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Beware of Being Unaware: Racial Disparities in Chronic Illness in the US

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  • Chatterji, P;
  • Joo, H;
  • Lahiri, K;

Abstract

We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 HRS. We explore two alternative definitions of awareness, and estimate a 3-step sequential model which accounts for selection along measured and unmeasured factors into: (1) participating in biomarker collection, (2) having illness (hypertension or diabetes), and (3) being aware of illness. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness that is used. Contrary to prior studies reporting that African-Americans are more aware of having hypertension than non-Latino whites, we do not find this conclusion to be true after self-selection and severity are considered. Likewise, prior studies show mixed evidence of racial/ethnic disparities in awareness of diabetes, but after accounting for selection, we find that African- Americans and Latinos are less aware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness – the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if s/he actually has the disease but self-reports not having it, we find striking racial/ethnic disparities in awareness.

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Bibliographic Info

Paper provided by HEDG, c/o Department of Economics, University of York in its series Health, Econometrics and Data Group (HEDG) Working Papers with number 11/11.

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Date of creation: Jul 2011
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Handle: RePEc:yor:hectdg:11/11

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Postal: HEDG/HERC, Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom
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Web page: http://www.york.ac.uk/economics/postgrad/herc/hedg/
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  1. Morenoff, Jeffrey D. & House, James S. & Hansen, Ben B. & Williams, David R. & Kaplan, George A. & Hunte, Haslyn E., 2007. "Understanding social disparities in hypertension prevalence, awareness, treatment, and control: The role of neighborhood context," Social Science & Medicine, Elsevier, vol. 65(9), pages 1853-1866, November.
  2. Amitabh Chandra & Jonathan Skinner, 2003. "Geography and Racial Health Disparities," NBER Working Papers 9513, National Bureau of Economic Research, Inc.
  3. Pinka Chatterji & Heesoo Joo & Kajal Lahiri, 2010. "Beware of Unawareness: Racial/Ethnic Disparities in Awareness of Chronic Diseases," NBER Working Papers 16578, National Bureau of Economic Research, Inc.
  4. Hajivassiliou, Vassilis & McFadden, Daniel & Ruud, Paul, 1996. "Simulation of multivariate normal rectangle probabilities and their derivatives theoretical and computational results," Journal of Econometrics, Elsevier, vol. 72(1-2), pages 85-134.
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  6. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
  7. Hugo Benitez-Silva & Moshe Buchinsky & Hiu Man Chan & Sofia Cheidvasser & John Rust, 2000. "How Large is the Bias is Self-Reported Disability?," NBER Working Papers 7526, National Bureau of Economic Research, Inc.
  8. Cutler, David M. & Lleras-Muney, Adriana, 2010. "Understanding Differences in Health Behaviors by Education," Scholarly Articles 5344195, Harvard University Department of Economics.
  9. Cutler, David M. & Lleras-Muney, Adriana, 2010. "Understanding differences in health behaviors by education," Journal of Health Economics, Elsevier, vol. 29(1), pages 1-28, January.
  10. Anna Aizer & Laura Stroud, 2010. "Education, Knowledge and the Evolution of Disparities in Health," NBER Working Papers 15840, National Bureau of Economic Research, Inc.
  11. Harding, Don & Pagan, Adrian, 2006. "Synchronization of cycles," Journal of Econometrics, Elsevier, vol. 132(1), pages 59-79, May.
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