Toshiko Kaneda

Neighborhood Socioeconomic Disadvantage and Access to Health Care

Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic disadvantage is associated with access to health care. We find that living in disadvantaged neighborhoods reduces the likelihood of having a usual source of care and of obtaining recommended preventive services, while it increases the likelihood of having unmet medical need. These associations are not explained by the supply of health care providers. Furthermore, though controlling for individual-level characteristics reduces the association between neighborhood disadvantage and access to health care, a significant association remains. This suggests that when individuals who are disadvantaged are concentrated into specific areas, disadvantage becomes an “emergent characteristic” of those areas that predicts the ability of residents to obtain health care.

Networks and Contexts: Variation in the Structure of Social Ties1

A core axiom of sociology is that social structure affects and is affected by human behavior. The term “social structure” conveys two quite different meanings. One meaning is relational, involving networks of ties between individuals or groups of individuals. A second meaning refers to the contexts containing these individuals. Studies of neighborhood and community effects depend on variability in both types of social structure. Using data from multiple villages in Nang Rong, Thailand, this article documents substantial variability in network structure and shows that network structure covaries with context in meaningful ways, suggesting reciprocal effects of changes in both. Finally, it considers implications of variability in network structure, showing that social cohesion affects the likelihood of finding and interviewing former village residents.

Unhealthy and Uninsured: Exploring Racial Differences in Health and Health Insurance Coverage Using a Life Table Approach

Millions of people in the United States do not have health insurance, and wide racial and ethnic disparities exist in coverage. Current research provides a limited description of this problem, focusing on the number or proportion of individuals without insurance at a single time point or for a short period. Moreover, the literature provides no sense of the joint risk of being uninsured and in need of medical care. In this article, we use a life table approach to calculate health- and insurance-specific life expectancies for whites and blacks, thereby providing estimates of the duration of exposure to different insurance and health states over a typical lifetime. We find that, on average, Americans can expect to spend well over a decade without health insurance during a typical lifetime and that 40% of these years are spent in less-healthy categories. Findings also reveal a significant racial gap: despite their shorter overall life expectancy, blacks have a longer uninsured life expectancy than whites, and this racial gap consists entirely of less-healthy years. Racial disparities in insurance coverage are thus likely more severe than indicated by previous research.

Access to Health Care: Does Neighborhood Residential Instability Matter?

Many Americans do not have access to adequate medical care. Previous research on this problem focuses primarily on individual-level determinants of access such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed medical care, however, has not received much attention. We address this gap in the literature by investigating the association between neighborhood residential instability and access to health care. Using individual-level data from the 2000 Medical Expenditure Panel Survey and block-group level data from the 2000 decennial census, we find that individuals who live in neighborhoods with high residential turnover have worse health care access than residents of other neighborhoods. This association persists even when the prevalence of poverty, the supply of health care, and a variety of individual characteristics are held constant. We offer explanations for these findings and suggest directions for future research.

A multi-level analysis of urban/rural and socioeconomic differences in functional health status transition among older Chinese.

The main purpose of the study is to assess urban versus rural differences in functional status transitions among older Chinese, aged 55+, and to examine how individual and community level socioeconomic indicators alter the rural/urban effects and themselves influence transitions. The study uses a hierarchical linear modeling approach that considers individual responses to be embedded within communities. Data come from the 2004 and 2006 rounds of the Chinese Health and Nutrition Survey. The study considers the functional transitions of 2944 individuals living across 209 communities in nine Chinese provinces. Functioning is measured at baseline as being able or not being able to conduct all of the following: walking, standing, climbing stairs, lifting, kneeling. Outcomes include having or not having a functional limitation, measured the same way, dying, or not responding. Outcomes are modeled adjusted for baseline functional status. Findings indicate urbanites have substantial advantages. They are less likely to have a limitation at follow-up and less likely to die over the study period. Some of this is explained by socioeconomic indicators measured at two levels. Cross-level interactions suggest education and having insurance operate differently in urban and rural areas. Community-level indicators are somewhat less predictive, and much of the urban advantage is unexplained. In conclusion, the study suggests differences in the influences of socioeconomic indicators in China versus what has been found in the past, and that place of residence in China is a particularly robust predictor of functional health transitions.

Socioeconomic status differentials in life and active life expectancy among older adults in Beijing.

Purpose: The study compares life and active life expectancy estimates across indicators of socioeconomic status (SES) for a cohort of older adults in the Beijing municipality. Our aim is to determine if associations found are consistent across indicators and with those typically observed in the Western industrialized countries. Method: A multistate life table method is used to estimate expected years of total and active life, defined as life spent without limitation in functions necessary for performing daily tasks. Results: We find that men of higher status experience advantages with respect to life and active life expectancies. Among women, only active life expectancy is significantly higher for those of higher status, but the difference by income is not statistically significant. With respect to the proportion of life spent in an active state, both men and women of higher status benefit in comparison to their lower status counterparts. Finally, we find that disparities by SES generally increase with age. Conclusions: Despite several inconsistencies across SES indicators by gender, findings generally confirm inequalities within a society that is organized very differently socially, economically, and politically from the West.

Gender differences in functional health and mortality among the Chinese elderly: Testing an exposure versus vulnerability hypothesis

In this study, the authors focused on older adults in Beijing with three objectives: to examine gender differences in functional health and mortality at the end of a five-year study period, controlling for initial functional health; to determine the extent to which these differences were a function of exposure versus vulnerability to risk factors; and to analyze the relative importance of social, economic, and psychological risk factors in explaining gender differences. The results show that women were more likely to survive and to be functionally dependent at follow-up compared with men among those functionally independent at baseline. No significant differences among those who were initially dependent were apparent. Differential vulnerability to risk factors, more so than exposure, explained the variation in health outcomes across gender. Smoking, a lack of formal education, a lack of health insurance, a low sense of control, stressful events, and rural living played large roles in explaining the differences.

Explaining Late Life Urban vs. Rural Health Discrepancies in Beijing

Social characteristics that differ by place of residence are consequential for health. To study implications of this among older adults in rural vs. urban China, this study employs data from the Beijing municipality, a region that has witnessed growth and gaps in development. Life and active life expectancy is assessed using a multistate life table technique that estimates hazard rates and subsequent expected years in various health states. Hazards are estimated for a model that adjusts regional differences for age and sex and for a series of other models including additional covariates. Results indicate urban residents have an advantage. Specific factors show socio-economic status and access to health service account for a large part, social support and health behaviors for little, while disease is a suppressor.

Health Insurance and Family Structure: The Case of Adolescents in Skipped-Generation Families:

Since 1970, both the number and proportion of children being parented by a grandparent without the help of a parent has increased substantially. The increase in skipped-generation households has generated much concern from policy makers because such households are, on average, disadvantaged compared with most other household types. One important challenge facing grandparents with parenting responsibilities is securing health insurance for their dependent grandchildren. In this study, the authors investigate the extent to which grandparents raising their grandchildren were able to secure health insurance for their dependent grandchildren. They find that adolescents living in skipped-generation families in 1995 were more often uninsured, more often publicly insured, and less often privately insured compared with adolescents in other family types. Even after controlling for income, work status, and education, adolescents in skipped-generation families were still more likely to have public insurance and less likely to have private insurance compared with other adolescents.