BEWARE OF BEING UNAWARE: RACIAL/ETHNIC DISPARITIES IN CHRONIC ILLNESS IN THE USA PINKA CHATTERJI, HEESOO JOO and KAJAL LAHIRI * Department of Economics, University at Albany: SUNY, Albany, NY, USA SUMMARY We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness – the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes. Copyright © 2012 John Wiley & Sons, Ltd. Received 7 October 2011; Revised 27 April 2012; Accepted 6 June 2012 KEY WORDS: trivariate probit with selection; hypertension; diabetes; disease awareness; HRS 1. INTRODUCTION Numerous studies show that African-Americans and Latinos are more likely than non-Latino whites to develop and have adverse consequences related to chronic health conditions such as heart disease, cancer, diabetes, arthritis, obesity, and hypertension (see NHDR, 2003 for a review). Racial/ethnic disparities in chronic diseases can result from a variety of mechanisms, including differences across groups in access to effective medical care, insurance status, socioeconomic status (SES), geography, and patient/provider interactions (Alegria et al., 2002; Balsa and McGuire, 2003; Chandra and Skinner, 2004; Balsa et al., 2005; LêCook et al., 2010). Recent work suggests that factors related to health knowledge and information also contribute to health disparities (Goldman and Lakdawalla, 2005; Aizer and Stroud, 2010; Cutler and Lleras-Muney, 2010). If patient-level factors such as therapy compliance or behavioral response to health information vary across groups, these differences ultimately may lead to disparities in effective treatment and health outcomes even when groups have equal access to medical care. Early awareness of having a chronic health condition is another aspect of health knowledge that influences an individual’s ability to manage the progression of a disease, and may contribute to health disparities. Without early preventative intervention, the course of a chronic disease is a continuum from the disease-free state to asymptomatic biological change, clinical illness, impairment, disability and ultimately death. In the present *Correspondence to: Department of Economics, University at Albany, SUNY, Albany, NY 12222, USA. E-mail: klahiri@albany.edu Copyright © 2012 John Wiley & Sons, Ltd. HEALTH ECONOMICS Health Econ. (2012) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/hec.2856