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Social Capital or Education: What Matters Most to Cut Time to Diagnosis?

Author

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  • Setti Rais Ali

    (Hospinnomics (PSE - AP-HP), PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - ENPC - École des Ponts ParisTech - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique)

  • Paul Dourgnon

    (Institute for genetic disease)

  • Lise Rochaix

    (Hospinomics - PSE - Paris School of Economics, PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - ENPC - École des Ponts ParisTech - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - PSL - Université Paris sciences et lettres - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique)

Abstract

Time to diagnosis, defined as the time span from first symptoms to final diagnosis, has received little if no attention, although it is perceived as highly variable across conditions, patients and countries and as a key determinant of health prognoses and outcomes. In this paper, we offer one of the first measures of time to diagnosis for four chronic conditions (bipolar trouble, Crohn disease, multiple sclerosis and psoriasis), and analyze the role played by patients education and social networks in explaining time to diagnosis. Adopting a patient's perspective, we use self-reported data from an online open access questionnaire administered to a large French social network of patients with chronic conditions. Duration models are used to explain variations in time to diagnosis. Our findings suggest that social participation and social support indeed reduce the probability of experiencing longer time spans to diagnosis. But contrary to expectations, higher levels of education have the reverse effect. We further analyze these results by identifying differences in patients' health care-seeking behavior: more educated patients tend to consult specialists first, which leads to longer time spans to diagnosis as they are less prone than GPs to referring patients to hospitals for additional tests, when needed. While our social networks findings support WHOs recommendations to enhance individual social capital, results on education provide support for reforms aimed at implementing GP referral systems.

Suggested Citation

  • Setti Rais Ali & Paul Dourgnon & Lise Rochaix, 2018. "Social Capital or Education: What Matters Most to Cut Time to Diagnosis?," Working Papers halshs-01703170, HAL.
  • Handle: RePEc:hal:wpaper:halshs-01703170
    Note: View the original document on HAL open archive server: https://halshs.archives-ouvertes.fr/halshs-01703170v2
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    Keywords

    Health inequalities; Education; Chronic disease; Diagnosis; Social capital;

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