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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.

Suggested Citation

  • Chatterji, P & Joo, H & Lahiri, K, 2011. "Beware of Being Unaware: Racial Disparities in Chronic Illness in the US," Health, Econometrics and Data Group (HEDG) Working Papers 11/11, HEDG, c/o Department of Economics, University of York.
  • Handle: RePEc:yor:hectdg:11/11
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    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. Amitabh Chandra & Jonathan Skinner, 2003. "Geography and Racial Health Disparities," NBER Working Papers 9513, National Bureau of Economic Research, Inc.
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    6. 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.
    7. 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.
    8. Anna Aizer & Laura Stroud, 2010. "Education, Knowledge and the Evolution of Disparities in Health," NBER Working Papers 15840, National Bureau of Economic Research, Inc.
    9. Hugo Benítez-Silva & Moshe Buchinsky & Hiu Man Chan & Sofia Cheidvasser & John Rust, 2004. "How large is the bias in self-reported disability?," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(6), pages 649-670.
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