Health Disparities

  • Sanjay Basu
  • Mark Cullen
  • Jeremy Freese
  • David Rehkopf

Leaders: Sanjay Basu, Mark Cullen, Jeremy Freese, David Rehkopf 

The affiliates within the Health Disparities RG are using new computer modeling and statistical techniques to examine how poverty affects the health of children and adults and how some anti-poverty programs are reducing those effects. Here’s a sampling of our projects. 

Income, geography, and life expectancy: Using deidentified tax data and Social Security Administration death records, Raj Chetty and his coauthors have shown that the richest 1 percent live 14.6 years longer, on average, than the poorest 1 percent. Although poor people typically have much shorter lives, Chetty also shows that the extent of this disadvantage depends on the place of residence, thus suggesting that there may be opportunities for policy to reduce the gap in life expectancy.

Infant health and poverty: Which poor neighborhoods are associated with very low birth weights? By identifying neighborhoods that are yielding very low birth weights, we can start to target home visiting and related programs.

Biological mechanisms of disadvantage: We all know that poverty “gets under the skin” and creates lasting disadvantage. Is this because children exposed to poverty-induced stress experience epigenetic changes? We’re going to know very soon.

Income and the developing brain: The prevailing view is that poverty is especially likely to shape children’s early development because of the high plasticity and rapid growth of the brain during the first three years of life. It’s high time for a rigorous study of how income affects the brain function and development of infants and toddlers. 

Health - CPI Research

Title Author Media
U.S. Employment and Opioids: Is There a Connection? Janet Currie, Jonas Y. Jin, Molly Schnell

U.S. Employment and Opioids: Is There a Connection?

Author: Janet Currie, Jonas Y. Jin, Molly Schnell
Publisher: NBER
Date: 03/2018

This paper uses quarterly county-level data to examine the relationship between opioid prescription rates and employment-to-population ratios from 2006–2014. We first estimate models of the effect of opioid prescription rates on employment-to-population ratios, instrumenting opioid prescriptions for younger ages using opioid prescriptions to the elderly. We also estimate models of the effect of employment-to-population ratios on opioid prescription rates using a shift-share instrument. We find that the estimated effect of opioids on employment-to-population ratios is positive but small for women, but there is no relationship for men. These findings suggest that although they are addictive and dangerous, opioids may allow some women to work who would otherwise leave the labor force. When we examine the effect of employment-to-population ratios on opioid prescriptions, our results are more ambiguous. Overall, our findings suggest that there is no simple causal relationship between economic conditions and the abuse of opioids. Therefore, while improving economic conditions in depressed areas is desirable for many reasons, it is unlikely to curb the opioid epidemic.

State of the Union 2018: Health Mark Duggan, Valerie Scimeca

State of the Union 2018: Health

Author: Mark Duggan, Valerie Scimeca
Publisher: Stanford Center on Poverty and Inequality
Date: 03/2018

The male-female life expectancy gap, which favors females, fell from 7.6 years in 1970 to 4.8 years in 2010, a reduction of more than one-third. Most of this convergence was caused by asubstantial decline from 1990 to 2000 in HIV-AIDS mortality and in the homicide rate. Because HIV-AIDS and homicide affect men more than women, a decline in these underlying rates had the effect of reducing the male-female life expectancy gap. Life expectancy has stagnated for the last several years for men and women, primarily due to increases in drug poisoning deaths and in the suicide rate. 

The Kids Are All Right Janet M. Currie

The Kids Are All Right

Author: Janet M. Currie
Publisher: Stanford Center on Poverty and Inequality
Date: 01/2018

In this article, we pose the following question: Has the overall set of changes to the safety net since PRWORA improved outcomes for children? To answer that question, we look at several measures of child well-being—mortality rates, teen pregnancy, drug use, and high school graduation rates—and find that across all these measures, poor children are much better off today.

The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes Mark Duggan, Gopi Shah Goda, Emilie Jackson

The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes

Author: Mark Duggan, Gopi Shah Goda, Emilie Jackson
Publisher: NBER
Date: 07/2017

The Affordable Care Act (ACA) includes several provisions designed to expand insurance coverage that also alter the tie between employment and health insurance. In this paper, we exploit variation across geographic areas in the potential impact of the ACA to estimate its effect on health insurance coverage and labor market outcomes in the first two years after the implementation of its main features. Our measures of potential ACA impact come from pre-existing population shares of uninsured individuals within income groups that were targeted by Medicaid expansions and federal subsidies for private health insurance, interacted with each state’s Medicaid expansion status. Our findings indicate that the majority of the increase in health insurance coverage since 2013 is due to the ACA and that areas in which the potential Medicaid and exchange enrollments were higher saw substantially larger increases in coverage. While labor market outcomes in the aggregate were not significantly affected, our results indicate that labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment

State of the Union 2017: Health Rucker C. Johnson

State of the Union 2017: Health

Author: Rucker C. Johnson
Publisher: Stanford Center on Poverty and Inequality
Date: 06/2017

Racial and ethnic minorities experience higher-than-average rates of illness, have higher age-specific death rates throughout the life course, and are more likely to suffer from early onset of illnesses and more severe diseases than whites. In this article, I examine these and other differences in health outcomes for whites and blacks in the United States and show that black-white health disparities are large and appear to widen over the life cycle. I also discuss several policy changes that served to narrow racial health disparities in the past and consider how future policies might help ameliorate racial inequities in health.

health - CPI Affiliates

David Rehkopf's picture David Rehkopf Health Disparities Research Group Leader, Assistant Professor of Medicine
Stanford University
Jeremy Freese's picture Jeremy Freese Health Disparities Research Group Leader, Professor of Sociology
Stanford University
Mark Cullen's picture Mark Cullen Health Disparities Research Group Leader, Director of Stanford Center for Population Health Sciences, Professor of Medicine
Stanford University
Sanjay Basu's picture Sanjay Basu Health Disparities Research Group Leader, Assistant Professor of Medicine
Stanford University
Fernando Riosmena's picture Fernando Riosmena Associate Professor, Population Program, Institute of Behavioral Science and Geography Department
University of Colorado at Boulder

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Health - Other Research

Title Author Media
Tracking Health Inequalities from High School to Midlife Jamie M. Carroll, Chandra Muller, Eric Grodsky, John Robert Warren

Tracking Health Inequalities from High School to Midlife

Author: Jamie M. Carroll, Chandra Muller, Eric Grodsky, John Robert Warren
Publisher: Social Forces
Date: 12/2017

Educational gradients in health status, morbidity, and mortality are well established, but which aspects of schooling produce those gradients is only partially understood. We draw on newly available data from the midlife follow-up of the High School and Beyond sophomore cohort to analyze the relationship between students’ level of coursework in high school and their long-term health outcomes. We additionally evaluate the mediating roles of skill development, postsecondary attendance and degree attainment, and occupational characteristics. We find that students who took a medium- to high-level course of study in high school have better self-reported health and physical functioning in midlife, even net of family background, adolescent health, baseline skills, and school characteristics. The association partially operates through pathways into postsecondary education. Our findings have implications for both educational policy and research on the educational gradient in health.

Exploding Asthma and ADHD Caseloads: The Role of Medicaid Managed Care Anna Chorniy, Janet Currie, Lyudmyla Sonchak

Exploding Asthma and ADHD Caseloads: The Role of Medicaid Managed Care

Author: Anna Chorniy, Janet Currie, Lyudmyla Sonchak
Publisher: NBER
Date: 10/2017

In the U.S., nearly 11% of school-age children have been diagnosed with ADHD, and approximately 10% of children suffer from asthma. In the last decade, the number of children diagnosed with these conditions has inexplicably been on the rise. This paper proposes a novel explanation of this trend. First, the increase is concentrated in the Medicaid caseload nationwide. Second, nearly 80% of states transitioned their Medicaid programs from fee-for-service (FFS) reimbursement to managed care (MMC) by 2016. Using Medicaid claims from South Carolina, we show that this change contributed to the increase in asthma and ADHD caseloads. Empirically, we rely on exogenous variation in MMC enrollment due a change in the “default” Medicaid plan from FFS or MMC, and an increase in the availability of MMC. We find that the transition from FFS to MMC explains most of the rise in the number of Medicaid children being treated for ADHD and asthma. These results can be explained by the incentives created by the risk adjustment and quality control systems in MMC.

The Non-Market Benefits of Education and Ability James J. Heckman, John Eric Humphries, Gregory Veramendi

The Non-Market Benefits of Education and Ability

Author: James J. Heckman, John Eric Humphries, Gregory Veramendi
Publisher: NBER
Date: 10/2017

This paper analyzes the non-market benefits of education and ability. Using a dynamic model of educational choice we estimate returns to education that account for selection bias and sorting on gains. We investigate a range of non-market outcomes including incarceration, mental health, voter participation, trust, and participation in welfare. We find distinct patterns of returns that depend on the levels of schooling and ability. Unlike the monetary benefits of education, the benefits to education for many non-market outcomes are greater for low-ability persons. College graduation decreases welfare use, lowers depression, and raises self-esteem more for less-able individuals.

Multi-Generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health Chloe N. East, Sarah Miller, Marianne Page, Laura R. Wherry

Multi-Generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health

Author: Chloe N. East, Sarah Miller, Marianne Page, Laura R. Wherry
Publisher: NBER
Date: 09/2017

We examine multi-generational impacts of positive in utero and early life health interventions. We focus on the 1980s Medicaid expansions, which targeted low-income pregnant women, and were adopted differently across states and over time. We use Vital Statistics Natality files to create unique data linking individuals’ in utero Medicaid exposure to the next generation’s health outcomes at birth. We find strong evidence that the health benefits associated with treated generations’ in utero access to Medicaid extend to later offspring in the form of higher average birth weight and decreased incidence of very low birth weight. Later childhood exposure to Medicaid does not lead to persistent health effects across generations. The return on investment is substantially larger than suggested by evaluations of the program that focus only on treated cohorts.

Desire for and to Avoid Pregnancy During the Transition to Adulthood Abigail Weitzman, Jennifer S. Barber, Yasamin Kusunoki, Paula England

Desire for and to Avoid Pregnancy During the Transition to Adulthood

Author: Abigail Weitzman, Jennifer S. Barber, Yasamin Kusunoki, Paula England
Publisher: Journal of Marriage and Family
Date: 08/2017

Unintended pregnancies disproportionately occur among teenage women, yet little is known about the determinants of pregnancy desire among this group. The authors use a comprehensive baseline survey and data on pregnancy desires to investigate which unmarried 18- to 20-year-old women want a pregnancy, want to avoid pregnancy, and report consistent pregnancy desire and disinclination. Variables that positively predict pregnancy desire generally negatively predict desire to avoid pregnancy. Although most young women have no desire and strong disinclination in most weeks, childhood public assistance is a strong predictor of wanting pregnancy and not wanting to avoid it. Comparing nested models suggests that the effects of childhood disadvantage operate through social environments where early pregnancy is less stigmatized. Young women in serious relationships, who are depressed, and who are not pursuing postsecondary education have more desire for pregnancy and less disinclination, but little of childhood disadvantage is mediated by these factors.