Estimating Socioeconomic Disparities in Self-Rated Health

 描述(由申请者提供)：根据社会经济地位(SES)研究健康差距是一个由来已久的研究传统。近年来，在欠发达和新兴发展地区，人们对这样做的兴趣一直在增长。人们对中国、印度和巴西等新兴经济体国家产生新的兴趣是有充分理由的，这不仅是因为这些国家人口众多，还因为它们的快速经济增长伴随着社会不平等加剧。然而，与西方环境中SES与健康之间有充分证据的积极关联不同，发展中国家的研究结果揭示了混合的、有时甚至是相互矛盾的模式。例如，在中国、菲律宾和泰国，几项研究发现，某些地位较低的群体报告的自我评估的全球健康状况明显好于他们的富裕同龄人，这是一种广泛使用的健康指标。一种可能的解释与调查回答中的测量偏差有关，因为不同文化、人口和社会经济背景的人可能会采用系统地不同的参照系来评估他们的整体健康状况，这一问题被称为报告异质性。在这个项目中，我们建议获得中国成年人自评健康的偏差校正的SES差距估计。我们将使用锚定的小插曲来实现这一点，即对假设的人或情况的简要描述，调查受访者被要求评估的规模与他们评估自己的情况的规模相同。该项目将采用新启动的具有全国代表性的纵向数据收集项目--中国家庭小组研究的2010年至2014年的数据。CFPS中的所有成年受访者都接受了小插曲和自我评估，产生了前所未有的大样本量，因此与之前的研究相比，统计力量更大。与以前使用标准但不受背景影响的小插曲的研究不同，CFPS小插曲专门设计用于在一般用途的家庭调查中锚定自我评级的总体健康状况，在这种调查中，财务和时间限制禁止收集多个特定领域的健康评级。本研究的具体目的是：(1)评估Vignettes方法在调整中国成年人自测健康报告异质性方面的效度和有效性；(2)通过不同维度的客观和主观SES来评估当代中国在Vignettes调整后的自测健康方面的差异。将采用分层有序概率模型及其变体来分析数据。我们将利用CFPS中的纵向措施来解决SES与健康关系的内生性问题。该项目的实证结果将有助于改进和应用Vignettes方法，以衡量来自不同文化和社会的不同人口亚群之间的健康不平等。这些发现还将为关于不同维度的SES在决定健康方面的不同重要性的辩论提供新的线索。

 DESCRIPTION (provided by applicant): Studying health disparities by socioeconomic status (SES) is a long established research tradition. In recent years, interest in doing this in less developed and newly developing regions has been growing. This new interest in countries with emerging economies such as China, India and Brazil is well justified, not just because of their large populations but also because their rapid economic growth has been accompanied by increases in social inequality. However, unlike the well-documented positive association between SES and health in Western settings, findings from developing countries have revealed mixed and sometimes even contradictory patterns. In China, Philippines, and Thailand, for example, several studies found that certain lower status groups reported significantly better self-rated global health status, a widely used health indicator, than their better-off peers. One possible explanation pertains to the measurement bias in survey responses in that people of varying cultural, demographic, and SES backgrounds may adopt systematically different frames of reference in rating their overall health, an issue known as reporting heterogeneity. In this project, we propose to obtain bias-corrected SES gap estimates of self-rated health in Chinese adults. We will achieve this using anchoring vignettes, brief descriptions of hypothetical people or situations that survey respondents are asked to evaluate on the same scale as they use to assess their own situations. This project will draw data from the 2010-2014 waves of the China Family Panel Studies (CFPS), a newly launched nationally-representative longitudinal data collection project. Both vignettes and self-assessments were administered to all the adult respondents in the CFPS, yielding an unprecedentedly large sample size and hence greater statistical power compared to the previous research. Unlike previous studies using standard yet context-blind vignettes, the CFPS vignettes are designed specifically to anchor self-rated overall health in a general-purpose household survey where financial and time constraints prohibit collecting multiple domain-specific health ratings. The specific aims of this proposal are: (1) to assess validity and effectiveness of vignettes methodology in adjusting reporting heterogeneity in self-rated health among Chinese adults; and (2) to estimate disparities in vignette- adjusted self-rated health by different dimensions of objective and subjective SES in contemporary China. The hierarchical ordered probit model and its variants will be employed to analyze the data. We will exploit longitudinal measures in the CFPS to address the endogeneity in the relationship between SES and health. The empirical findings from this project will contribute to the growing efforts of improving and applying the vignettes methodology in measuring health inequalities across different population subgroups from different cultures and societies. The findings will also shed new light on the debate about the varying importance of different dimensions of SES in determining health.