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Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?

  • Susan L. Ettner

    (Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA)

  • Betsy L. Cadwell

    (Centers for Disease Control and Prevention, Atlanta, GA, USA)

  • Louise B. Russell

    (Department of Economics, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA)

  • Arleen Brown

    (Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA)

  • Andrew J. Karter

    (Division of Research, Kaiser Permanente, Oakland, CA, USA)

  • Monika Safford

    (Deep South Center on Effectiveness, Birmingham VA Medical Center, University of Alabama at Birmingham, Birmingham, AL, USA)

  • Carol Mangione

    (Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA)

  • Gloria Beckles

    (Centers for Disease Control and Prevention, Atlanta, GA, USA)

  • William H. Herman

    (The University of Michigan Health System, Ann Arbor, MI, USA)

  • Theodore J. Thompson

    (Centers for Disease Control and Prevention, Atlanta, GA, USA)

Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping|cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race|ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping|cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping|cooking was greater among racial|ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3 min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices. Copyright © 2008 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1394
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Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 18 (2009)
Issue (Month): 6 ()
Pages: 645-663

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Handle: RePEc:wly:hlthec:v:18:y:2009:i:6:p:645-663
Contact details of provider: Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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  1. Duan, Naihua, et al, 1983. "A Comparison of Alternative Models for the Demand for Medical Care," Journal of Business & Economic Statistics, American Statistical Association, vol. 1(2), pages 115-26, April.
  2. David Cutler & Edward Glaeser & Jesse Shapiro, 2003. "Why Have Americans Become More Obese?," NBER Working Papers 9446, National Bureau of Economic Research, Inc.
  3. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
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