Essays on the Complexities of Social Inequalities and Health Disparities

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In this dissertation, I conduct three studies focusing on differences in social groups and their health outcomes or opinions related to medical practices. In Chapter 1, I outline each study and its findings.

Chapter 2 focuses on the Great Recession in the United States (2007–2009) and how this crisis is associated with health disparities. In this chapter, I use nine waves spanning 16 years (1998-2014) of the RAND version of the Health and Retirement Study (HRS) to examine disparities in cardiovascular disease, stroke, or related death (e.g., circulatory disease) among Americans ages 50 and older to determine whether these health disparities among different educational groups narrowed, widened, or remained constant during and after the Great Recession. In general, findings from discrete-time hazard analyses suggest that the disparities remained relatively constant with some (nonsignificant) evidence of some narrowing between the most educated and least educated groups.

Chapter 3 examines whether there is symmetry in the effects of certain health behaviors—smoking, drinking, weight management—on cardiovascular disease, stroke, or related death between socioeconomic groups. This chapter also uses nine waves (1998–2014) of the RAND HRS. Discrete-time hazard regression analyses indicate that while those with higher socioeconomic status maintain better health outcomes regardless of health behaviors, the effects of health behaviors are not equally distributed. Poor weight management and higher numbers of daily cigarettes are associated with a greater increased risk for those with more education than for those with less. The effects of heavy drinking, however, are less severe for the those with the most education compared to those with the least education.

Chapter 4 studies the role of social change by investigating trends in approval for euthanasia among cohorts in the United States and how those trends are influenced by cohort replacement and religious attitudes. This chapter uses 16 waves of the General Social Survey (1985–2014) and estimates differences in approval ratings between cohorts using logistic regression models. Results show that baby boomers are significantly more likely to approve of euthanasia than either their predecessors or successors, suggesting a cohort effect. Individuals belonging to more conservative religious groups and displaying higher levels of religiosity are less likely to approve. With the meaningful effect of cohorts on approval for euthanasia, findings suggest that as baby boomers age and as the population becomes less religious, approval for euthanasia might increase again.






Marsala, Miles S (2020). Essays on the Complexities of Social Inequalities and Health Disparities. Dissertation, Duke University. Retrieved from


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