Patterns of SES Health Disparities Among Older Adults in Three Upper Middle- and Two High-Income Countries

Abstract

Objectives To examine the socioeconomic status (SES) health gradient for obesity, diabetes, and hypertension within a diverse group of health outcomes and behaviors among older adults (60+) in upper middle-income countries benchmarked with high-income countries. Method We used data from three upper middle-income settings (Colombia-SABE-Bogotá, Mexico-SAGE, and South Africa-SAGE) and two high-income countries (England-ELSA and US-HRS) to estimate logistic regression models using age, gender, and education to predict health and health behaviors. Results The sharpest gradients appear in middle-income settings but follow expected patterns found in high-income countries for poor self-reported health, functionality, cognitive impairment, and depression. However, weaker gradients appear for obesity, hypertension, diabetes, and other chronic conditions in Colombia and Mexico and the gradient reverses in South Africa. Strong disparities exist in risky health behaviors and in early nutritional status in the middle-income settings. Discussion Rapid demographic and nutritional transitions, urbanization, poor early life conditions, social mobility, negative health behavior, and unique country circumstances provide a useful framework for understanding the SES health gradient in middle-income settings. In contrast with high-income countries, the increasing prevalence of obesity, an important risk factor for chronic conditions and other aspects of health, may ultimately change the SES gradient for diseases in the future.

Cuba’s cardiovascular risk factors: International comparison of levels and education gradients

“…The measure of socioeconomic status used in the analysis is attained level of formal education, given that it is better measured than other socioeconomic constructs, and it is established early in life thus less susceptible to reverse causality biases. To compare education levels we constructed a 3-category low/medium/high education variable in each country, consistent with prior literature (see: [ 3 – 5 ]). As in these prior studies, one set of education attainment year cutoffs is used in middle-income countries and a different set is used in the U.S., attempting to roughly categorize education into terciles in each of the two settings.…”

“…education levels we constructed a 3-category low/medium/high education variable in each country, consistent with prior literature (see: [3][4][5]). As in these prior studies, one set of education attainment year cutoffs is used in middle-income countries and a different set is used in the U.S., attempting to roughly categorize education into terciles in each of the two settings.…”

“…The comparison countries are heterogeneous in their health and social systems, ranging from Costa Rica's historically strong social sector and low inequality (often argued to be similar to Cuba) to the substantially less equitable systems in the other countries. We build on prior work such as a six-country study using the WHO's Study on Global Aging and Adult Health Wave 1 data [2], a study comparing education gradients in CVD risk factors in Costa Rica versus the U.S. [3], and other more recent international comparisons [4][5][6]. We also build on recent comparative analyses across the 10/66 study countries documenting significant socioeconomic status (SES) gradients in mortality in Cuba that are surprisingly similar to those of the Dominican Republic [7].…”

Does digital technology reduce health disparity? Investigating difference of depression stemming from socioeconomic status among Chinese older adults

“…A recent analysis among European older adults shows that education and income are the SES indicators more frequently significantly associated with depression but not occupation [ 7 ]. This effect might be more significant in developing countries [ 5 , 8 , 9 , 11 , 30 ]. In China, education and income are robustly associated with later life depression [ 5 , 8 ].…”

Aging in Different Welfare Contexts: A Comparative Perspective on Later-Life Employment and Health

“…Yet, to date, no comparative research of this kind has been conducted. Specifically, while the welfare state literature provides compelling evidence that state policies and provisions can play a key role in shaping population health ( Clarke & Smith, 2011 ; McEniry, Samper-Ternent, Flórez, Pardo & Cano-Gutierrez, 2018 ), less is known about whether and how such contextual factors shape patterns of work/retirement and their associations with health.…”