The Roots of Health Inequality and the Value of Intrafamily Expertise

Chen, Yiqun; Persson, Per; Polyakova, Maria

doi:10.1257/app.20200405

Cited by 16 publications

(17 citation statements)

References 89 publications

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“…Our findings are also specific to a particular period in the history of a particular infectious disease. Nonetheless, they complement a growing literature that emphasizes the importance of non-medical factors in driving health inequality (e.g., Fuchs 1974;Case and Deaton 2015;Chetty et al 2016;Finkelstein et al 2021;Chen, Persson, et al 2022).…”

Section: Introductionmentioning

confidence: 65%

Heterogeneity in Damages from A Pandemic

Finkelstein¹,

Kocks²,

Polyakova³

et al. 2022

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Section: Introductionmentioning

confidence: 65%

Heterogeneity in Damages from A Pandemic

Finkelstein¹,

Kocks²,

Polyakova³

et al. 2022

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“…5,6,[18][19][20][21][22] Qualitatively, the results among children and adolescents who were all enrolled in Medicaid (at least at the time of measurement) were consistent with findings in non-US high-income contexts that children in lower-income families have worse health even in the presence of health insurance. [22][23][24][25][26][27][28][29] For the US context, unlike the study by Evans et al 7 but similar to the study by Case et al 5 and other studies, injuries and a diagnosis of asthma were significantly associated with family income. [30][31][32] There was no statistically significant association between family income and 10-year mortality among children aged 5 to 9 years, which is in contrast to many studies that have found that an income-mortality gradient is present at any age.…”

Section: Discussionmentioning

confidence: 86%

Association of Family Income With Morbidity and Mortality Among US Lower-Income Children and Adolescents

Udalova

Bhatia

Polyakova

2022

JAMA

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ImportanceFamily income is known to be associated with children’s health; the association may be particularly pronounced among lower-income children in the US, who tend to have more limited access to health resources than their higher-income peers.ObjectiveTo investigate the association of family income with claims-based measures of morbidity and mortality among children and adolescents in lower-income families in the US enrolled in Medicaid or the Children’s Health Insurance Program.Design, Setting, and ParticipantsThis cross-sectional analysis included 795 000 participants aged 5 to 17 years enrolled in Medicaid (Medicaid Analytic eXtract claims, 2011-2012) living in families with income below 200% of the federal poverty threshold (American Community Survey, 2008-2013). Follow-up ended in December 2021.ExposuresFamily income relative to the federal poverty threshold.Main Outcomes and MeasuresRecord of International Classification of Diseases, Ninth Revision codes for an infection, mental health disorder, injury, asthma, anemia, or substance use disorder and death record within 10 years of observation (Social Security Administration death records through 2021).ResultsAmong 795 000 individuals in the sample (all statistics weighted: mean [SD] income-to-poverty ratio, 90% [53%]; mean [SD] age, 10.6 [3.9] years; 56% aged 10 to 17 years), 33% had a diagnosed infection, 13% had a mental health disorder, 6% had an injury, 5% had asthma, 2% had anemia, 1% had a substance use disorder, and 0.6% died between 2011 and 2021, with the mean (SD) age at death of 19.8 (4.2) years. For those aged 5 to 9 years, higher family income was associated with lower adjusted prevalence of all outcomes, except mortality: children in families with an additional 100% income relative to the federal poverty threshold had 2.3 (95% CI, 1.8-2.9) percentage points fewer infections, 1.9 (95% CI, 1.5-2.2) percentage points fewer mental health diagnoses, 0.7 (95% CI, 0.5-0.8) percentage points fewer injuries, 0.3 (95% CI, 0.09-0.5) percentage points less asthma, 0.2 (95% CI, 0.08-0.3) percentage points less anemia, and 0.06 (95% CI, 0.03-0.09) percentage points fewer substance use disorder diagnoses. Except for injury and anemia, the associations were more pronounced among those aged 10 to 17 years than those 5 to 9 years (P for interaction &lt;.05). For those aged 10 to 17 years, an additional 100% income relative to the federal poverty threshold was associated with a lower 10-year mortality rate by 0.18 (95% CI, 0.12-0.25) percentage points.Conclusions and RelevanceAmong children and adolescents in the US aged 5 to 17 years with family income under 200% of the federal poverty threshold who accessed health care through Medicaid or the Children’s Health Insurance Program, higher family income was significantly associated with a lower prevalence of diagnosed infections, mental health disorders, injury, asthma, anemia, and substance use disorders and lower 10-year mortality. Further research is needed to understand whether these associations are causal.

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“…Drawing on admission lottery data that links children's field of education to relatives' health outcomes, two quasiexperimental studies come to opposite conclusions. Chen et al (2022), using Swedish data, find important health benefits to having a physician in the family, Artmann et al (2022) however find no such causal effect in the Netherlands.…”

Section: Causal Pathways and Current Evidencementioning

confidence: 98%

Does Children’s Education Improve Parental Longevity? Evidence From Two Educational Reforms in England

Madia¹,

Präg²,

Monden³

2022

Preprint

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Parents of better-educated children are healthier and live longer. Is this a non-monetary return to education which crosses generational boundaries, or is this the consequence of unobserved factors (e.g. shared genes or living conditions) driving both children’s education and parental health? Using data from the English Longitudinal Study of Aging (ELSA) and two educational reforms that raised the mandatory school-leaving age from age 14 to 15 years in 1947 and from age 15 to 16 years in 1972, we investigate the causal effect of children’s education on parental longevity. Results suggest that both one-year increases in school-leaving age significantly reduced the hazard of dying for fathers as well as for mothers. We do not find a consistent pattern when comparing differences in the effects of daughters’ and sons’ education. Lower class parents benefitted more from the 1972 reform than higher class parents. We discuss these results against the backdrop of generational conflict and the specific English context.

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The Roots of Health Inequality and the Value of Intrafamily Expertise

Cited by 16 publications

References 89 publications

Heterogeneity in Damages from A Pandemic

Heterogeneity in Damages from A Pandemic

Association of Family Income With Morbidity and Mortality Among US Lower-Income Children and Adolescents

Does Children’s Education Improve Parental Longevity? Evidence From Two Educational Reforms in England

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