Ethnic differences in health related quality of life for patients with type 2 diabetes

Background - The objective of this study was to investigate the association between ethnicity and health related quality of life (HRQoL) in patients with type 2 diabetes. Methods - The EuroQol EQ-5D measure was administered to 1,978 patients with type 2 diabetes in the UK Asian Diabetes Study (UKADS): 1,486 of south Asian origin (Indian, Pakistani, Bangladeshi or other south Asian) and 492 of white European origin. Multivariate regression using ordinary least square (OLS), Tobit, fractional logit and Censored Least Absolutes Deviations estimators was used to estimate the impact of ethnicity on both visual analogue scale (VAS) and utility scores for the EuroQol EQ-5D. Results - Mean EQ-5D VAS and utility scores were lower among south Asians with diabetes compared to the white European population; the unadjusted effect on the mean EQ-5D VAS score was −7.82 (Standard error [SE] = 1.06, p < 0.01) and on the EQ-5D utility score was −0.06 (SE = 0.02, p < 0.01) (OLS estimator). After controlling for socio-demographic and clinical confounders, the adjusted effect on the EQ-5D VAS score was −9.35 (SE = 2.46, p < 0.01) and on the EQ-5D utility score was 0.06 (SE = 0.04), although the latter was not statistically significant. Conclusions - There was a large and statistically significant association between south Asian ethnicity and lower EQ-5D VAS scores. In contrast, there was no significant difference in EQ-5D utility scores between the south Asian and white European sub-groups. Further research is needed to explain the differences in effects on subjective EQ-5D VAS scores and population-weighted EQ-5D utility scores in this context.

Linking labour force participation, education, labour wages and household consumption in developing countries:push and pull effects in self-employment - evidence from Nigeria

The contribution of this thesis is in understanding the origins in developing countries of differences in labour wage and household consumption vis-à-vis educational abilities (and by extension employment statuses). This thesis adds to the labour market literature in developing countries by investigating the nature of employment and its consequences for labour wage and household consumption in a developing country. It utilizes multinomial probit, blinder-oaxaca, Heckman and quantile regressions to examine one human capital indicator: educational attainment; and two welfare proxies: labour wage and household consumption, in a developing country, Nigeria. It finds that, empirically, the self-employed are a heterogeneous group of individuals made up of a few highly educated individuals, and a significant majority of ‘not so educated’ individuals who mostly earn less than paid workers. It also finds that a significant number of employers enjoy labour wage premiums; and having a higher proportion of employers in the household has a positive relationship with household consumption. The thesis furthermore discovers an upper educational threshold for women employers not found for men. Interestingly, the thesis also finds that there is indeed an ordering of labour wages into low-income self-employment (which seems to be found mainly in “own account” self-employment), medium-income paid employment, and high-income self-employment (which seems to be found mainly among employers), and that this corresponds to a similar ordering of low human capital, medium human capital and high human capital among labour market participants, as expressed through educational attainments. These show that as a whole, employers can largely be classed as experiencing pulled self-employment, as they appear to be advantaged in all three criteria (educational attainments, labour wage and household consumption). A minority of self-employed “own account” workers (specifically those at the upper end of the income distribution who are well educated), can also be classed as experiencing pulled self-employment. The rest of the significant majority of self-employed “own account” workers in this study can be classed as experiencing pushed self-employment in terms of the indicators used.