1 James P. Smith Childhood Health and the Effects on Adult SES Outcomes

1

James P. Smith

Childhood Health and the Effects on Adult SES Outcomes

2

Objective

• Summarize the effects of childhood health on major adult SES outcomes from an obscure but important panel

• Family effects can be ‘controlled’ since sibling data exist

3

Data

– Panel Study of Income Dynamics (PSID)

– Premier yearly panel data of full age distribution in US

• Started in 1967 so more than 40 years in panel now

– All original PSID members and their immediate family members have been followed as panel members

– Traditionally very strong on economic variables (income, wealth and work)

• Since 1999 expanding amount of information on current and past health of respondents

4

Data

Since 1999 expanding amount of information on Adult health of respondents

– Self-reported GHS and prevalence and incidence of major chronic conditions for all panel members

– Standard list of health behaviors

5

Data Sample for Analysis

– Respondents must be in PSID 1999 to have the right current health data

– Select adult children of original PSID families—born between 1952 and 1974—so only up to around age 50

– Have all such siblings so unobserved common family and neighborhood effects can be dealt with

– For such families have income, work, wealth and health histories for respondent, siblings, and parents

6

Data on childhood health

– Respondents was asked multiple times to self-report their childhood health up to age 16 along standard scale from excellent to poor

• I convert it to ‘good health’ meaning excellent or very good

• Very little test- retest error in that formulation

– In 2007 wave I put into PSID retrospective childhood health histories for seventeen important childhood diseases

• Also in 2005-2007 HRS internet panel

7


– How well are these new childhood recall data related to childhood health and to adult health

– Does childhood health predict adult SES levels later in life and how strong are the effects

8

Comparison of Responses in Childhood Health Histories of HRS Internet Panel to External Sources and to

PSID Respondents Ages 50+

HRS External PSID Internet Source Ages 50+ Very Common Diseases Measles 88.0 92.4a 82.9 Mumps 65.5 64.6a 67.3 Chicken Pox 83.5 83.9a 80.0 Moderately Common Diseases Asthma 4.0 6.0a,b 4.5 Respiratory Disorder 13.8 12.3b 8.9 Speech Impediment 1.6 1.9 2.0 Allergic Condition 10.9 13.4a 7.8 Heart Trouble 1.8 1.6 1.5 Chronic Ear Problem 9.9 6.9 6.5 Severe Headaches or Migraines 6.1 6.0 6.1 Stomach 4.8 3.1 3.1 Depression 2.2 2.1 2.1 Very Rare Diseases Childhood Diabetes 0.1 0.4a,b 0.2 Hypertension 0.4 0.6b 0.4 Epilepsy/Seizures 0.7 0.3 0.4 N 3,964 NA 7,778 Source: HRS internet – calculations by author based on HRS internet panel. External Source a1963-1965 National Health Examination Survey; b1971-1975 National Health and Nutrition Survey; all others 1986 National Health Interview Survey. PSID Ages 50+ – calculations by author based on childhood health retrospective designed by author and placed into the 2007 wave of PSID. Smith (2008) forthcoming

9

0

100

200

300

400

500

600

700

800

900

1950 1960 1970 1980 1990 2000

Ca

se

s (

tho

us

an

ds

)

Vaccine Licensed

Measles—United States, 1950-2005

CDC, 2007.

10

PSID Responses to Child Health History by Age

Age in 2007 21-30 31-40 41-50 51-60 61-70 71+

Year age 16 2002-1993 1992-1983 1982-1973 1972-1963 1962-1953 < 1952

Year age 0 1986-1977 1976-1967 1966-1957 1956-1967 1946-1957 <1936

Measles

7.6 15.5 49.8 81.8 85.2 86.7

Mumps

4.3 12.7 43.4 68.1 67.3 68.6

Chicken Pox

83.0 79.1 75.9 83.0 79.6 72.3

Vaccine 1963

Vaccine 1967

Vaccine 1995

11

Predicting Self-Reported Childhood General Health Status (probit for childhood health being either Excellent or Very Good)

Childhood Disease dF/dx z Measles -0.029 2.73 Mumps -0.086 0.83 Chicken pox 0.066 7.09 Asthma -0.156 10.15 Respiratory disorder -0.071 5.31 Diabetes -0.369 5.03 Speech impairment - 0.036 1.54 Allergic condition(s) -0.026 2.00 Heart trouble -0.174 5.26 Chronic ear problem -0.081 5.24 Epilepsy/seizures -0.106 2.06 Severe headaches or migraines -0.052 3.59 Stomach problem -0.123 5.93 High Blood Pressure -0.091 1.67 Difficulty seeing even with eye glasses -0.059 3.06 Depression -0.096 4.54 Drug or alcohol problems -0.071 2.44 Other psychological problems -0.015 0.52 Age 21-40 0.049 4.02 Age-41-60 0.049 3.81 Age 61 plus 0.020 1.33 N 11,086

12

Predicting Self-Reported Adult General Health Status (probit for adult health being either Excellent or Very Good)

Childhood Disease dF/dx z dF/dx z Measles -0.034 2.22 -0.027 1.83 Mumps -0.023 1.58 -0.024 1.69 Chicken pox 0.100 7.31 0.087 6.35 Asthma -0.070 3.06 -0.130 4.32 Respiratory disorder -0.038 0.19 0.012 0.57 Diabetes -0.450 4.33 -0.408 3.66 Speech impairment -0.023 0.61 -0.016 0.42 Allergic condition(s) -0.008 0.37 0.000 0.01 Heart trouble -0.077 1.67 -0.039 0.84 Chronic ear problem -0.031 1.36 -0.014 0.59 Epilepsy/seizures -0.098 1.62 -0.070 1.15 Severe headaches or migraines -0.050 2.18 -0.038 1.66 Stomach problem -0.117 3.57 -0.088 2.67 High Blood Pressure -0.350 3.57 -0.338 3.36 Difficulty seeing even with glasses -0.141 4.73 -0.130 4.32 Depression -0.127 3.63 -0.105 2.97 Drug or alcohol problems -0.175 2.44 -0.168 3.43 Other psychological problems -0.050 0.91 -0.042 0.77 Age 21-40 0.240 13.2 0.237 12.92 Age-41-60 0.124 8.16 0.120 7.84 Childhood health ‘Good’ 0.209 13.97 N 8,913 8,913 8,913 8,913

13

Self-reported Health Status Excellent or Very “Good” by Health Status before Age 16

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Age

Per

cen

t "G

oo

d"

Good Health before Age 16 Bad Health before Age 16

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Prevalence With or Without a Sibling Having the Disease/Condition

25.8

69.5

16.6

5.4

55.3

84.0

28.5

13.3

0

10

20

30

40

50

60

70

80

90

Measles or Mumps Chicken Pox

Asthma/Respiratory/Allergy Depression/Drugs/Alcolol/Other

Sibling without disease Sibling with disease

15


– How well are these new childhood recall data related to childhood health and to adult health

– Does childhood health predict adult SES levels later in life and how big are the effects

• Have effects estimated now for self-reported childhood health

– Disease specific ones are in progress

» Show effects of psychological illness

16

Models Estimated Types of Models

– Level Models

• Adult SES outcomes– 1999 levels of education,

household income, individual income, labor supply and wealth

– Dynamic Models

• Changes between age 25 and year 1999

17

Predicting Adult Education in 1999–PSID

Education in 1999 Fixed Effects Baseline Model Extended Model Estimates

Age in 1999 -0.012 (0.19) -0.134 (1.44)

Age in 1999 squared 0.001 (0.66) -0.002 (1.55)

Black -1.178 (14.3.) 0.232 (2.57)

Hispanic -0.412 (1.88) -0.206 (1.11)

Female 0.196 (2.92) 0.303 (3.83)

Health 16 EX-VG 0.353 (4.28) 0.114 (1.15)

Ln Parental Income 1-16 0.779 (10.8) 0.363 (0.14)

Mother Ed 12-15 0.646 (7.45)

Mother Ed College or more 1.216 (8.97)

Father Ed 12-15 0.246 (2.89)

Father Ed college or more 1.406 (11.9)

Number of Siblings -0.127 (6.52)

Constant 3.429 (2.65) 11.24 (2.92)

N 3055 2248

18

Predicting Adult Ln Household Income in 1999

Ln Household Income 1999 Fixed Effects Baseline Model Extended Model Estimates Age in 1999 0.093 (4.62) 0.081 (1.80) Age in 1999 squared -0.001 (3.54) -0.001 (1.41) Black -0.083 (2.87) Hispanic 0.023 (0.40) Female -0.057 (2.72) 0.028 (0.73) Married in 1999 0.666 (29.5) 0.758 (18.2) Health up to 16 EX-VG 0.130 (5.03) 0.240 (4.98) Ln Parental Income 1-16 0.227 (9.79) 0.011 (0.07) Mother Ed 12-15 0.038 (1.37) Mother Ed college or more 0.044 (1.03) Father Ed 12-15 0.060 (2.24) Father Ed college or more 0.030 (0.79) Number of Siblings -0.017 (2.81) Education in 1999 0.097 (16.7) 0.099 (7.68) Constant 4.501 (11.1) 6.795 (3.62) N 3033 2222 ______________________________________________________________________________

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$5,857

$10,084

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

Everyone Within Sibling

Impact of Good Childhood Health on Family Income

20

Predicting Adult Ln Household Income at Age 25 and Change in Ln Household Income between Age 25 and 1999

Ln Household Income Fixed Effects At age 25 % Change to 1999 Estimates Age in 1999 -0.009 (0.29) 0.105 (3.79) 0.147 (2.23) Age in 1999 squared -0.000 (0.48) -0.001 (3.14) -0.002 (2.23) Black -0.191 (3.38) -0.037 (1.10) Hispanic 0.058 (0.86) 0.003 (0.05) Female -0.056 (2.19) -0.026 (1.08) 0.078 (2.00) Married at age 25 0.677 (26.2) Married-Married 0.498 (14.6) 0.582 (8.05) Married–Single -0.139 (2.96) -0.264 (2.76) Single-Married 0.612 (16.8) 0.610 (8.03) Health up to age 16 EX-VG 0.104 (3.35) 0.052 (1.78) 0.245 (4.07) Ln Parental Income ages1-16 0.216 7.68) 0.195 (7.30) 0.336 (1.58) Mother Ed 12-15 years 0.113 (3.49) 0.029 (0.94) Mother Ed college or more 0.082 (1.59) 0.031 (0.65) Father Ed 12-15 years 0.043 (1.35) 0.015 (0.50) Father Ed college or more -0.043 (0.97) -0.026 (0.62) Number of Siblings -0.022 (3.02) -0.011 (1.61) Education in 1999 0.068 (9.59) 0.082 (12.1) 0.092 (5.47) Ln Income at age 25 -0.713 (49.8) -0.691 (23.2) Constant 6.760 (11.4) 2.074 (3.64) -0.857 (0.33) N 2058 2045 1358

21

Lifetime Family Income Effects of Good Childhood Health

$12,000

$10,084

$7,500

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

25 30 35 40 45 50 55 60

Total lifetime effect = $381,000.

37Age

22

What are the pathways?Predicting Adult Earnings in 1999

Individual Earnings 1999 Arithmetic Earnings Fixed Effects Ln Earnings Fixed Effects

Age in 1999 2,448 (3.61) 1,762 (0.94) 0.102 (4.21) 0.058 (0.93) Age in 1999 squared -29.0 (3.10) -15.33 (0.61) -0.001 (3.55) -0.001 (0.75) Black -885 (0.97) -0.008 (0.23) Hispanic -2,635 (1.35) -0.042 (0.58) Female -16,153 (22.7) -19,461 (12.1) -0.500 (19.8) -0.551 (10.3) Married in 1999 293 (0.39) 323 (0.19) 0.074 (2.75) 0.057 (0.99) Health to age 16 EX-VG 3,348 (3.84) 8,107 (4.05) 0.123 (3.90) 0.248 (3.66) Ln Parental Income 1-16 0.067 (5.73) 0.153 (1.91) 0.215 (7.67) -0.023 (0.11) Mother Ed 12-15 years 789 (1.02) 0.006 (0.17) Mother Ed college or more -370 (0.15) -0.016 (1.44) Father Ed 12-15 years -443 (0.31) 0.049 (1.53) Father Ed college or more 677 (0.75) -0.050 (1.12 Number of Siblings 184 (0.40) -0.015 (1.99) Education in 1999 3,189 (16.2) 4,058 (7.62) 0.111 (15.7) 0.123 (6.94) Constant -60,814 (5.04) -69,041 (1.91) 4.502 (9.22) 7.549 (2.96) N 3055 2248 2674 1862

23

What are the pathways?Impact of Good Childhood Health on

Weeks Worked

Full Sample estimate is 2.3 weeks

Within Sibling estimate is 4.3 weeks

Labor supply effects come through both external (participation)

and internal margins

24

$3,348

$8,107

$10,084

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

Everyone Within Sibling Family Income

Impact of Good Childhood Health on Individual Earnings

25

What are the pathways?Impact of Good Childhood Health

on Spousal Earnings

Correlation in Spousal childhood health is 0.34

Estimate of own childhood health on Spousal earnings is $2,367

26

$1,847

$10,005

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

Everyone Within Sibling

Impact of Good Childhood Health on Family Wealth

27

Why are within sibling effects larger?

• Subjective threshold scales differ more across than within families

• Estimated Effects are bigger in larger families

– Education is the exception• Low correlation in price of education

and childhood health• Parents can compensate for education

outcomes

28

Go inside disease

• Psychological problems before age 17– Depression, drug/alcohol problems, other

• Can control for unobserved family effects and concomitant existence of physical illnesses during childhood

• Recall rates of these problems match closely contemporaneous prevalence rates for recent cohorts

• Examine effects on education, ln family income, individual earnings, weeks worked, household wealth, and marriage

29

Estimates of Impact of Childhood Psychological Problems on Adult SES Outcomes

OLS Estimates

All models control for age quadratic, gender, race, Hispanic, education of both parents, and parental income during childhood. Childhood health models add a set of controls for fifteen types of physical illnesses during childhood. Source Smith and Smith (2008)

30


OLS Estimates

Education Ln Family

Income Individual

Income Weeks

Worked Wealth Any Problem

Family background -0.555** -0.261** + childhood health problems

-0.573** -0.198**

Depression Family background -0.337* -0.222** + childhood health problems

-0.342* -0.155*

Drug/Alcohol Family background -0.835** -0.189* + childhood health problems

-0.864** -0.171*

Other Family background -0.345 -0.220* + childhood health problems

-0.380 -0.150

All models control for age quadratic, gender, race, Hispanic, education of both parents, and parental income during childhood. Childhood health models add a set of controls for fifteen types of illnesses during childhood. Source Smith and Smith (2008) **Statistically significant at one percent level, * statistically significant at five percent level, + statistically significant at ten percent level.

31


Fixed Effects Within Sibling Estimates

Education Ln Family

Income Individual

Income Weeks


Family background -0.255* -0.231** + childhood health problems

-.0.355** -0.199*

Depression Family background -0.174 -0.166* + childhood health problems

-0.246 -0.129+

Drug/Alcohol Family background -0.817** -0.188+ + childhood health problems

-0.842** -0.191+

Other Family background -0.011 -0.229+ + childhood health problems

-0.109 -0.190


32


OLS Estimates

Education Ln Family

Income Individual

Income Weeks


Family background -0.555** -0.261** -6,962** -7.39** -16,848** + childhood health problems

-0.573** -0.198** -6,105** -6.45** -13,876**

Depression Family background -0.337* -0.222** -5,221* -7.88** -10,208* + childhood health problems

-0.342* -0.155* -4,178* -6.64** -5,293

Drug/Alcohol Family background -0.835** -0.189* -4,918* -2.17 -16,546* + childhood health problems

-0.864** -0.171* -5,504* -1.79 -15,279*

Other Family background -0.345 -0.220* -4,649+ -6.75** -13,673+ + childhood health problems

-0.380 -0.150 -4,309 -6.92** -14,616+


33


Fixed Effects Within Sibling Estimates

Education Ln Family

Income Individual

Income Weeks


Family background -0.255* -0.231** -5,339** -7.28** -22,302** + childhood health problems

--.0.355** -0.199* -4,094** -5.76** -17,534*

Depression Family background -0.174 -0.166* -2,851 -7.49** -16,200+ + childhood health problems

-0.246 -0.129+ -2,005 -6.16* -10,418

Drug/Alcohol Family background -0.817** -0.188+ -3,554 -4.71 -6,126 + childhood health problems

-0.842** -0.191+ -3,682 -4.71 -5,547

Other Family background -0.011 -0.229+ -7,006+ -6.14+ -13,867 + childhood health problems

-0.109 -0.190 -3,948 -4.13 -12,432


34

Psychological problems before age 17

• Weeks Worked effect separated into probability of working at all and weeks if work at least one week

– 75% of effect is participation in labor market

• Individual Earnings effect smaller than family income effect

– Probability of being married reduced by ten percentage points

– Also married spouse with lower earning capacity

35

Psychological Problems in Childhood

• Effects on Family Income are quite large– $10,400 per year or $300,000 per lifetime

reduction in family income– 2.1 trillion dollar lifetime loss in this

country

• Ability to work and likelihood of marriage and who you end up marrying a large part of this

36

Is early childhood health important?

• Depends on what one means by important and for what

– For those in ‘poor health’ as children it is very important for their adult economic and health lives

– adults outcomes–ed, wealth, income in levels and growth trajectories

– And also adult health

• But what fraction are in poor health as a child?

37

Is early childhood health important?

• Depends on what one means by important and for what

• But what fraction are not in good health as a child?

– By my definition it is 17% in HRS and higher in PSID panel

• So it is clearly not the only thing that matters

– Predictive Life does not end at age ten (months or years)

– But a fifth of the sample is not trivial

– Implications for Mortality not yet clear

» But Mortality is not everything

» Life is more important

38

Is early childhood health important?- An International Perspective

• Same Instruments have been put into full HRS panel in 2008

• Also placed into the ELSA (the English HRS) and will be placed in SHARE (fifteen European countries) next wave

39

Prevalence of Diseases Before Age 17, Ages 55-64

Disease England United States

Measles/Mumps/Chicken Pox 91.15 93.42

Depression 2.29 3.00

Asthma 3.49 4.59

Diabetes 0.10 0.21

Respiratory disorder 9.70 11.64

Allergic conditions 6.06 10.54

Heart trouble 0.82 1.88

Ear problems 7.96 7.66

Epilepsy or seizures 0.46 0.64

Headaches or migraines 5.13 6.44

Documents

1 James P. Smith Childhood Health and the Effects on Adult SES Outcomes