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Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time

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Abstract

Purpose

Limited research in health valuation analyzes samples with high proportions of racial/ethnic minorities within the United States. The primary objective was to explore patterns of health valuation across race/ethnicity using the Collaborative Psychiatric Epidemiology Surveys. A secondary objective was to analyze whether mental health disorder and immigrant status were associated with these estimates.

Methods

Health valuation questions using different metrics (time and money) were analyzed. Ordered logit models stratified across poor and moderate health tested differences by race/ethnicity, with mental health disorder and immigrant status as covariates.

Results

Asians in moderate health and Latinos were willing to pay more for health than non-Latino whites. Asians in moderate health were willing to trade more time for health. Latinos in poor health were less willing to trade time and gave disproportionate zero-trade responses. Lifetime history of anxiety disorder was positively associated with both metrics. Immigrant status confounded money valuation for Asians in moderate health, and time valuation for Latinos in poor health.

Conclusions

Health valuation estimates vary across race/ethnicity depending upon the metric. Time valuation scenarios appear less feasible for Latinos in poor health. More research is necessary to understand these differences and the role of immigrant status in health valuation.

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References

  1. Holtgrave, D. (2004). HIV prevention, cost-utility analysis, and race/ethnicity: Methodological considerations and recommendations. Medical Decision Making, 24, 181–191.

    Article  PubMed  Google Scholar 

  2. Cykert, S., Joines, J., Kissling, G., & Hansen, C. (1999). Racial differences in patients’ perceptions of debilitated health states. Journal of General Internal Medicine, 14, 217–222.

    Article  CAS  PubMed  Google Scholar 

  3. Franks, P., Lubetkin, E. I., & Melnikow, J. (2007). Do personal and societal preferences differ by socio-demographic group? Health Economics, 16(3), 319–325.

    Article  PubMed  Google Scholar 

  4. Schleinitz, M. D., DePalo, D., Blume, J., & Stein, M. (2006). Can differences in breast cancer utilities explain disparities in breast cancer care? Journal of General Internal Medicine, 21(12), 1253–1260.

    Article  PubMed  Google Scholar 

  5. Shaw, J., Johnson, J., Chen, S., Levin, J., & Coons, S. (2007). Racial/ethnic differences in preferences for the EQ-5D health states: Results from the U.S. valuation study. Journal of Clinical Epidemiology, 60, 479–790.

    Article  PubMed  Google Scholar 

  6. Wittenberg, E., Halpern, E., Divi, N., Prosser, L. A., Araki, S. S., & Weeks, J. C. (2006). The effect of age, race and gender on preference scores for hypothetical health states. Quality of Life Research, 15(4), 645–653.

    Article  PubMed  Google Scholar 

  7. Gold, M. R., & Muennig, P. (2002). Measure-dependent variation in burden of disease estimates: Implications for policy. Medical Care, 40(3), 260–266.

    Article  PubMed  Google Scholar 

  8. Bennett, K. J., & Torrance, G. W. (1996). Measuring health state preferences and utilities: Rating scale, time trade-off, and standard gamble techniques. Philadelphia: Lippincott-Raven Publishers.

    Google Scholar 

  9. Healey, A., & Chisholm, D. (1999). Willingness to pay as a measure of the benefits of health care. The Journal of Mental Health Policy and Economics, 2, 55–58.

    Article  PubMed  Google Scholar 

  10. Rabin, R., & de Charro, F. (2001). EQ-SD: A measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343.

    Article  CAS  PubMed  Google Scholar 

  11. Johnson, J. A., Luo, N., Shaw, J. W., Kind, P., & Coons, S. J. (2005). Valuations of EQ-5D Health States: Are the United States and United Kingdom different? Medical Care, 43(3), 221–228.

    Article  PubMed  Google Scholar 

  12. Badia, X., Roset, M., Herdman, M., & Kind, P. (2001). A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states. Medical Decision Making, 21(1), 7–16.

    Article  CAS  PubMed  Google Scholar 

  13. Card, D. (2009). How immigration affects US cities. Princeton, New Jersey: Princeton Univ Press.

    Google Scholar 

  14. Massey, D. S. (1995). The new immigration and ethnicity in the United States. Population and Development Review, 21(3), 631–652.

    Article  Google Scholar 

  15. Passel, J. S., & Suro, R. (2005). Rise, peak, and decline: Trends in US immigration 1992–2004. Washington, DC: Pew Hispanic Center.

    Google Scholar 

  16. Clarke, J. L., & Meiris, D. C. (2007). Building bridges: Integrative solutions for managing complex comorbid conditions. American Journal of Medical Quality, 22(2S), 5S.

    Article  PubMed  Google Scholar 

  17. Bennett, K., Torrance, G., Boyle, M., Guscott, R., & Moran, L. (2000). Development and testing of a utility measure for major, unipolar depression (McSad). Quality of Life Research, 9, 109–120.

    Article  CAS  PubMed  Google Scholar 

  18. Chouinard, G., & Albright, P. (1997). Economic and health state utility determinations for schizophrenic patients treated with resperidone or haloperidol. Journal of Clinical Psychopharmacology, 17(4), 298–307.

    Article  CAS  PubMed  Google Scholar 

  19. Dwight-Johnson, M., Lagomasino, I., Aisenberg, E., & Hay, J. (2004). Using conjoint analysis to assess depression treatment preferences among low-income Latinos. Psychiatric Services, 55(8), 934–936.

    Article  PubMed  Google Scholar 

  20. Konig, H. H., Gunther, O. H., Angermeyer, M. C., & Roick, C. (2009). Utility assessment in patients with mental disorders: Validity and discriminative ability of the time trade-off method. Pharmacoeconomics, 27(5), 405.

    Article  PubMed  Google Scholar 

  21. Morey, E., Thacher, J., & Craighead, W. (2007). Patient preferences for depression treatment programs and willingness to pay for treatment. The Journal of Mental Health Policy and Economics, 10, 73–85.

    PubMed  Google Scholar 

  22. Revicki, D. A., Brandenburg, N., Matza, L., Hornbrook, M. C., & Feeny, D. (2008). Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder. Quality of Life Research, 17(10), 1285–1294.

    Article  PubMed  Google Scholar 

  23. Revicki, D., & Wood, M. (1998). Patient-assessed health state utilities for depression-related outcomes: Differences by depression severity and antidepressant medications. Journal of Affective Disorders, 48, 25–36.

    Article  CAS  PubMed  Google Scholar 

  24. Voruganti, L., Awad, A., Oyewumi, L., Cortese, L., Zirul, S., & Ghawan, R. (2000). Assessing health utilities in schizophrenia. Pharmacoeconomics, 17(3), 273–286.

    Article  CAS  PubMed  Google Scholar 

  25. Gunther, O. H., Friemel, S., Bernert, S., Matschinger, H., Angermeyer, M. C., & Konig, H. H. (2007). The burden of depressive disorders in Germany-results from the European Study of the Epidemiology of Mental Disorders (ESEMeD). Psychiatrische Praxis, 34(6), 292–301.

    Article  PubMed  Google Scholar 

  26. Saarni, S. I., Suvisaari, J., Sintonen, H., Pirkola, S., Koskinen, S., Aromaa, A., et al. (2007). Impact of psychiatric disorders on health-related quality of life: General population survey. British Journal of Psychiatry, 190(4), 326.

    Article  PubMed  Google Scholar 

  27. Wells, K., & Sherbourne, C. (1999). Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices. Archives of General Psychiatry, 56, 897–904.

    Article  CAS  PubMed  Google Scholar 

  28. Alegría, M., Takeuchi, D., Canino, G., Duan, N., Shrout, P., Meng, X.-L., et al. (2004). Considering context, place and culture: The National Latino and Asian American Study. International Journal of Methods in Psychiatric Research, 13(4), 208–220.

    Article  PubMed  Google Scholar 

  29. Kessler, R., & Merikangas, K. (2004). The national comorbidity survey replication (NCS-R). International Journal of Methods in Psychiatric Research, 13(2), 60–68.

    Article  PubMed  Google Scholar 

  30. Heeringa, S., Wagner, J., Torres, M., Duan, N., Adams, T., & Berglund, P. (2004). Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES). International Journal of Methods in Psychiatric Research, 13(4), 221–240.

    Article  PubMed  Google Scholar 

  31. Kessler, R. C., & Ustun, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121.

    Article  PubMed  Google Scholar 

  32. Borrell, L. N., & Dallo, F. J. (2008). Self-rated health and race among Hispanic and non-Hispanic adults. Journal of Immigrant and Minority Health, 10(3), 229–238.

    Article  PubMed  Google Scholar 

  33. Liang, J., Quinones, A. R., Bennett, J. M., Ye, W., Xu, X., Shaw, B. A., et al. (2010). Evolving self-rated health in middle and old age: How does it differ across Black, Hispanic, and White Americans? Journal of Aging and Health, 22(1), 3–26.

    Article  PubMed  Google Scholar 

  34. Sorkin, D., Tan, A. L., Hays, R. D., Mangione, C. M., & Ngo-Metzger, Q. (2008). Self-reported health status of Vietnamese and Non-Hispanic White older adults in California. Journal of the American Geriatrics Society, 56(8), 1543–1548.

    Article  PubMed  Google Scholar 

  35. Zhang, W., McCubbin, H., McCubbin, L., Chen, Q., Foley, S., Strom, I., et al. (2010). Education and self-rated health: An individual and neighborhood level analysis of Asian Americans, Hawaiians, and Caucasians in Hawaii. Social Science and Medicine, 70(4), 561–569.

    Article  PubMed  Google Scholar 

  36. Lee, S., & Grant, D. (2009). The effect of question order on self-rated general health status in a multilingual survey context. American Journal of Epidemiology, 169(12), 1525–1530.

    Article  PubMed  Google Scholar 

  37. Souchek, J., Byrne, M. M., Kelly, P. A., O’Malley, K., Richardson, M., Pak, C., et al. (2005). Valuation of arthritis health states across ethnic groups and between patients and community members. Medical Care, 43(9), 921–928.

    Article  PubMed  Google Scholar 

  38. Gaskin, D. J., & Frick, K. D. (2008). Race and ethnic disparities in valuing health. Medical Decision Making, 28(1), 12.

    Article  PubMed  Google Scholar 

  39. Handler, R., Hynes, L., & Nease, R. (1997). Effect of locus of control and consideration of future consequences on time tradeoff utilities for current health. Quality of Life Research, 6, 54–60.

    Article  CAS  PubMed  Google Scholar 

  40. Byrne, M. M., O’Malley, K. J., & Suarez-Almazor, M. E. (2004). Ethnic differences in health preferences: Analysis using willingness-to-pay. Journal of Rheumatology, 31(9), 1811–1818.

    PubMed  Google Scholar 

  41. Pitkin Derose, K., Bahney, B., Lurie, N., & Escarce, J. (2009). Immigrants and health care access, quality, and cost. Medical Care Research Review, 66(4), 355–408.

    Article  Google Scholar 

  42. Flores, G., Abreu, M., & Tomany-Korman, S. C. (2006). Why are Latinos the Most uninsured racial/ethnic group of US children? A community-based study of risk factors for and consequences of being an uninsured Latino Child. Pediatrics, 118(3), e730.

    Article  PubMed  Google Scholar 

  43. Lee, T. T., Ziegler, J. K., Sommi, R., Sugar, C., Mahmoud, R., & Lenert, L. A. (2000). Comparison of preferences for health outcomes in schizophrenia among stakeholder groups. Journal of Psychiatric Research, 34(3), 201–210.

    Article  CAS  PubMed  Google Scholar 

  44. Bereza, B. G., Machado, M., & Einarson, T. R. (2009). Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clinical Therapeutics, 31(6), 1279–1308.

    Article  PubMed  Google Scholar 

  45. Dwight-Johnson, M., Sherbourne, C., Liao, D., & Wells, K. (2000). Treatment preferences among depressed primary care patients. Journal of General Internal Medicine, 15, 527–534.

    Article  CAS  PubMed  Google Scholar 

  46. O’Brien, B., Novosel, S., Torrance, G., & Streiner, D. (1995). Assessing the economic value of a new antidepressant: A willingness-to-pay approach. Pharmacoeconomics, 8(1), 34–45.

    Article  PubMed  Google Scholar 

  47. Fong, V. L. (2008). The other side of the healthy immigrant paradox: Chinese Sojourners in Ireland and Britain who return to china due to personal and familial health crises. Cultural Medical Psychiatry, 32(4), 627–641.

    Article  Google Scholar 

  48. Baron, J. (1999). Does decision analysis have a race problem? Journal of General Internal Medicine, 14, 260–261.

    Article  CAS  PubMed  Google Scholar 

  49. Wells, K., Schoenbaum, M., Duan, N., Miranda, J., Tang, L., & Sherbourne, C. (2007). Cost-effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder. Psychiatric Services, 58, 1269–1278.

    Article  PubMed  Google Scholar 

  50. Fu, A. Z., & Kattan, M. W. (2006). Racial and ethnic differences in preference-based health status measure*. Current Medical Research and Opinion, 22(12), 2439–2448.

    Article  PubMed  Google Scholar 

  51. Saalfrank, M. F., Wang, J., & Brown, L. M. (2009). Racial and ethnic differences in preferences for health states and the implications for cost utility analysis. Expert Review of Pharmacoeconomics and Outcomes Research, 9(4), 365–373.

    Article  PubMed  Google Scholar 

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Acknowledgments

The NLAAS data used in this analysis were provided by the Center for Multicultural Mental Health Research at the Cambridge Health Alliance. The project was supported by NIH Research Grant # U01 MH 062209 funded by the National Institute of Mental Health and by Robert Wood Johnson Foundation grant #58678. We acknowledge the analytic input of Dr. Naihua Duan and the thoughtful comments of Dr. Eve Wittenberg on an earlier version of this manuscript. We thank Jose Valdes for his assistance with manuscript preparation and tables.

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Authors and Affiliations

  1. Center For Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, 120 Beacon Street, 4th Floor, Somerville, MA, 02143, USA

    Norah E. Mulvaney-Day, Chih-nan Chen, Mara Laderman & Margarita Alegría

  2. Western Psychiatric Institute & Clinic, University of Pittsburgh Medical School, 230 McKee Place, #229, Pittsburgh, PA, 15213, USA

    Marcela Horvitz-Lennon

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  1. Norah E. Mulvaney-Day
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Correspondence to Norah E. Mulvaney-Day.

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Mulvaney-Day, N.E., Horvitz-Lennon, M., Chen, Cn. et al. Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time. Qual Life Res 19, 1529–1540 (2010). https://doi.org/10.1007/s11136-010-9713-6

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