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Health, Aging and Socio-Economic Status in Mexico

Sonia Laszlo (McGill)

Franque Grimard (McGill)

Wilfredo Lim (Columbia)

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Motivation – Research questions What are the long-term health effects of

socio-economic status (SES) during childhood?

How much persists beyond its effect on human capital investment and earnings capacity?

Long term effects of education?

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Motivation - Literature

Income gradient: health outcomes positively affected by income or SES Via child health: Case et al. AER ’02; Currie & Stabile AER

’03 Child health education (Glewwe & Miguel, HDE ’08) Child health & education income (large literature)

But: income and health jointly determined Recently: in utero or childhood SES

Maccini & Yang (AER forthcoming), Almond (JPE ’06): long term health effects of conditions prevailing in utero

Akresh & Verwimp (’07): conditions prevailing in early childhood have long run health outcomes

Review: Strauss and Thomas (HDE ’08)

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Motivation – Aging population We focus on the aging population (50+) in Mexico Developing countries:

Changing burden of disease Pressures on medical resources and financing Yet little literature in economics on these countries

Contribution: Build on Case et al. (JHE ’05) and Buckley et al. (JHE ’04) Long-term effects of childhood SES on health of the elderly

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Why aging in a developing country? Epidemiological transition :

Demographic transition shift in disease burden from infectious to non-communicable diseases.

Demographic transition:

Total fertility rate Life expectancy

Years 55-60 75-80 95-00 55-60 75-80 95-00

Mexico 6.80 5.25 2.67 55.2 65.0 73.7

Centr Am 6.31 4.90 2.90 54.5 64.1 71.9

South Am 5.74 4.27 2.65 55.1 62.9 70.3

North Am 3.72 1.78 1.95 69.7 73.4 76.7

Gap w NA 3.08 3.47 0.72 14.5 8.4 3.0

Source: UN, ESA

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What We Do

Examine Determinants of: Good health for individuals aged 50+ in Mexico in

2001 and 2003 Conditional on good or bad health in 2001

transition (à la Buckley et al., JHE ’04) Does education matter? Does childhood SES matter?

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Directions of ‘causality’

AdulthoodChildhood ‘Golden Years’

Income

Health

Education

Health

Health

CSES

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Directions of ‘causality’

AdulthoodChildhood ‘Golden Years’

Income

Health

Education

Health

Health

CSES

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Directions of ‘causality’

Education

AdulthoodChildhood ‘Golden Years’

Income

Health

Education

Health

Health

CSES

Parental SES

Shocks

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Modeled after the U.S. Health and Retirement Study. We use the two-year panel data set (2001 and 2003) on

Mexicans born prior to 1951 No geographic location codes – limitation Self-reported health: “Would you say your health is…”

Excellent 1 Very good 2 Good 3 Fair 4 Poor 5

We know self reported health measures are measured with error (Baker et al., JHR ’04) We check for robustness to some sensitivity analysis in our

measure

Mexican Health and Aging Study (MHAS)

Good Health = 1

Good Health = 0

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MHAS - We use:

Childhood SES “Before age 10…” : Did your residence have a toilet? Did you regularly go to bed hungry? Did anyone sleep in the same room where you cooked? Did you regularly wear shoes?

Current SES Education, age, gender, marital status Per capita household assets, ‘income’

Parental background Mom’s and dad’s education Dad’s occupation

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Variable

Good Health in 2003 0.380 0.295Good Health in 2001 0.443 0.320Respondent's years of education 5.180 4.370

(4.787) (4.021)Number of children ever born 5.910 5.992

(3.581) (3.611)Before age 10, residence had toilet inside house 0.269 0.302Before age 10, generally go to bed hungry 0.344 0.291Before age 10, wore shoes regularly 0.779 0.778Before age 10, someone slept in same room used for cooking 0.220 0.198

A. Male Sample (N=3818)

B. Female Sample (N=4392)

Table 1 - Descriptive Statistics

Raw correlations

Toilet in residence

Went to bed hungry

regularly

Wore shoes regularly

Sleep where cook

Men Good Health 2001 0.1628 -0.1161 0.0877 -0.0417Good Health 2003 0.1600 -0.1433 0.0765 -0.0691

Women Good Health 2001 0.1674 -0.1211 0.0631 -0.0677Good Health 2003 0.1766 -0.1655 0.0878 -0.0942

At age 10…

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Determinants of (Unconditional) Good Health

2001 2003 2001 2003

Respondent's years of education 0.017 0.017 0.015 0.010(0.004)*** (0.004)*** (0.005)*** (0.005)**

Respondent's age -0.051 -0.065 -0.019 -0.020(0.022)** (0.022)*** (0.019) (0.020)

Respondent's age squared (/1,000) 0.358 0.453 0.133 0.127(0.173)** (0.172)*** (0.015) (0.154)

Log per capita assets 0.002 0.009 0.007 0.014 (0.011) (0.010) (0.010) (0.010)

Number of children ever born 0.007 0.000 -0.007 0.005 (0.005) (0.004) (0.004)* (0.004)

Before age 10, residence had toilet inside house 0.025 -0.016 0.065 0.010 (0.041) (0.037) (0.035)* (0.033)

Before age 10, generally go to bed hungry -0.033 -0.071 -0.025 -0.078 (0.035) (0.032)** (0.039) (0.035)**

Before age 10, wore shoes regularly 0.027 0.019 -0.093 -0.034 (0.036) (0.034) (0.042)** (0.040)

Before age 10, someone slept in same room used for cooking 0.019 0.020 -0.043 -0.028 (0.038) (0.034) (0.038) (0.037)

Location dummies & marital status controls Y Y Y YControl for quality of answer Y Y Y YObservations 3818 3818 4392 4392Chi-Squared statistic for joint significance of the CSES variables 2.43 5.71 9.10* 6.15pseudo R-squared 0.0624 0.0565 0.0676 0.0466Wald Chi-Squared for regression 102.32*** 92.81*** 98.12*** 61.32***

Robust standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%

Table 2 - Good Health, Unconditional (Probit Marginal Effects)

Men Women

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Age and Health 2001 and 2003 by gender

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

Age in 2001

"Pro

bab

ility

of

Go

od

Hea

lth

"

Men 2001 Men 2003 Women 2001 Women 2003

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Probability of Good Health by Years of Education (Men)

0.000

0.100

0.200

0.300

0.400

0.500

0.600

0.700

0.800

0.900

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Years of Education

Pro

bab

ility

of

Go

od

Hea

lth

2001 2003

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Probability of Good Health by Years of Education (Women)

0.000

0.100

0.200

0.300

0.400

0.500

0.600

0.700

0.800

0.900

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Years of Education

Pro

bab

ility

of

Go

od

Hea

lth

2001 2003

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Transition from health status in 2001 to good health in 2003 Follow Buckley et al. (’04) Condition on good / bad health in 2001:

Conditioning to some extent controls for endogeneity of education/SES

Control for remaining endogeneity in education using parental characteristics Parental residence primarily urban, parental education,

dad’s occupation (agriculture, construction, services, business, office, etc…)

iXiiiii XEDUCSESGoodHealthGoodHealth 210103 )|(Prob

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ResultsConditional on Good Health

2001

Conditional on Bad Health

2001

Conditional on Good Health

2001

Conditional on Bad Health

2001Respondent's years of education 0.020 0.006 0.009 0.016

(0.006)*** (0.005) (0.008) (0.004)Respondent's age -0.084 -0.037 -0.015 -0.013

(0.036)** (0.024) (0.036) (0.018)Respondent's age squared (/1,000) 0.622 0.242 0.066 0.079

(0.277)** (0.179) (0.290) (0.137)Log per capita assets 0.006 0.012 0.035 -0.004

(0.016) (0.010) (0.018)** (0.008)Number of children ever born 0.002 0.000 0.006 -0.006

(0.007) (0.005) (0.008) (0.004)*Before age 10, residence had toilet inside house -0.123 0.057 0.033 -0.030

(0.057)** (0.046) (0.059) (0.028)Before age 10, generally go to bed hungry -0.117 -0.028 -0.118 -0.055

(0.055)** (0.035) (0.070)* (0.030)*Before age 10, wore shoes regularly -0.028 0.036 0.018 -0.017

(0.060) (0.036) (0.068) (0.340)Before age 10, someone slept in same room used for cooking -0.035 0.042 -0.073 0.007

(0.059) (0.039) (0.076) (0.036)Location dummies Y Y Y YControl for quality of answer Y Y Y YObservations 1693 2125 1407 2985Chi-Squared statistic for joint significance of the CSES variables 9.49** 4.90 6.93 3.96pseudo R-squared 0.6450 0.0395 0.0649 0.0242Wald Chi-Squared for regression 56.59*** 29.56** 32.03*** 27.37**

Robust standard errors in parentheses. * significant at 10%; ** significant at 5%; *** significant at 1%

Table 3 - Good Health in 2003, Conditional (Probit Marginal Effects)

Men Women

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Is fertility playing a role?

AdulthoodChildhood ‘Golden Years’

Income

Health

Education

Health

Health

CSES

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Is fertility playing a role?

AdulthoodChildhood ‘Golden Years’

Income

Health

Education

Health

Health

CSES

Fertility

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Is fertility playing a role?

Cannot answer question directly – lack of data on reproductive health in MHAS

Yet: Gender differences in LR determinants of health during

‘golden years’ Stronger (>primary) education gradient for women Weak (but negative) effects of number of children ever born

on ‘golden years’ health and transition from bad health And:

CSES strongly significant effect on number of children ever born

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Robustness checks

Education endogenous? CSES endogenous? Number of children ever born endogenous? Use parental background as IV Results

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Conclusions

Childhood SES Education adult health Poverty during childhood matters above and beyond its

effects on education (and income) Effect pronounced for transition from good to good

health Find differential gender effects Policy?

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Validity of Subjective Health Measure

Ailment 2001 2003 2001 2003 2001 2003Hypertension 6788 6951 38.16 35.80 -0.2027*** -0.2165***Diabetes 6785 6945 15.50 16.98 -0.1978*** -0.1626***Cancer 6795 6956 1.88 0.75 -0.0127 -0.0584***Respiratory Problems 6796 6957 5.96 4.22 -0.1065*** -0.0759***Heart Problems 6793 6966 3.20 2.18 -0.0877*** -0.0692***Stroke 6793 6966 2.06 0.92 -0.0602*** -0.0337***Arthritis 6793 6956 20.17 18.63 -0.1929*** -0.1924***Any of the above 6969 6969 55.76 53.85 -0.3092*** -0.2981***

Table 2 - Incidence of ailmentsCorrelation with

Subjective Health Measure

% with AilmentNumber of Non-

Missing Observations

Notes: ***, **, * significant at 1%, 5% and 10% respectively.