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Cognitive Abilities, Healthcare and Screening Tests

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Abstract

We relate indicators of cognitive abilities and health promotion to the propensity to screen for breast cancer, using microeconomic data available in a sample of women aged 50 or above in 11 European countries. Our findings suggest that health promotion activities attenuate the effect of human capital on the decision to undertake mammography, thus implying that disparities in education achievements and cognitive skills do not fully translate into differences in the propensity to do preventive screening.

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Notes

  1. A growing body of literature documents the opposite link between health and education, and particularly that early childhood health status has a causal impact on subsequent schooling outcomes (Conti et al. 2010).

  2. Cutler and LLeras-Muney (2010), using data from the 1987 NHIS Cancer Control Supplement, report that in the US half of people with a high school degree or less get their information from a doctor, compared to one-third of those with at least some college education. In contrast, 49% of people with some college education report receiving their most useful health information from books, newspapers, or magazines, compared to 18% among the less educated.

  3. SHARE data collection has been primarily funded by the European Commission through the 5th framework program (project QLK6-CT-2001-00360 in the thematic program Quality of Life). Additional funding came from the US National Institute on Ageing (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, Y1-AG-4553-01 and OGHA 04–064). Data collection in Austria (through the Austrian Science Foundation, FWF), Belgium (through the Belgian Science Policy Administration) and Switzerland (through BBW/OFES/UFES) was nationally funded. The SHARE data set is presented in Börsch-Supan et al. (2005).

  4. The questionnaire and the sample design are patterned after the US Health and Retirement Survey (HRS) and the English Longitudinal Study of Ageing (ELSA). Börsch-Supan et al. (2005) report details on sampling, response rates and definitions of variables.

  5. Christelis et al. (2010) use the cognitive function indicators to investigate stock market participation in Europe.

  6. See www.cancer.org/.

  7. Picone, Sloan and Taylor (2004) find that better health and a lower time preference are associated with higher demand for preventive screening.

  8. The aggregation of the four questions in an overall indicator of numeracy is arbitrary to some extent. we check the robustness of the results to alternative definitions—for instance the simple sum of the correct answers to the four questions.

  9. Regions correspond to the NUTS2 level in the EUROSTAT classification. The minimum population is 800,000 inhabitants, while the maximum is 3,000,000

  10. While the index originally proposed by the OECD is the fraction of smokers, we consider the fraction of non-smokers as, consistently with the flu vaccination rate, higher values would denote better health promotion.

  11. For notational reasons, for each region we only report the country which they belong to.

  12. Our results are robust to alternative measures of the waiting time.

  13. Specifically: (1) voluntary or charity work; (2) care for a sick or disabled adult; (3) help for family, friends or neighbours; (4) attendance of an educational or training course; (5) participation in a sport, social or other kind of club; (6) taking part in a religious organization; (7) taking part in a political or community-related organization.

  14. The results using non-smoking and flu vaccination rates as proxies for health promotion confirm the same patterns and are available from the authors upon request.

  15. Some of the regional variables cannot be constructed for the entire sample, thus in the specification shown in column 1 we lose 126 observations with respect to the full sample.

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Acknowledgments

We thank two anonymous referees, James Banks and Jim Smith for comments on an earlier version of this paper, and the Italian Ministry of University and Research for financial support. Part of the project was carried out when the third author was visiting the Stanford Department of Economics on a Fulbright scholarship.

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Correspondence to Tullio Jappelli.

Appendix

Appendix

Table 7 Regressions for propensity to screen, with preference traits

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Avitabile, C., Jappelli, T. & Padula, M. Cognitive Abilities, Healthcare and Screening Tests. Population Ageing 4, 251–269 (2011). https://doi.org/10.1007/s12062-011-9047-3

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