Department of Economics, University at Albany: SUNY, Albany, NY 12222, USA.
Health Econ. 2012 Sep;21(9):1040-60. doi: 10.1002/hec.2856. Epub 2012 Jul 5.
We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. 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 used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware 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 he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes.
我们利用 2006 年健康与退休研究中的生物标志物数据，研究了慢性病意识方面的种族/民族差异。我们探索了两种不同的意识定义，并估计了一个三变量概率比例回归模型，其中包括共同的、未测量的因素，这些因素是以下三个方面的基础：（1）自我报告的慢性病；（2）参与生物标志物采集；（3）在参与生物标志物采集的情况下患有疾病。我们的研究结果表明，目前对慢性病的种族/民族差异的估计对选择和使用的疾病意识定义都很敏感。我们发现，非裔美国人不太可能不知道自己患有高血压，而非拉丁裔白人则不太可能不知道自己患有高血压，但在考虑到选择因素后，这种影响的幅度明显下降。在考虑到选择因素后，我们发现，与非拉丁裔白人相比，非裔美国人和拉丁裔更有可能不知道自己患有糖尿病。这些发现是基于一种广泛使用的意识定义——即有疾病的人报告疾病的可能性。当我们使用另一种意识定义时，即如果一个人自我报告没有疾病，但实际上有疾病，则认为他或她不知道自己有疾病，那么我们发现，在高血压和糖尿病方面，与非拉丁裔白人相比，少数族裔的不知道的情况更高。
