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 J. Bair; Ed Brizendine; Aaro E. Carroll; Gilbert C. Liu; Paris Roach; Usha Subramanian; Honghong Zhou; 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

doi:10.1002/hec.1394

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 J. Bair, Ed Brizendine, Aaro E. Carroll, Gilbert C. Liu, Paris Roach, Usha Subramanian, Honghong ZhouJoseph 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

^*Corresponding author for this work

Medicine, General Medicine Division

Research output: Contribution to journal › Article › peer-review

27 Scopus citations

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 language	English (US)
Pages (from-to)	645-663
Number of pages	19
Journal	Health Economics (United Kingdom)
Volume	18
Issue number	6
DOIs	https://doi.org/10.1002/hec.1394
State	Published - 2009

Funding

Keywords

Diabetes
Disparities
Opportunity costs of time
Self-care
Socioeconomic status

ASJC Scopus subject areas

Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/hec.1394

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Ettner, S. L., Cadwell, B. L., Russell, L. B., Brown, A., Karter, A. J., Safford, M., Mangione, C., Beckles, G., Herman, W. H., Thompson, T. J., Marrero, D., Ackermann, R. T., Williams, S. R., Bair, M. J., Brizendine, E., Carroll, A. E., Liu, G. C., Roach, P., Subramanian, U., ... Davis, J. (2009). Investing time in health: Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care? Health Economics (United Kingdom), 18(6), 645-663. https://doi.org/10.1002/hec.1394

@article{4a5dc4812f9d4e77814a1a5fcc20e29f,

title = "Investing time in health: Do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?",

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.",

keywords = "Diabetes, Disparities, Opportunity costs of time, Self-care, Socioeconomic status",

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

year = "2009",

doi = "10.1002/hec.1394",

language = "English (US)",

volume = "18",

pages = "645--663",

journal = "Health Economics (United Kingdom)",

issn = "1057-9230",

publisher = "John Wiley and Sons Ltd",

number = "6",

}

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, MJ, Brizendine, E, Carroll, AE, 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 (United Kingdom), vol. 18, no. 6, pp. 645-663. https://doi.org/10.1002/hec.1394

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 J.

AU - Brizendine, Ed

AU - Carroll, Aaro E.

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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UR - http://www.scopus.com/inward/citedby.url?scp=68849120135&partnerID=8YFLogxK

U2 - 10.1002/hec.1394

DO - 10.1002/hec.1394

M3 - Article

C2 - 18709636

AN - SCOPUS:68849120135

SN - 1057-9230

VL - 18

SP - 645

EP - 663

JO - Health Economics (United Kingdom)

JF - Health Economics (United Kingdom)

IS - 6

ER -

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

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UN SDGs

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