Abstract
We use longitudinal data from the China Health and Nutrition Survey, covering the years 1997–2011, to estimate the effect of a diabetes diagnosis on an economic outcome (employment probabilities) and behavioural risk factors (alcohol consumption, smoking cessation, body mass index (BMI), physical activity and hypertension) for men and women. We apply two complementary statistical techniques—marginal structural models (MSMs) and fixed effects (FE) models—to deal with confounding. Both methods suggest, despite their different underlying assumptions, similar patterns that indicate important differences between men and women. Employment probabilities decline substantially after the diagnosis for women (−12.4 (MSM) and −15.5 (FE) percentage points), but do not change significantly for men. In particular, the MSM estimates indicate an increase in hypertension (13 percentage points) and a decrease in physical activity for women, while men have small and statistically insignificant changes in these outcomes. For BMI, the MSM results indicate statistically significant changes for men (−.76), but not for women, while the FE estimates show similar reductions for men and women (−.80 and −.73 respectively). Men also reduce their alcohol consumption, but do not cease to smoke. For women these risk factors have a prevalence close to zero to begin with, though women seem to still reduce alcohol consumption somewhat. These results suggest important gender differences in the impact of diabetes in China. To narrow these inequities policies supporting women to reduce diabetes related risk factors are likely important.
Original language | English |
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Article number | 100925 |
Journal | Economics and Human Biology |
Volume | 39 |
Early online date | 15 Sep 2020 |
DOIs | |
Publication status | Published - Dec 2020 |
Keywords
- Behavioural risk factors
- China
- Diabetes
- Employment
- Marginal structural model
Profiles
-
Max Bachmann
- Norwich Medical School - Professor of Health Services Research
- Norwich Institute for Healthy Aging - Member
- Population Health - Member
- Norwich Epidemiology Centre - Member
- Health Services and Primary Care - Member
Person: Research Group Member, Research Centre Member, Academic, Teaching & Research
-
Pieter Serneels
- School of Global Development - Professor of Economics
- Centre for Behavioural and Experimental Social Science - Member
- Tyndall Centre for Climate Change Research - Member
- Impact Evaluation - Member
Person: Research Group Member, Academic, Teaching & Research