Healthy, wealthy, and wise? Tests for direct causal paths between health and socioeconomic status
Healthy, wealthy, and wise? Tests for direct causal paths between health and socioeconomic status
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DOI：
10.1016/s0304-4076(02)00145-8
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发表时间：
2003-01-01
影响因子：
6.3
通讯作者：
Ribeiro, T
中科院分区：
文献类型：
--
作者：
Adams, P;Hurd, MD;Ribeiro, T
本文提供的统计方法，允许社会经济地位和健康的关联，部分解开面板数据排除一些假设的因果路径，或界定其范围内的行动。这些方法被应用到资产和健康动态的最古老的老人（AHEAD）面板测试的因果关系的情况下，从社会经济地位（SES）的健康创新和死亡率，从健康状况的创新财富。我们的结论是，在美国老年人口中，医疗保险覆盖了大多数急性护理，养老金收入不受工作能力的影响，证据支持SES与死亡率和大多数突发性健康状况发生率没有直接因果关系的假设（事故和一些急性疾病），一旦最初的健康状况得到控制，但SES与逐渐发病的健康状况的发生率有一定的关联（精神疾病，以及一些退行性和慢性疾病），这是由于因果关系或持续的未观察到的行为或遗传因素，这些因素对SES和健康创新具有共同影响。有各种证据表明，健康状况与财富创新之间存在关联。配偶的死亡似乎对遗属的财富产生了负面影响;这可能是一种直接的因果关系。有证据表明，健康状况与完整夫妇和单身人士的流动财富的增加有关。从这些发现中，我们得出结论，没有证据表明与SES相关的急性疾病治疗会导致死亡率差异。与SES相关的预防性护理是否会影响慢性疾病和精神疾病的发病，这一问题仍然悬而未决。本文的附录包含详细的模型估计、数据以及用于数据准备和估计的程序，可在http://elsa.berkeley.edu/wp/hww/hww202.html上找到。(C)2002 Elsevier Science B. V.保留所有权利。
This paper provides statistical methods that permit the association of socioeconomic status and health to be partially unraveled in panel data by excluding some postulated causal paths, or delimiting their range of action. These methods are applied to the Asset and Health Dynamics of the Oldest Old (AHEAD) Panel to test for the absence of causal links from socioeconomic status (SES) to health innovations and mortality, and from health conditions to innovations in wealth. We conclude that in this elderly American population, where Medicare covers most acute care and pension income is not affected by ability to work, the evidence supports the hypothesis of no direct causal link from SES to mortality and to incidence of most sudden onset health conditions (accidents and some acute conditions), once initial health conditions are controlled, but there is some association of SES with incidence of gradual onset health conditions (mental conditions, and some degenerative and chronic conditions), due either to causal links or to persistent unobserved behavioral or genetic factors that have a common influence on both SES and innovations in health. There is mixed evidence for an association of health conditions and innovations in wealth. The death of a spouse appears to have a negative effect on the wealth of the survivor; this is plausibly a direct causal effect. There is evidence for some association of health conditions with increased dissaving from liquid wealth for intact couples and singles. From these findings, we conclude that there is no evidence that SES-linked therapies for acute diseases induce mortality differentials. The question of whether SES-linked preventative care influences onset of chronic and mental diseases remains open. The appendix to this paper containing the detailed model estimates, the data, and the programs used for data preparation and estimation, can be found at http://elsa.berkeley.edu/wp/hww/hww202.html. (C) 2002 Elsevier Science B.V. All rights reserved.