Putting cumulative (dis)advantages in context: Comparing the role of educational inequality in later-life functional health trajectories in England and Germany

Abstract

Background The cumulative (dis)advantage (CAD) perspective more and more is examined in a comparative way, to highlight the role of context in generating inequality over the life course. This study adds to this field of research by examining trajectories of activities of daily living (ADL) in later life by educational level in a country comparison of England and Germany, emphasizing differing institutional conditions. Method Data used are the English Longitudinal Study of Ageing (ELSA; 11,352 individuals) and the German subsample of the Survey of Health and Retirement in Europe (SHARE; 5,573 individuals). Using population averaged Poisson panel regression models, 12-year trajectories of six birth cohorts are investigated, covering the age range of 50 to 90 years. Results Respondents in England have a higher level of limitations at age 50, and more limited increases over age than in Germany. An educational gradient exists in both countries at age 50. Notably, the educational gradient increases for more recently born cohorts, but declines with increasing age in England, while in Germany educational differences increase for more recently born cohort only. Discussion The current study indicates that CAD processes between educational groups are context sensitive. While England showed convergence of disparities with increasing age, in Germany no differential development was found.

Education and age trajectories of chronic conditions: Are tests of the cumulative advantage and disadvantage hypothesis biased by underreporting?

“…ELSA data have been widely used in studies on the prevalence of chronic conditions (Hamer et al, 2018) and in tests of the CAD hypothesis (Leopold, 2018;Wetzel & Vanhoutte, 2020). For the purposes of the present study, ELSA data are particularly suitable, as they include longitudinal information not only on self-reported, but also on objectively measured chronic conditions.…”

“…Following previous studies of CAD using ELSA data (Leopold, 2018;Wetzel & Vanhoutte, 2020), we measured education categorically, drawing on information about respondents' highest levels of education and respondents' age at finishing education. We distinguished between lower, intermediate, and higher levels of education.…”

Inequalities in Disability-Free and Disabling Multimorbid Life Expectancy in Costa Rica, Mexico, and the United States

“…The extent of disadvantage can vary within and between countries due to differences in social, demographic, and structural factors, as well as inequalities in access to health and social care. Although cumulative (dis)advantage has mainly been used to understand disparities within a single setting, recent studies have taken a comparative approach to understand how differences in political, educational, and health systems might shape the cumulative (dis)advantage process across countries ( Leopold, 2018 ; Wetzel & Vanhoutte, 2020 ). However, these studies have only focused on the US and European contexts.…”

Estimating the Impact of Relative Financial Circumstances in Childhood on Adult Mental Wellbeing: a Mediation Analysis

“…Second, although widely assumed that later-born cohorts on average are healthier than earlier-born cohorts, reflecting a multidimensional process of improvement in medical care and increasing living standards (Wetzel & Vanhoutte, 2020), there is no living generation that has 'escaped' from some form of economic and turbulence in the UK (Wood et al, 2017). Although the latter half of the twentieth century presented large gains in the material standard of living in the UK, each decade has been marked by large social, political, and economic changes, including the large scale industrial restructuring of the 1970s, the growth in inequality in the 1980 and 1990 s and the great recession in the 2000s (Wood et al, 2017).…”