Diabetes, employment and behavioural risk factors in China: Marginal structural models versus fixed effects models  

Till Seuring, Pieter Serneels, Marc Suhrcke, Max O Bachmann

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We use longitudinal data from the China Health and Nutrition Survey, covering
the years 1997 to 2011, to estimate the eect of a diabetes diagnosis on an economic
outcome (employment probabilities) and behavioural risk factors (alcohol consumption,
smoking cessation, body mass index (BMI), physical activity and hypertension) for men
and women. We apply two complementary statistical techniques—marginal structural
models (MSMs) and fixed eects (FE) models—to deal with confounding. Both methods
suggest, despite their dierent underlying assumptions, similar patterns that indicate
important dierences between men and women. Employment probabilities decline
substantially after the diagnosis for women (-12.4 (MSM) and -15.5 (FE) percentage
points), but do not change significantly for men. In particular, the MSM estimates
indicate an increase in hypertension (13 percentage points) and a decrease in physical
activity for women, while men have small and statistically insignificant changes in these
outcomes. For BMI, the MSM results indicate statistically significant changes for men
(-.76), but not for women, while the FE estimates show similar reductions for men and
women (-.80 and -.73 respectively). Men also reduce their alcohol consumption, but do
not cease to smoke. For women these risk factors have a prevalence close to zero to begin
with, though women seem to still reduce alcohol consumption somewhat. These results
suggest important gender dierences in the impact of diabetes in China. To narrow
these inequities policies supporting women to reduce diabetes related risk factors are
likely important.
Original languageEnglish
Article number100925
Number of pages13
JournalEconomics and Human Biology
Early online date15 Sept 2020
Publication statusPublished - 1 Dec 2020

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