Socioeconomic inequalities in health after age 50: Are health risk behaviors to blame?

Abstract

Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N=19,245), this study examined the degree to which four behavioral risk factors – smoking, obesity, physical inactivity, and heavy drinking – are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998–2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23–45% of the mortality disparities among men and middle aged women, but only about 5% of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33% of the disparities in disability onset found among women survivors, and about 9–14% among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities.

Posição socioeconômica no curso de vida e comportamentos de risco relacionados à saúde: ELSA-Brasil

“…Isso pode explicar a associação observada entre exposição à desvantagem na vida adulta e ex-tabagismo. Além disso, a associação entre piores condições socioeconômicas e maior chance de ser ex-tabagista já foi descrita em outros estudos 30 , inclusive em análise prévia do ELSA-Brasil 31 .…”

Gesundheitliche Ungleichheit im höheren Lebensalter

“…Erst in den letzten Jahren, in dem Maße wie lebensphasen-und lebensverlaufsbe-zogene Betrachtungen der gesundheitlichen Ungleichheit an Bedeutung gewonnen haben, ist eine stärkere Forschungstä-tigkeit zu beobachten. Dies gilt vor allem für die Vereinigten Staaten, Großbritannien und die skandinavischen Länder, in denen die Sozialepidemiologie schon länger etabliert ist (Huisman et al 2013, Shaw et al 2014, Fors, Thorslund 2015, Read et al 2016. Aber auch in Deutschland liegen mittlerweile mehrere Studien vor, die sich mit der gesundheitlichen Ungleichheit im höheren Lebensalter beschäftigt haben (von dem Knesebeck et al 2003, von dem Knesebeck, Vonneilich 2009, Kümpers 2012, Kruse, Schmitt 2016.…”

“…Beispielsweise wurden im Rahmen der »Health and Retirement Study« soziale Unterschiede in der Mortalität und im Auftreten funktioneller Einschränkungen über einen Zeitraum von zehn Jahren untersucht (Shaw et al 2014 (Shaw et al 2014).…”

Yaşlı sağlığının sosyal belirleyicileri

“…Eğitim, üretim aktivitelerine ve kaynaklara erişimi kolaylaştırdığı, hane gelirini artırdığı için sağlığı etkilemektedir. Sağlığın korunması ve geliştirilmesi ile ilgili bilgiye erişim ve davranış kazanılmasında da eğitim önemlidir (32,33). Eğitim, sağlığı belirleyen diğer sosyal faktörleri de olumlu yönde etkiler.…”