Diabetes, Employment and Behavioural Risk Factors in China: Marginal Structural Models Versus Fixed Effects Models

30 Pages Posted: 24 Sep 2018

See all articles by Till Seuring

Till Seuring

University of East Anglia (UEA)

Pieter M. Serneels

University of Oxford - Centre for the Study of African Economies (CSAE)

Marc Suhrcke

World Health Organization - European Office for Investment & Development

Max Bachmann

University of East Anglia (UEA)

Date Written: September 2018

Abstract

A diabetes diagnosis can motivate its recipients to reduce their health risks by changing lifestyles but can adversely affect their economic activity. We investigate the effect of a diabetes diagnosis on employment status and behavioural risk-factors taking into account their potentially intertwined relationships. Longitudinal data from the China Health and Nutrition Survey covering the years 1997 to 2011 are used to estimate the effect of a diabetes diagnosis on employment probabilities, alcohol consumption, smoking cessation, body mass index, physical activity and hypertension. To deal with potential confounding, two complementary statistical techniques - marginal structural and fixed effects models - are applied.The marginal structural and fixed effects models generate similar results despite their different underlying assumptions. Both strategies find patterns distinct for males and females, suggesting a decrease in employment probabilities after the diagnosis for women but not for men. Further, few improvements and even further deterioration of behavioural risk factors are found for women, while for men these risk factors either improve or remain the same. These results suggest differences in the impact of diabetes between sexes in China and highlight the potential of reducing behavioural risk factors for women to narrow these inequities.

Keywords: China, diabetes, employment, behavioural risk factors, marginal structural model

JEL Classification: D83, E24, F61, I12, I14, J24

Suggested Citation

Seuring, Till and Serneels, Pieter M. and Suhrcke, Marc and Bachmann, Max, Diabetes, Employment and Behavioural Risk Factors in China: Marginal Structural Models Versus Fixed Effects Models (September 2018). IZA Discussion Paper No. 11817. Available at SSRN: https://ssrn.com/abstract=3253476

Till Seuring (Contact Author)

University of East Anglia (UEA) ( email )

Norwich Research Park
Norwich, Norfolk NR4 7TJ
United Kingdom

Pieter M. Serneels

University of Oxford - Centre for the Study of African Economies (CSAE) ( email )

Oxford OX1 3UL
United Kingdom

Marc Suhrcke

World Health Organization - European Office for Investment & Development ( email )

Campo Santo Stefano
San Marco 2847
30124 Venice
Italy

Max Bachmann

University of East Anglia (UEA)

Norwich Research Park
Norwich, Norfolk NR4 7TJ
United Kingdom

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