Chen Xi, Yan Binjian, Gill Thomas M
Department of Health Policy and Management, Yale School of Public Health, New Haven, USA.
Department of Economics, Yale University, New Haven, USA.
Soc Indic Res. 2022 Apr;160(2-3):689-716. doi: 10.1007/s11205-020-02436-2. Epub 2020 Jul 12.
This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study in 2013 and 2015 with the newly released 2014 Life History Survey, and two waves of the Health and Retirement Study in 2014 and 2016 with the newly released 2015 Life History Mail Survey in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7-16 and 14-30% of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/urban status contribute more to health inequality in China, while family socioeconomic status contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity.
本文估计了童年境遇对老年健康不平等的影响程度，并评估了童年境遇的主要领域对美国和中国健康不平等的重要性。我们将2013年和2015年的两波中国健康与养老追踪调查与新发布的2014年生命历程调查相联系，并将2014年和2016年的两波健康与退休研究与美国新发布的2015年生命历程邮件调查相联系，以量化因几乎无法控制的童年境遇导致的健康不平等。使用夏普利值分解方法，我们表明童年境遇分别可能解释中国和美国老年健康不平等的7%-16%和14%-30%。具体而言，对于自评健康、心理健康和身体健康，童年境遇对美国健康不平等的影响大于中国。考察童年境遇的领域，地区和城乡身份对中国健康不平等的影响更大，而家庭社会经济地位对美国健康不平等的影响更大。我们的研究结果支持了生命历程方法在确定老年健康关键决定因素方面的价值。区分健康不平等的来源并纠正因童年早期境遇导致的不平等，应该是促进健康公平政策的基础。
