@article {9270, title = {Diabetes and labor market exits: Evidence from the Health \& Retirement Study (HRS)}, journal = {The Journal of the Economics of Ageing}, volume = {9}, year = {2017}, pages = {100-110}, abstract = {The objective of this paper is to estimate the effect of diabetes on labor market exit using longitudinal data from the 1992-2010 Health and Retirement Study (HRS). We estimate a discrete time hazard model to test whether diabetes affects the hazard of leaving employment among individuals who were working for pay at the age of 55-56. Using a probit model, we also estimate the effect of having undiagnosed or poorly controlled diabetes on the probability of labor market exit two years later. Our results indicate that diabetes is associated with an increased hazard of exiting the labor market for males, but not for females. This effect for males persists when we include controls for onset of other health conditions, two of which are documented complications of diabetes (stroke and heart conditions). We also find that diagnosed diabetes with medication use, regardless of whether or not it is under control, is associated with large negative effects on the likelihood of employment two years later. (C) 2016 Elsevier B.V. All rights reserved.}, keywords = {Chronic disease, Diabetes, Employment and Labor Force, Retirement Planning and Satisfaction}, issn = {2212828X}, doi = {10.1016/j.jeoa.2016.08.005}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2212828X16300639http://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/plain}, author = {Chatterji, Pinka and Heesoo Joo and Kajal Chatterji Lahiri} } @article {9398, title = {Economic Burden of Informal Caregiving Associated With History of Stroke and Falls Among Older Adults in the U.S.}, journal = {American Journal of Preventive Medicine}, volume = {53}, year = {2017}, pages = {S197-S204}, abstract = {Introduction Older adults are at high risk for stroke and falls, both of which require a large amount of informal caregiving. However, the economic burden of informal caregiving associated with stroke and fall history is not well known. Methods Using the 2010 Health and Retirement Study, data on non-institutionalized adults aged >=65 years (N=10,129) in 2015{\textendash}2017 were analyzed. Two-part models were used to estimate informal caregiving hours. Based on estimates from the models using a replacement cost approach, the authors derived informal caregiving hours and costs associated with falls in the past 2 years for stroke and non-stroke persons. Results Both the prevalence of falls overall and of falls with injuries were higher among people with stroke than those without (49.5\% vs 35.1\% for falls and 16.0\% vs 10.3\% for injurious falls, p<0.01). Stroke survivors needed more informal caregiving hours than their non-stroke counterparts, and the number of informal caregiving hours was positively associated with non-injurious falls and even more so with injurious falls. The national burden of informal caregiving (2015 U.S. dollars) associated with injurious falls amounted to $2.9 billion (95\% CI=$1.1 billion, $4.7 billion) for stroke survivors (about 0.5 million people), and $6.5 billion (95\% CI=$4.3 billion, $8.7 billion) for those who never had a stroke (about 3.6 million people). Conclusions In U.S. older adults, informal caregiving hours and costs associated with falls are substantial, especially for stroke survivors. Preventing falls and fall-related injuries, especially among stroke survivors, therefore has potential for reducing the burden of informal caregiving.}, keywords = {Caregiving, Economics, Falls, Health Shocks, Stroke}, issn = {07493797}, doi = {10.1016/j.amepre.2017.07.020}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0749379717304270http://api.elsevier.com/content/article/PII:S0749379717304270?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0749379717304270?httpAccept=text/plain}, author = {Heesoo Joo and Wang, Guijing and Yee, Sue Lin and Zhang, Ping and Sleet, David} } @article {8247, title = {Cost of informal caregiving for patients with heart failure.}, journal = {Am Heart J}, volume = {169}, year = {2015}, month = {2015 Jan}, pages = {142-48.e2}, publisher = {169}, abstract = {

BACKGROUND: Heart failure is a serious health condition that requires a significant amount of informal care. However, informal caregiving costs associated with heart failure are largely unknown.

METHODS: We used a study sample of noninstitutionalized US respondents aged >=50 years from the 2010 HRS (n = 19,762). Heart failure cases were defined by using self-reported information. The weekly informal caregiving hours were derived by a sequence of survey questions assessing (1) whether respondents had any difficulties in activities of daily living or instrumental activities of daily living, (2) whether they had caregivers because of reported difficulties, (3) the relationship between the patient and the caregiver, (4) whether caregivers were paid, and (5) how many hours per week each informal caregiver provided help. We used a 2-part econometric model to estimate the informal caregiving hours associated with heart failure. The first part was a logit model to estimate the likelihood of using informal caregiving, and the second was a generalized linear model to estimate the amount of informal caregiving hours used among those who used informal caregiving. Replacement approach was used to estimate informal caregiving cost.

RESULTS: The 943 (3.9\%) respondents who self-reported as ever being diagnosed with heart failure used about 1.6 more hours of informal caregiving per week than those who did not have heart failure (P < .001). Informal caregiving hours associated with heart failure were higher among non-Hispanic blacks (3.9 hours/week) than non-Hispanic whites (1.4 hours/week). The estimated annual informal caregiving cost attributable to heart failure was $3 billion in 2010.

CONCLUSION: The cost of informal caregiving was substantial and should be included in estimating the economic burden of heart failure. The results should help public health decision makers in understanding the economic burden of heart failure and in setting public health priorities.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Cost of Illness, Heart Failure, Humans, Linear Models, Male, Middle Aged, Models, Econometric}, issn = {1097-6744}, doi = {10.1016/j.ahj.2014.10.010}, url = {http://search.proquest.com/docview/1634498117/abstract/1B5FA0446C27487FPQ/46http://ac.els-cdn.com/S0002870314006176/1-s2.0-S0002870314006176-main.pdf?_tid=0594e8aa-b649-11e5-862d-00000aab0f6bandacdnat=1452286224_94f2bbbda86fc78991ea145942769029http://medi}, author = {Heesoo Joo and Fang, Jing and Jan L Losby and Wang, Guijing} } @article {8127, title = {Cost of informal caregiving associated with stroke among the elderly in the United States}, journal = {Neurology}, volume = {83}, year = {2014}, note = {Times Cited: 1 0 1}, pages = {1831-1837}, publisher = {83}, abstract = {Objectives: We estimated the informal caregiving hours and costs associated with stroke. Methods: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. We compared informal caregiving hours between case and control groups in 2006 (prestroke period for case group) and in 2008 (poststroke period for case group) and estimated incremental informal caregiving hours attributable to stroke by applying a difference-in-differences technique to propensity score-matched populations. We used a replacement approach to estimate the economic value of informal caregiving. Results: The weekly incremental informal caregiving hours attributable to stroke were 8.5 hours per patient. The economic value of informal caregiving per stroke survivor was 8,211 per year, of which 4,356 (53 ) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at 14.2 billion in 2008. Conclusions: Recent changes in public health and social support policies recognize the economic burden of informal caregiving. Our estimates reinforce the high economic burden of stroke in the United States and provide up-to-date information for policy development and decision-making.}, keywords = {Adult children, Health Conditions and Status, Healthcare, Public Policy}, author = {Heesoo Joo and Dunet, Diane O. and Fang, Jing and Wang, Guijing} } @article {7737, title = {Beware of being unaware: racial/ethnic disparities in chronic illness in the USA.}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Sep}, pages = {1040-60}, abstract = {

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.

}, keywords = {Aged, Biomarkers, Black People, Chronic disease, Data collection, Diabetes Mellitus, ethnicity, Female, Health Knowledge, Attitudes, Practice, Health Status Disparities, Hispanic or Latino, Humans, Hypertension, Male, Racial Groups, Self Report, United States, White People}, issn = {1099-1050}, doi = {10.1002/hec.2856}, author = {Chatterji, Pinka and Heesoo Joo and Kajal Chatterji Lahiri} } @mastersthesis {6365, title = {Health Disparities among the U.S. Elderly}, volume = {Ph.D.}, year = {2012}, school = {State University of New York at Albany}, address = {Albany, NY}, abstract = {This dissertation examines health disparities related to race/ethnicity and socioeconomic status among the U.S. elderly taking into account empirical challenges including: (1) self-selection and unobserved factors; (2) subjective and objective measures of disease; and (3) attrition bias. Using the 2006 Health and Retirement Study, we find that current estimates of racial/ethnic disparities in awareness of chronic disease are sensitive to self-selection and unobserved factors. Contrary to prior studies reporting that African-Americans are more aware of having hypertension than non-Latino whites, we do not find this conclusion to be true after controlling for self-selection and disease severity. Likewise, prior studies show mixed evidence of racial/ethnic disparities in awareness of diabetes, but after accounting for selection, we find that African-Americans and Latinos are less aware of having diabetes compared to non-Latino whites. Using the National Health and Nutrition Examination Survey from 1999-2008, we find that education is not associated with self-reported measures of diabetes and hypertension, and it is positively associated with self-reported high cholesterol. However, there is a strong negative association between education and diabetes and hypertension when we use objective measures. There is no association between education and objective measures of high cholesterol. When we account for the possibility of shared, unmeasured determinants of disease prevalence and diagnosis that are correlated with education, we find that education is negatively associated with having undiagnosed hypertension and diabetes. In addition, we find that trends in cardiovascular disease (CVD) risk factors, including (1) high blood glucose, (2) high blood pressure, (3) high cholesterol, and (4) smoking, improved over the past two decades among individuals with diabetes, but racial/ethnic and education-related disparities have emerged in some areas. Finally, we estimate income-related health inequality, measured by the concentration index with an unbalanced panel dataset, explicitly accounting for attrition due to mortality, using the RAND version of HRS. We find that income-related health inequality improves as people age, but this improvement primarily comes from the high mortality rate among poorer individuals. A balanced panel dataset analysis generates misleading results of progressive health deterioration, while an unbalanced panel dataset analysis brings out this regressive deterioration.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Women and Minorities}, author = {Heesoo Joo} }