Investing time in health

Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?

Susan L. Ettner, Betsy L. Cadwell, Louise B. Russell, Arleen Brown, Andrew J. Karter, Monika Safford, Carol Mangione, Gloria Beckles, William H. Herman, Theodore J. Thompson, David Marrero, Ronald T. Ackermann, Susanna R. Williams, Matthew Bair, Ed Brizendine, Aaron Carroll, Gilbert C. Liu, Paris Roach, Usha Subramanian, Honghong Zhou & 82 others Joseph V. Selby, Andrew J. Karter, Bix E. Swain, Assiamira Ferrara, John Hsu, Julie A. Schmittdiel, Connie Uratsu, David J. Curb, Beth Waitzfelder, Rosina Everitte, Thomas Vogt, Richard Chung, Adams Dudley, Chien Wen Tseng, Qimei He, Xinli Li, Ruth Baldino, Carol M. Mangione, Arleen Brown, Elaine Quiter, Kendrik Duru, Susan Ettner, Shaista Malik, Martin F. Shapiro, Neil Steers, Norman Turk, Lisa Chan, Glenda Ventura, Norman L. Lasser, Stephen H. Schneider, Dorothy A. Caputo, Jesse C. Crosson, Stephen Crystal, Monica Girotra, David S. Kountz, Leslie Faith Taub Morritt, Shou En Lu, Pin Wen Wang, Gabrielle J. Davis, Lucyna Lis, Sonja Ross, William Marrone, William H. Herman, Jennifer Goewey, Michele Heisler, Catherine Kim, Joyce Lee, Kingsley Onyemere, Aruna Sarma, Ray Burke, Laura McEwen, Rebecca Niehus, Edward W. Gregg, Bernice Moore, Gloria Beckles, James P. Boyle, Tiffany Gary, Linda Geiss, Bob Gerzoff, Betsy L. Cadwell, Roberta H. Hilsdon, Henry Kahn, Venkat Narayan, Jinan Saaddine, Mark R. Stevens, Ted Thompson, Ed Tierney, Ping Zhang, Rui Li, Brenda Colley Gilbert, Millie Trotter, Shay Clayton, Larry Weller, Dori Bilik, Sanford A. Garfield, Eve Kerr, Rodney Hayward, Sarah Krein, John Piette, Mary Hogan, Fatima Makki, Jennifer Davis

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3 min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

Original languageEnglish
Pages (from-to)645-663
Number of pages19
JournalHealth Economics
Volume18
Issue number6
DOIs
StatePublished - 2009

Fingerprint

Vulnerable Populations
Self Care
Health
Foot
Cooking
Exercise
Bayes Theorem
Managed Care Programs
Research
African Americans
Chronic Disease
Demography
Education
Costs and Cost Analysis

Keywords

  • Diabetes
  • Disparities
  • Opportunity costs of time
  • Self-care
  • Socioeconomic status

ASJC Scopus subject areas

  • Health Policy

Cite this

Ettner, S. L., Cadwell, B. L., Russell, L. B., Brown, A., Karter, A. J., Safford, M., ... Davis, J. (2009). Investing time in health: Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care? Health Economics, 18(6), 645-663. https://doi.org/10.1002/hec.1394

Investing time in health : Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care? / Ettner, Susan L.; Cadwell, Betsy L.; Russell, Louise B.; Brown, Arleen; Karter, Andrew J.; Safford, Monika; Mangione, Carol; Beckles, Gloria; Herman, William H.; Thompson, Theodore J.; Marrero, David; Ackermann, Ronald T.; Williams, Susanna R.; Bair, Matthew; Brizendine, Ed; Carroll, Aaron; Liu, Gilbert C.; Roach, Paris; Subramanian, Usha; Zhou, Honghong; Selby, Joseph V.; Karter, Andrew J.; Swain, Bix E.; Ferrara, Assiamira; Hsu, John; Schmittdiel, Julie A.; Uratsu, Connie; Curb, David J.; Waitzfelder, Beth; Everitte, Rosina; Vogt, Thomas; Chung, Richard; Dudley, Adams; Tseng, Chien Wen; He, Qimei; Li, Xinli; Baldino, Ruth; Mangione, Carol M.; Brown, Arleen; Quiter, Elaine; Duru, Kendrik; Ettner, Susan; Malik, Shaista; Shapiro, Martin F.; Steers, Neil; Turk, Norman; Chan, Lisa; Ventura, Glenda; Lasser, Norman L.; Schneider, Stephen H.; Caputo, Dorothy A.; Crosson, Jesse C.; Crystal, Stephen; Girotra, Monica; Kountz, David S.; Taub Morritt, Leslie Faith; Lu, Shou En; Wang, Pin Wen; Davis, Gabrielle J.; Lis, Lucyna; Ross, Sonja; Marrone, William; Herman, William H.; Goewey, Jennifer; Heisler, Michele; Kim, Catherine; Lee, Joyce; Onyemere, Kingsley; Sarma, Aruna; Burke, Ray; McEwen, Laura; Niehus, Rebecca; Gregg, Edward W.; Moore, Bernice; Beckles, Gloria; Boyle, James P.; Gary, Tiffany; Geiss, Linda; Gerzoff, Bob; Cadwell, Betsy L.; Hilsdon, Roberta H.; Kahn, Henry; Narayan, Venkat; Saaddine, Jinan; Stevens, Mark R.; Thompson, Ted; Tierney, Ed; Zhang, Ping; Li, Rui; Gilbert, Brenda Colley; Trotter, Millie; Clayton, Shay; Weller, Larry; Bilik, Dori; Garfield, Sanford A.; Kerr, Eve; Hayward, Rodney; Krein, Sarah; Piette, John; Hogan, Mary; Makki, Fatima; Davis, Jennifer.

In: Health Economics, Vol. 18, No. 6, 2009, p. 645-663.

Research output: Contribution to journalArticle

Ettner, SL, Cadwell, BL, Russell, LB, Brown, A, Karter, AJ, Safford, M, Mangione, C, Beckles, G, Herman, WH, Thompson, TJ, Marrero, D, Ackermann, RT, Williams, SR, Bair, M, Brizendine, E, Carroll, A, Liu, GC, Roach, P, Subramanian, U, Zhou, H, Selby, JV, Karter, AJ, Swain, BE, Ferrara, A, Hsu, J, Schmittdiel, JA, Uratsu, C, Curb, DJ, Waitzfelder, B, Everitte, R, Vogt, T, Chung, R, Dudley, A, Tseng, CW, He, Q, Li, X, Baldino, R, Mangione, CM, Brown, A, Quiter, E, Duru, K, Ettner, S, Malik, S, Shapiro, MF, Steers, N, Turk, N, Chan, L, Ventura, G, Lasser, NL, Schneider, SH, Caputo, DA, Crosson, JC, Crystal, S, Girotra, M, Kountz, DS, Taub Morritt, LF, Lu, SE, Wang, PW, Davis, GJ, Lis, L, Ross, S, Marrone, W, Herman, WH, Goewey, J, Heisler, M, Kim, C, Lee, J, Onyemere, K, Sarma, A, Burke, R, McEwen, L, Niehus, R, Gregg, EW, Moore, B, Beckles, G, Boyle, JP, Gary, T, Geiss, L, Gerzoff, B, Cadwell, BL, Hilsdon, RH, Kahn, H, Narayan, V, Saaddine, J, Stevens, MR, Thompson, T, Tierney, E, Zhang, P, Li, R, Gilbert, BC, Trotter, M, Clayton, S, Weller, L, Bilik, D, Garfield, SA, Kerr, E, Hayward, R, Krein, S, Piette, J, Hogan, M, Makki, F & Davis, J 2009, 'Investing time in health: Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?', Health Economics, vol. 18, no. 6, pp. 645-663. https://doi.org/10.1002/hec.1394
Ettner, Susan L. ; Cadwell, Betsy L. ; Russell, Louise B. ; Brown, Arleen ; Karter, Andrew J. ; Safford, Monika ; Mangione, Carol ; Beckles, Gloria ; Herman, William H. ; Thompson, Theodore J. ; Marrero, David ; Ackermann, Ronald T. ; Williams, Susanna R. ; Bair, Matthew ; Brizendine, Ed ; Carroll, Aaron ; Liu, Gilbert C. ; Roach, Paris ; Subramanian, Usha ; Zhou, Honghong ; Selby, Joseph V. ; Karter, Andrew J. ; Swain, Bix E. ; Ferrara, Assiamira ; Hsu, John ; Schmittdiel, Julie A. ; Uratsu, Connie ; Curb, David J. ; Waitzfelder, Beth ; Everitte, Rosina ; Vogt, Thomas ; Chung, Richard ; Dudley, Adams ; Tseng, Chien Wen ; He, Qimei ; Li, Xinli ; Baldino, Ruth ; Mangione, Carol M. ; Brown, Arleen ; Quiter, Elaine ; Duru, Kendrik ; Ettner, Susan ; Malik, Shaista ; Shapiro, Martin F. ; Steers, Neil ; Turk, Norman ; Chan, Lisa ; Ventura, Glenda ; Lasser, Norman L. ; Schneider, Stephen H. ; Caputo, Dorothy A. ; Crosson, Jesse C. ; Crystal, Stephen ; Girotra, Monica ; Kountz, David S. ; Taub Morritt, Leslie Faith ; Lu, Shou En ; Wang, Pin Wen ; Davis, Gabrielle J. ; Lis, Lucyna ; Ross, Sonja ; Marrone, William ; Herman, William H. ; Goewey, Jennifer ; Heisler, Michele ; Kim, Catherine ; Lee, Joyce ; Onyemere, Kingsley ; Sarma, Aruna ; Burke, Ray ; McEwen, Laura ; Niehus, Rebecca ; Gregg, Edward W. ; Moore, Bernice ; Beckles, Gloria ; Boyle, James P. ; Gary, Tiffany ; Geiss, Linda ; Gerzoff, Bob ; Cadwell, Betsy L. ; Hilsdon, Roberta H. ; Kahn, Henry ; Narayan, Venkat ; Saaddine, Jinan ; Stevens, Mark R. ; Thompson, Ted ; Tierney, Ed ; Zhang, Ping ; Li, Rui ; Gilbert, Brenda Colley ; Trotter, Millie ; Clayton, Shay ; Weller, Larry ; Bilik, Dori ; Garfield, Sanford A. ; Kerr, Eve ; Hayward, Rodney ; Krein, Sarah ; Piette, John ; Hogan, Mary ; Makki, Fatima ; Davis, Jennifer. / Investing time in health : Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?. In: Health Economics. 2009 ; Vol. 18, No. 6. pp. 645-663.
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TY - JOUR

T1 - Investing time in health

T2 - Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?

AU - Ettner, Susan L.

AU - Cadwell, Betsy L.

AU - Russell, Louise B.

AU - Brown, Arleen

AU - Karter, Andrew J.

AU - Safford, Monika

AU - Mangione, Carol

AU - Beckles, Gloria

AU - Herman, William H.

AU - Thompson, Theodore J.

AU - Marrero, David

AU - Ackermann, Ronald T.

AU - Williams, Susanna R.

AU - Bair, Matthew

AU - Brizendine, Ed

AU - Carroll, Aaron

AU - Liu, Gilbert C.

AU - Roach, Paris

AU - Subramanian, Usha

AU - Zhou, Honghong

AU - Selby, Joseph V.

AU - Karter, Andrew J.

AU - Swain, Bix E.

AU - Ferrara, Assiamira

AU - Hsu, John

AU - Schmittdiel, Julie A.

AU - Uratsu, Connie

AU - Curb, David J.

AU - Waitzfelder, Beth

AU - Everitte, Rosina

AU - Vogt, Thomas

AU - Chung, Richard

AU - Dudley, Adams

AU - Tseng, Chien Wen

AU - He, Qimei

AU - Li, Xinli

AU - Baldino, Ruth

AU - Mangione, Carol M.

AU - Brown, Arleen

AU - Quiter, Elaine

AU - Duru, Kendrik

AU - Ettner, Susan

AU - Malik, Shaista

AU - Shapiro, Martin F.

AU - Steers, Neil

AU - Turk, Norman

AU - Chan, Lisa

AU - Ventura, Glenda

AU - Lasser, Norman L.

AU - Schneider, Stephen H.

AU - Caputo, Dorothy A.

AU - Crosson, Jesse C.

AU - Crystal, Stephen

AU - Girotra, Monica

AU - Kountz, David S.

AU - Taub Morritt, Leslie Faith

AU - Lu, Shou En

AU - Wang, Pin Wen

AU - Davis, Gabrielle J.

AU - Lis, Lucyna

AU - Ross, Sonja

AU - Marrone, William

AU - Herman, William H.

AU - Goewey, Jennifer

AU - Heisler, Michele

AU - Kim, Catherine

AU - Lee, Joyce

AU - Onyemere, Kingsley

AU - Sarma, Aruna

AU - Burke, Ray

AU - McEwen, Laura

AU - Niehus, Rebecca

AU - Gregg, Edward W.

AU - Moore, Bernice

AU - Beckles, Gloria

AU - Boyle, James P.

AU - Gary, Tiffany

AU - Geiss, Linda

AU - Gerzoff, Bob

AU - Cadwell, Betsy L.

AU - Hilsdon, Roberta H.

AU - Kahn, Henry

AU - Narayan, Venkat

AU - Saaddine, Jinan

AU - Stevens, Mark R.

AU - Thompson, Ted

AU - Tierney, Ed

AU - Zhang, Ping

AU - Li, Rui

AU - Gilbert, Brenda Colley

AU - Trotter, Millie

AU - Clayton, Shay

AU - Weller, Larry

AU - Bilik, Dori

AU - Garfield, Sanford A.

AU - Kerr, Eve

AU - Hayward, Rodney

AU - Krein, Sarah

AU - Piette, John

AU - Hogan, Mary

AU - Makki, Fatima

AU - Davis, Jennifer

PY - 2009

Y1 - 2009

N2 - Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3 min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

AB - Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3 min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

KW - Diabetes

KW - Disparities

KW - Opportunity costs of time

KW - Self-care

KW - Socioeconomic status

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