NA 3.08 3.47 0.72 14.5 8.4 3.0
Source: UN, ESA
6
What We Do
Examine Determinants of: Good health for individuals aged 50+ in Mexico in
2001 and 2003 Conditional on good or bad health in 2001
transition (à la Buckley et al., JHE ’04) Does education matter? Does childhood SES matter?
7
Directions of ‘causality’
AdulthoodChildhood ‘Golden Years’
Income
Health
Education
Health
Health
CSES
8
Directions of ‘causality’
AdulthoodChildhood ‘Golden Years’
Income
Health
Education
Health
Health
CSES
9
Directions of ‘causality’
Education
AdulthoodChildhood ‘Golden Years’
Income
Health
Education
Health
Health
CSES
Parental SES
Shocks
10
Modeled after the U.S. Health and Retirement Study. We use the two-year panel data set (2001 and 2003) on
Mexicans born prior to 1951 No geographic location codes – limitation Self-reported health: “Would you say your health is…”
Excellent 1 Very good 2 Good 3 Fair 4 Poor 5
We know self reported health measures are measured with error (Baker et al., JHR ’04) We check for robustness to some sensitivity analysis in our
measure
Mexican Health and Aging Study (MHAS)
Good Health = 1
Good Health = 0
11
MHAS - We use:
Childhood SES “Before age 10…” : Did your residence have a toilet? Did you regularly go to bed hungry? Did anyone sleep in the same room where you cooked? Did you regularly wear shoes?
Current SES Education, age, gender, marital status Per capita household assets, ‘income’
Parental background Mom’s and dad’s education Dad’s occupation
12
Variable
Good Health in 2003 0.380 0.295Good Health in 2001 0.443 0.320Respondent's years of education 5.180 4.370
(4.787) (4.021)Number of children ever born 5.910 5.992
(3.581) (3.611)Before age 10, residence had toilet inside house 0.269 0.302Before age 10, generally go to bed hungry 0.344 0.291Before age 10, wore shoes regularly 0.779 0.778Before age 10, someone slept in same room used for cooking 0.220 0.198
A. Male Sample (N=3818)
B. Female Sample (N=4392)
Table 1 - Descriptive Statistics
Raw correlations
Toilet in residence
Went to bed hungry
regularly
Wore shoes regularly
Sleep where cook
Men Good Health 2001 0.1628 -0.1161 0.0877 -0.0417Good Health 2003 0.1600 -0.1433 0.0765 -0.0691
Women Good Health 2001 0.1674 -0.1211 0.0631 -0.0677Good Health 2003 0.1766 -0.1655 0.0878 -0.0942
At age 10…
13
Determinants of (Unconditional) Good Health
2001 2003 2001 2003
Respondent's years of education 0.017 0.017 0.015 0.010(0.004)*** (0.004)*** (0.005)*** (0.005)**
Respondent's age -0.051 -0.065 -0.019 -0.020(0.022)** (0.022)*** (0.019) (0.020)
Respondent's age squared (/1,000) 0.358 0.453 0.133 0.127(0.173)** (0.172)*** (0.015) (0.154)
Log per capita assets 0.002 0.009 0.007 0.014 (0.011) (0.010) (0.010) (0.010)
Number of children ever born 0.007 0.000 -0.007 0.005 (0.005) (0.004) (0.004)* (0.004)
Before age 10, residence had toilet inside house 0.025 -0.016 0.065 0.010 (0.041) (0.037) (0.035)* (0.033)
Before age 10, generally go to bed hungry -0.033 -0.071 -0.025 -0.078 (0.035) (0.032)** (0.039) (0.035)**
Before age 10, wore shoes regularly 0.027 0.019 -0.093 -0.034 (0.036) (0.034) (0.042)** (0.040)
Before age 10, someone slept in same room used for cooking 0.019 0.020 -0.043 -0.028 (0.038) (0.034) (0.038) (0.037)
Location dummies & marital status controls Y Y Y YControl for quality of answer Y Y Y YObservations 3818 3818 4392 4392Chi-Squared statistic for joint significance of the CSES variables 2.43 5.71 9.10* 6.15pseudo R-squared 0.0624 0.0565 0.0676 0.0466Wald Chi-Squared for regression 102.32*** 92.81*** 98.12*** 61.32***
Robust standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%
Table 2 - Good Health, Unconditional (Probit Marginal Effects)
Men Women
14
Age and Health 2001 and 2003 by gender
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
Age in 2001
"Pro
bab
ility
of
Go
od
Hea
lth
"
Men 2001 Men 2003 Women 2001 Women 2003
15
Probability of Good Health by Years of Education (Men)
0.000
0.100
0.200
0.300
0.400
0.500
0.600
0.700
0.800
0.900
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years of Education
Pro
bab
ility
of
Go
od
Hea
lth
2001 2003
16
Probability of Good Health by Years of Education (Women)
0.000
0.100
0.200
0.300
0.400
0.500
0.600
0.700
0.800
0.900
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years of Education
Pro
bab
ility
of
Go
od
Hea
lth
2001 2003
17
Transition from health status in 2001 to good health in 2003 Follow Buckley et al. (’04) Condition on good / bad health in 2001:
Conditioning to some extent controls for endogeneity of education/SES
Control for remaining endogeneity in education using parental characteristics Parental residence primarily urban, parental education,
dad’s occupation (agriculture, construction, services, business, office, etc…)
iXiiiii XEDUCSESGoodHealthGoodHealth 210103 )|(Prob
18
ResultsConditional on Good Health
2001
Conditional on Bad Health
2001
Conditional on Good Health
2001
Conditional on Bad Health
2001Respondent's years of education 0.020 0.006 0.009 0.016
(0.006)*** (0.005) (0.008) (0.004)Respondent's age -0.084 -0.037 -0.015 -0.013
(0.036)** (0.024) (0.036) (0.018)Respondent's age squared (/1,000) 0.622 0.242 0.066 0.079
(0.277)** (0.179) (0.290) (0.137)Log per capita assets 0.006 0.012 0.035 -0.004
(0.016) (0.010) (0.018)** (0.008)Number of children ever born 0.002 0.000 0.006 -0.006
(0.007) (0.005) (0.008) (0.004)*Before age 10, residence had toilet inside house -0.123 0.057 0.033 -0.030
(0.057)** (0.046) (0.059) (0.028)Before age 10, generally go to bed hungry -0.117 -0.028 -0.118 -0.055
(0.055)** (0.035) (0.070)* (0.030)*Before age 10, wore shoes regularly -0.028 0.036 0.018 -0.017
(0.060) (0.036) (0.068) (0.340)Before age 10, someone slept in same room used for cooking -0.035 0.042 -0.073 0.007
(0.059) (0.039) (0.076) (0.036)Location dummies Y Y Y YControl for quality of answer Y Y Y YObservations 1693 2125 1407 2985Chi-Squared statistic for joint significance of the CSES variables 9.49** 4.90 6.93 3.96pseudo R-squared 0.6450 0.0395 0.0649 0.0242Wald Chi-Squared for regression 56.59*** 29.56** 32.03*** 27.37**
Robust standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%
Table 3 - Good Health in 2003, Conditional (Probit Marginal Effects)
Men Women
19
Is fertility playing a role?
AdulthoodChildhood ‘Golden Years’
Income
Health
Education
Health
Health
CSES
20
Is fertility playing a role?
AdulthoodChildhood ‘Golden Years’
Income
Health
Education
Health
Health
CSES
Fertility
21
Is fertility playing a role?
Cannot answer question directly – lack of data on reproductive health in MHAS
Yet: Gender differences in LR determinants of health during
‘golden years’ Stronger (>primary) education gradient for women Weak (but negative) effects of number of children ever born
on ‘golden years’ health and transition from bad health And:
CSES strongly significant effect on number of children ever born
22
Robustness checks
Education endogenous? CSES endogenous? Number of children ever born endogenous? Use parental background as IV Results
23
Conclusions
Childhood SES Education adult health Poverty during childhood matters above and beyond its
effects on education (and income) Effect pronounced for transition from good to good
health Find differential gender effects Policy?
24
Validity of Subjective Health Measure
Ailment 2001 2003 2001 2003 2001 2003Hypertension 6788 6951 38.16 35.80 -0.2027*** -0.2165***Diabetes 6785 6945 15.50 16.98 -0.1978*** -0.1626***Cancer 6795 6956 1.88 0.75 -0.0127 -0.0584***Respiratory Problems 6796 6957 5.96 4.22 -0.1065*** -0.0759***Heart Problems 6793 6966 3.20 2.18 -0.0877*** -0.0692***Stroke 6793 6966 2.06 0.92 -0.0602*** -0.0337***Arthritis 6793 6956 20.17 18.63 -0.1929*** -0.1924***Any of the above 6969 6969 55.76 53.85 -0.3092*** -0.2981***
Table 2 - Incidence of ailmentsCorrelation with
Subjective Health Measure
% with AilmentNumber of Non-
Missing Observations
Notes: ***, **, * significant at 1%, 5% and 10% respectively.
Recommended