The Chronic Disease Index: Analyzing Health Inequalities Over the Lifecycle

We study chronic illness to analyze the evolution of health inequalities over the life-cycle. Using rich individually-linked and population-wide data in the Netherlands, we find that measurable chronic conditions explain around a third of the mortality gap at old age, but the gap in chronic illness already opens up in early adulthood. By age 35, the bottom 50% of the income distribution have exceeded the chronic illness burden of 50-year olds in the top 50%. Leveraging our panel data, we show that low-income individuals develop chronic illness at a faster rate and that chronically-ill individuals sort into low-income groups. Aggregated over the life-cycle, the aging channel is about 40% more important than the sorting channel. In counterfactual analyses we demonstrate the value of health interventions that target the incidence of chronic conditions of low-income groups already earlier in life, long before affecting mortality later in life. Our analysis of mediating factors indicates the importance of individuals’ location relative to their health behaviors, especially at younger ages. Joint paper with