Age, SES, and health: a population level analysis of health inequalities over the lifecourse

Abstract

This paper tests two competing hypotheses on the relationship between age, SES, and health inequality at the cohort/population level. The accumulation hypothesis predicts that the level of SES-based health inequality, and consequently the overall level of health inequality, within a cohort progressively increases as it ages. The divergence-convergence hypothesis predicts that these inequalities increase only up to early-old age then decrease. Data from a Canadian national health survey are used in this study, and are adjusted for SES-biases in mortality. Bootstrap methods are employed to assess the statistical precision and significance of the results. The Gini coefficient is used to estimate change in the overall level of health inequality with age, and the Concentration coefficient estimates the contribution of SES-based health inequalities to this change. Health is measured using the Health Utilities Index, and income and education provide the measure of SES. First, the findings show that the Gini coefficient progressively increases from 0.048 (95% CI: 0.045, 0.051) at ages 15-29 to 0.147 (95% CI: 0.131, 0.163) at ages 80+. Second, the data reveal that health inequalities between SES groups (Concentration coefficients for income and education) tend to follow a similar pattern of divergence. Together these findings provide support for the accumulation hypothesis. A notable implication of the study's findings is that the level of health inequality increases when compensating for age-specific socio-economic differences in mortality. These selective effects of mortality should be considered in future research on health inequalities and the lifecourse.

Physical Activity Resource Attributes and Obesity in Low-Income African Americans

“…2 Obesity continues to be more prevalent among individuals with lower socioeconomic status (SES), 3 and the health of American racial minorities is lower than the general population, even after adjusting for SES. 4 Recent studies and ecological models of health behavior suggest that environmental factors may be important to facilitate health behaviors 2,5-7 and improve health outcomes. 8 Ecological models of health incorporate intra-and extra-individual influences that may influence individual behaviors at multiple levels 6,9 and provide researchers with innovative opportunities for health intervention.…”

Socio-economic differences in disability by age in sub-Saharan Africa: A cross-national study using the World Health Survey

“…This relationship appears robust across multiple indicators of both SES (for example, education, income, occupation, and wealth) and health (mortality, chronic diseases, disability, and self-rated health) (Beckett 2000;Dupre 2007;Eikemo et al 2008;Hosseinpoor et al 2012bHosseinpoor et al , 2013House et al 1994;Kitagawa and Hauser 1973;Lauderdale 2001;Prus 2007;Robert and House 1996;Ross and Wu 1996;von dem Knesebeck et al 2006). The robustness and virtual universality of the SES- closely related to age than to any other predictor, and thus the health effects of SES may diminish with age House et al 1994).…”

What Money Can (and Can't) Buy: A Behavior Genetic Analysis of the Physical and Mental Health Benefits of Socioeconomic Advantage in Modern America

“…As noted above, the association between socioeconomic status and mean levels of health or health behaviors appears to grow stronger with age (Fone et al, 2013;KarrikerJaffe et al, 2013;Ross & Wu, 1996;Miech & Shanahan, 2000;Prus, 2007;SinghManoux et al, 2004;van de Mheen et al, 1998;Williams et al, 2013;Yen & Kaplan, 1998). We also observed in our dissertation analyses that variance effects were generally more apparent in adulthood.…”

“…Unfortunately, these also happen to be the SES indicators that may be most appropriate for inferring causality in the SES-health gradient. Lifespan research suggests that the effects of low SES on health accumulate over time (Fone et al, 2013;Karriker-Jaffe et al, 2013;Ross & Wu, 1996;Miech & Shanahan, 2000;Prus, 2007;Singh-Manoux, Ferrie, Chandola, Marmot, 2004;van de Mheen, Stronks, & Mackenbach, 1998;Williams et al, 2013;Yen & Kaplan, 1998) and have their debut in childhood (Singh-Manoux et al, 2004;van de Mheen et al, 1998). Future research may explore opportunities for conducting natural experiments on the SES-health gradient, comparing, for example, SES effects on health in children and adolescents in capitalist versus socialist nations; countries with high income inequality versus those with low inequality; or societies with inexpensive or nocost post-secondary educational opportunities versus those with costly ones.…”