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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

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
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?
empirical regularities
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
adult ses health mortality gradients
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
evidence is strong water tight
Evidence is strong, water tight
  • Education differentials
  • Income (permanent)
  • Wealth:
      • Studies with PSID
      • Studies with HRS
      • Studies with NLSM (couples)
  • Occupation (prestige/social class)
selection processes
Selection processes
  • Direct or “drift”
  • Reverse causality
  • Heterogeneity
  • Indirect ‘health selection proper’
indirect selection
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
need a unified theory
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)
conditions of possibility
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)
a new problem relations involved in selection
A new problem: relations involved in “selection”

Social class

of origin

(genes/environments)

Social class

of

destination

Traits, antecedent

health status

Adult health

status

slide21

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

slide22

“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)

two tasks
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
the data
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
procedures
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
what pays out there
What pays out there?
  • Years of education?
  • Credentials?
  • Cognitive performance?
  • Labor market experience?
  • Personalities?
  • Parents’ wallets?
  • Luck?
slide29

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

slide30

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

representation of relations bcs58
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

slide32

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

slide33

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

slide34

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

slide35

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

slide36

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

slide37

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

main inference
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.
decomposition of effects
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)
monte carlo matrix exercise
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

slide48

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

representation of relations bcs5849
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

representation of relations bcs5850
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

representation of relations bcs5851
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

representation of relations bcs5852
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

representation of relations bcs5853
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

representation of relations bcs5854
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

representation of relations bcs5855
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

representation of relations bcs5856
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

representation of relations bcs5857
Representation of relations: BCS58

Social Class 30

SR Health

30

Educational

attainment

Cognition

Early

Health

SR Health

40

Social Class 40

some estimates effects on log odds of being in poor health general model
Some estimates: effects on log odds of being in poor health: general model
  • SRH at age 40
    • Social Class at 40: -.109(.04)
    • Ed Attainment:-.155(.120)
    • Social Class at 30:-.031(.060)
    • LBW:.679(.24)
    • SRH at 30:1.148(.108)!!!!!!!
  • LBW or Chronic conditions at 11 have similar effects
main results relation between adult social class and health status
Main results: relation between adult social class and health status
  • Social class of origins has significant net effects
  • Large effects of cognition (education)
  • Persistent direct effects of birthweight
  • Persistent effects of No of chronic conditions at age 7
main inferences
Main inferences
  • The effects of lagged social class and health status at age 41-42 are mainly explained by education-cognition
  • Effects of birthweight and No of chronic conditions at age 7 are direct and important
main inferences cont
Main inferences (cont.)
  • Effects of SClass(30) on SRH(40) are strong even after controlling for early life conditions
  • Effects of LBW and chronic conditions on SRH (40) at 11 are strong
  • But, contemporaneous and lagged effects of social class persist
decomposition of effects62
Decomposition of effects
  • Close to 60 percent of the correlation between lagged social class at age 33 and self reported health status at age 41-42 works through early childhood health indicators (birthweight, chronic conditions at ages 7 and 11)
decomposition of effects63
Decomposition of effects
  • About 10 percent of total effects of Social Class at 30 on SRH at 40 are attributable to early conditions
  • The remainder is NOT selection
  • The remainder is NOT trivial: people of lower social classes have a relative risk of being in poor health that is 1.70 as high as that of higher classes
monte carlo matrix exercise64
Monte Carlo matrix exercise

Use structural equation model to produce social class-health status mobility matrices

Each iteration generates a random matrix (with random entries)

From each matrix several measures of social class and health mobility can be extracted

inference from matrix exercise
Inference from matrix exercise
  • Early health status accounts for only 7 to 10 percent of the actual probability of immobility
  • Early health status accounts for no more than 10 percent of the association between lagged social class and self reported health status during adulthood.
conclusions
Conclusions
  • Early childhood health has a small but non-ignorable contribution to overall transmission of social inequalities
  • It is not an important mechanisms leading to health selection. If selection is important it must be due to other types of mechanisms
  • We are likely to have underestimated its effects due to:
      • Measurement problems
      • Attrition processes
new strategies
New strategies
  • BCS 1958 and 1970 with Multiple Imputation
  • Artificial cohorts with multiple imputation
data bases
Data Bases

ECLS

or

NLSY

NELS

data bases75
Data Bases

ECLS

or

NLSY

NELS

data bases76
Data Bases

ECLS

or

NLSY

NELS

Imputation

slide77

END

For the time being

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