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Health and Mortality Differentials among adults: does selection matter?

Health and Mortality Differentials among adults: does selection matter?. Alberto Palloni Carolina Milesi Robert White Alyn Turner Center for Demography and Ecology University of Wisconsin-Madison. Some history: why did I end up here?. Mortality and health differentials over the life course

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Health and Mortality Differentials among adults: does selection matter?

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  1. Health and Mortality Differentials among adults: does selection matter? Alberto Palloni Carolina Milesi Robert White Alyn Turner Center for Demography and Ecology University of Wisconsin-Madison

  2. Some history: why did I end up here? • Mortality and health differentials over the life course • The role of social classes • The argument of selection • Stages of research: • Early health and adult social class---stratification • Early health and adult mortality/health differentials • What if selection occurs? Are social classes ignorable if selection is relevant?

  3. Empirical regularities • Increasing income and wealth inequality in the US: sustained from 1985 onward, steeper after 1995 • Persistently high intergenerational correlation of earnings, income and wealth • ρ = βcp * (σp /σc ) [.30-.60] • Stalling social mobility: increased stickiness • Persistent adult health and mortality differentials everywhere

  4. Adult SES health/mortality gradients • Magnitude: They are large • Over time: increasing • By age: increase until age 50-55 then (tend to) decrease • Continuous: not accounted for by extremes • Pervasive: causes of death, health status, self-reported conditions • Fairly global (or almost) regardless of prevailing health care system

  5. Age equivalence of mortality rates for high and low education groups

  6. Age equivalence of mortality rates for high and low education groups

  7. Age equivalence of mortality rates for high and low education groups

  8. Age equivalence of mortality rates for high and low education groups

  9. Age equivalence of mortality rates for high and low education groups

  10. Proportion with poor self-reported health by education and age, 1975 Source: NHIS, 1975

  11. Proportion with poor self-reported health by education and age, 2000 Source: NHIS, 2000

  12. Evidence is strong, water tight • Education differentials • Income (permanent) • Wealth: • Studies with PSID • Studies with HRS • Studies with NLSM (couples) • Occupation (prestige/social class)

  13. The origins of social class differentials in health and mortality Social class traits Health

  14. Selection processes • Direct or “drift” • Reverse causality • Heterogeneity • Indirect ‘health selection proper’

  15. Indirect Selection • Health inequalities by SES early in life translate into health inequalities by SES late in life. • This requires that: • Health inequalities early in life be a significant determinant of adult social stratification • Either that early health directly affect adut health OR that there be paths linking early health with conditions (exposure to risks) that are class related

  16. Need a unified theory • How does early health affect stratification? • Social stratification theory • Labor economics and wage determination • How does early health affect adult health? • Early effects theory (Barker-type hypotheses) • Life cycle trajectories (Kuh, Ben-Shlomo, Smith, Wadsworth)

  17. Conditions of possibility • Allocation of health in early childhood is non-random (class dependent) • There must be a relation between early childhood health and acquisition of traits that determine social stratification • There must be a relation between early health and later exposure to risk (direct or indirect)

  18. A new problem: relations involved in “selection” Social class of origin (genes/environments) Social class of destination Traits, antecedent health status Adult health status

  19. What is social class?

  20. What is child health status?

  21. “Emotional development during the first five years offers a window into the psychological growth of young children”(National Research Council, 2003)

  22. “Early social experiences, especially those with primary attachment figures, can have profound consequences for both biobehavioral and physiological functioning throughout the life span” (Suomi, 1999)

  23. What is adult health status?

  24. Two tasks • Early health status affects adult social class positions • Early health status matters for intergenerational transmission of inequalities • Early health status is responsible for effects that account for some or all of adult SES health gradients

  25. The data • British Cohort Survey 1958 • Only males • Use information from 0 up to 41-42 • Do not do multiple imputation to resolve attrition • We go from circa 8,000 to 1,000 cases • Disproportionate attrition among low class

  26. Procedures • Formulate and estimated structural equation model: • Limited: one factor models • Limited: ignore attrition and non response • Use estimates to decompose paths • Use estimates to simulate life course

  27. Task 1: intergenerational transmission of inequalities

  28. What pays out there? • Years of education? • Credentials? • Cognitive performance? • Labor market experience? • Personalities? • Parents’ wallets? • Luck?

  29. “It is common knowledge outside academic journals that motivation, tenacity, trustworthiness, and perseverance are important traits for success in life” (Heckman and Rubinstein, 2001)

  30. Path diagram of relations between early child health conditions and earnings Cognitive Skills 1 1 Educational Attainment Parental Social Class 1 1 3  Early Health 4 Social Class 2 2 2 Parental Health Non- Cognitive Skills 2

  31. Representation of relations: BCS58 Cognitive skills age 11 Educational attainment age 16 SR Health 30 Parental social class SR Health 40 Chronic conditions age 7 Chronic conditions age 16 Low birth weight Social class age 40 Non- cognitive skills age 11 Parental health Social class age 30

  32. Main results Cognitive skills age 11 Educational attainment age 16 Parental social class Low birth weight Chronic conditions age 7 Chronic conditions age 16 Non- cognitive skills age 11 Parental health Social class age 41/42

  33. Main results Cognitive skills age 11 Educational attainment age 16 Parental social class Low birth weight Chronic conditions age 7 Chronic conditions age 16 Non- cognitive skills age 11 Parental health Social class age 41/42

  34. Main results Cognitive skills age 11 Educational attainment age 16 Parental social class Low birth weight Chronic conditions age 7 Chronic conditions age 16 Non- cognitive skills age 11 Parental health Social class age 41/42

  35. Main results Cognitive skills age 11 Educational attainment age 16 Parental social class Low birth weight Chronic conditions age 7 Chronic conditions age 16 Non- cognitive skills age 11 Parental health Social class age 41/42

  36. Main results Cognitive skills age 11 Educational attainment age 16 Parental social class Low birth weight Chronic conditions age 7 Chronic conditions age 16 Non- cognitive skills age 11 Parental health Social class age 41/42

  37. Main results Cognitive skills age 11 Educational attainment age 16 Parental social class Low birth weight Chronic conditions age 7 Chronic conditions age 16 Non- cognitive skills age 11 Parental health Social class age 41/42

  38. Main inference • The effects of early health on social class are important but they only work through cognitive skills and non-cognitive traits. None are direct.

  39. Decomposition of effects • Close to 50 percent of the correlation between parental and offspring social class works through early childhood health indicators (birthweight, chronic conditions at ages 7 and 11)

  40. Decomposition of effects of parental social class on sons’ social class

  41. Decomposition of effects of parental social class on sons’ social class

  42. Decomposition of effects of parental social class on sons’ social class

  43. Decomposition of effects of parental social class on sons’ social class

  44. Monte Carlo matrix exercise Use structural equation model to produce mobility matrices Each iteration generates a random matrix (with random entries) From each matrix several measures of mobility can be extracted

  45. Probability of staying in LOWEST class

  46. Probability of staying in HIGHEST class

  47. Task 2: contribution of early health on adult health status social class gradients

  48. Figure 1: Simplified path diagram representing the relations between early child health conditions and adult social class ρ2 $ * 1 1 PARENTAL SOCIOECONOMIC COGNITIVE EDUCATIONAL BACKGROUND SKILLS ATTAINMENT ( * " * ρ0 1 2 3 1 , 1 (3 EARLY HEALTH SOCIAL CLASS (at age 33) * 4 " 2 ( , 2 2 * 5 PARENTAL HEALTH SOFT SKILLS SOCIAL CLASS (at age 41-42) $ 2 * 6 ρ1

  49. Representation of relations: BCS58 Cognitive skills age 11 Educational attainment age 16 SR Health 30 Parental social class SR Health 40 Chronic conditions age 7 Chronic conditions age 16 Low birth weight Social class age 40 Non- cognitive skills age 11 Parental health Social class age 30

  50. Representation of relations: BCS58 Social Class 30 SR Health 30 Educational attainment Cognition Early Health SR Health 40 Social Class 40

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