Advantages and disadvantages across the life course and health status in old age among women in Chile

Gendered employment trajectories and later life health in liberal regime countries: A quantitative study in the United States, England, Switzerland and Chile

We explore the association between adulthood employment patterns and later life health among men and women in four liberal regime countries: two from Europe (England and Switzerland) and two from the Americas (United States and Chile). We carefully harmonized life-history data from the surveys SHARE (N = 1,143), HRS (N = 4,006), ELSA (N = 3,083), and EVDA (N = 802). The samples included individuals born between 1944 and 1954, with information on employment histories from age 15 to 65 and on 11 health outcomes in later life. In line with welfare regime and health literature, we find significant differences in health outcomes between countries, which are likely explained by differences in health systems. However, we extend previous literature by showing that positive health outcomes are consistently explained by standard employment histories, and poor health outcomes are consistently explained by non-standard employment histories. Importantly, men and women following the same employment pathway across countries are either similarly penalized or compensated in their health. This suggests that it is not gender per se that affects health in later life, but the employment trajectory experienced. Nonetheless, women are disproportionately more likely to experience non-standard employment and thus suffer a greater health disadvantage. Policy measures to mitigate negative health effects of non-standard employment trajectories may therefore pay attention to the specific reasons why women are more likely to experience non-standard trajectories.

Work-Family Life Course Trajectories and Women's Mental Health: The Moderating Role of Defamilization Policies in 15 European Territories

This study employs multichannel sequence analysis of data from the Survey of Health, Ageing, and Retirement in Europe to explore variations in the association between work-family life trajectories and women's mental health across European cohorts born between 1924 and 1965 within different policy contexts. It finds that trajectories characterized by prolonged employment and delayed familial commitments are generally associated with increased depressive symptoms. Notably, the strength of this association varies significantly across cohorts and is notably moderated by defamilization policies. These policies, which aim to reduce dependency on family for managing social risks, buffer mental health challenges in traditional family roles but are less effective for women in trajectories with delayed family formation. This investigation highlights the nuanced ways in which historical and cultural contexts alongside policy environments shape mental health outcomes at various life stages, offering valuable insights into our understanding of health disparities across the life course, with an emphasis on exposure to changing institutions.

The dilution effects of healthy lifestyles on the risk of depressive symptoms attributed to life-course disadvantages among Chinese middle-aged and older adults

BACKGROUND

Life-course disadvantages and unhealthy lifestyles are well-known to independently induce depressive symptoms, but whether adopting healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages remain unknown in China.

METHODS

This population-based cross-sectional study included 5724 middle-aged and older people from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms and healthy lifestyles (including regular exercise, reasonable sleep, never smoking, and no heavy alcohol consumption) were collected in 2018 while life-course disadvantages were collected in 2014.

RESULTS

Multiple healthy lifestyles were associated with decreased depressive risks more significantly as the life-course disadvantages increased, with odds ratios (ORs) and 95 % confidence intervals (CIs) of 0.44 (0.25-0.80) and 0.33 (0.21-0.53) for 4 healthy lifestyles in participants with mild and severe life-course disadvantages, respectively. Life-course disadvantages and unhealthy lifestyles had enormous joint effects on depressive symptoms. Finally, adopting multiple healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages and even mask some risks attributed to childhood disadvantages.

LIMITATIONS

Given that dietary data were not gathered by the CHARLS, diet was not included in the lifestyles used in this study. In addition, information on life-course disadvantages was primarily self-reported, which may lead to potential recall bias. Finally, the cross-sectional design of this study cannot capture causal associations well.

CONCLUSIONS

Adopting multiple healthy lifestyles can well-dilute the depressive risks attributed to life-course disadvantages in middle-aged and older Chinese, which is of great importance for reducing the depressive burden and the construction of healthy aging in China.

Childhood Socioeconomic Position, Adulthood Employment Trajectories, and Later Life Functional Limitations in Chile

Relying on a life course perspective, we explored the association between childhood socioeconomic position (SEP), adulthood employment trajectories, and their interactions, with different domains of functional limitations among older people in Chile. We used data from a face-to-face, comprehensive and representative life history survey of older people (N = 802), and weighted bivariate, multivariate, and longitudinal quantitative methods. As a way to address potential problems of reverse causality, we adjust multivariate analyses by lifetime health indicators. Our results show that low childhood SEP and non-standard adulthood employment trajectories characterized by part-time work negatively affect later life functional limitations. The increased risk among people with low childhood SEP is higher if they follow a "part-time employment trajectory" in adulthood. In the conclusion, we emphasize that analyzing life course determinants of functional limitations serves to inform and help design strategies to reduce dependency in later life and promote healthy aging.

Childhood Socioeconomic Position and Cardiovascular Disease Among Older Women and Men: The Moderating Role of Parenthood Onset

Objectives: Based on a life-course approach, the purpose of this study is to analyze how the age at the birth of a first child moderates the relationship between childhood socioeconomic position (SEP) and cardiovascular diseases (CVD) incidence in old age, separately for women and men.

Methods: We used a rich and representative life history survey of people aged from 65 to 75 living in Santiago, Chile (n = 802), and weighted multivariate statistical models. Data collection process involved the use of face-to-face life history calendars, administered by well-trained interviewers.

Results: Early motherhood increases the risk of suffering CVD among older women with a disadvantaged childhood SEP, while late motherhood decreases it. By contrast, early fatherhood decreases CVD risk among older men with an adverse childhood SEP, while late fatherhood increases it.

Conclusion: Our findings about the moderating role of parenthood onset on CVD risk among older women and men with a disadvantaged childhood SEP contributes to public health reflections on unexplored cardiovascular risk factors, which lead to substantial changes in women’s and men’s life courses, and might optimize cardiovascular prevention strategies.

Socioeconomic gradients in child development: Evidence from a Chilean longitudinal study 2010-2017

Empirical evidence shows that lack of resources during infancy and the process of accumulating disadvantages throughout childhood have important consequences for cognitive and socio-emotional development. This paper examines socioeconomic gradients across language and socio-emotional measures. Using longitudinal data from 7-year, three-wave panel data, we study the patterns of socioeconomic status and child development in Chile and estimate how much of the wealth gap can be explained by different mediators like maternal educational and skills, child attendance of preschool and school, possession of books, or domestic violence indicators. We show that there are strong associations between household wealth and child development, and that, as the child grows, the gap between the most extreme quintiles of the distribution, both in cognitive and socio-emotional skills, persists but decreases in magnitude. Taking advantage of the longitudinal nature of the data, we calculate a permanent skill for each child and each skill dimension in this 7-year period. The analysis for the permanent component shows that wealth gaps are important to determine language, but not socio-emotional skills, and that the gap is larger for girls than for boys in the early childhood period. While mediators account for some of the associations, there is still a large socioeconomic gap that persists in receptive language among children. The most important factors that mediate the wealth gaps are inherited from maternal characteristics. By understanding the dynamism of social and cognitive vulnerability experienced during childhood and employing longitudinal data and methods, this study contributes to and extends the existing literature on socioeconomic gaps and child development in the Latin American context.

Employment Trajectories Across the Life Course and Oral Health Among Older Persons in a Developing Country

A significant research gap on socioeconomic determinants of oral health among older persons is that socioeconomic indicators, like employment status, have essentially been problematized and measured using a cross-sectional approach. Based on a life course approach, and using data from a population-representative, face-to-face and longitudinal-retrospective survey focused on older people in Chile (N = 802), we reconstructed representative types of individual employment trajectories and measured their association with different oral health indicators in old age. Our results show that employment trajectories characterized by continuous, formal, full-time employment have a protective effect for multiple oral health indicators among older people. Our study demonstrates the need for public policies on oral health in old age to incorporate a life course approach and to consider the negative impact of constantly working in informal employment or being out of the labor market permanently, particularly in countries like Chile where temporary and informal employment has risen steadily.

Lifetime socioeconomic determinants of health trajectories among older adults

Drawing on life course theory and research, we explored how socioeconomic circumstances during childhood and adulthood shape self-reported health trajectories among older Mexican adults. We used data from the Mexican Health and Aging Study panel survey (2001-2015) and used sequence analysis to estimate types of self-reported health trajectories in older adulthood. We then explored the association between those health trajectories and socioeconomic determinants at different life stages, including education, occupation, employment, economic status, parental education, and adverse living conditions and illnesses during childhood. Our contributions are threefold. First, we identified four types of health trajectories for men and eight for women, representing a more nuanced longitudinal health status profile than previously shown. Second, we found that childhood and adult socioeconomic circumstances influence self-reported health trajectories at older age. Third, our results suggest there is no simple monotonic relationship between life course circumstances and self-reported health trajectories.

It Is Not Just Mortality: A Call From Chile for Comprehensive COVID-19 Policy Responses Among Older People

Objective

Provide a synthesis of the COVID-19 policies targeting older people in Chile, stressing their short- and long-term challenges.

Method

Critical analysis of the current legal and policy measures, based on national-level data and international experiences.

Results

Although several policies have been enacted to protect older people from COVID-19, these measures could have important unintended negative consequences in this group’s mental and physical health, as well as financial aspects.

Discussion

A wider perspective is needed to include a broader definition of health—considering financial scarcity, access to health services, mental health issues, and long-term care—in the policy responses to COVID-19 targeted to older people in Chile.

Lifetime employment, tobacco use, and alcohol consumption trajectories and cardiovascular diseases in old age

Despite the great advances of life course epidemiology studies during the last decade in understanding the general health effects of employment trajectories, research has yet to evaluate the effects of employment trajectories along with other major risk factors, such as tobacco and alcohol consumption, on cardiovascular diseases (CVDs)-the main cause of deaths worldwide. This is highly relevant, since health advantages in one domain (e.g., being a permanent formal full-time worker) may offset health disadvantages in other domains (e.g., being a regular smoker or alcohol consumer); conversely, disadvantages in both domains may interact, leading to even greater health risks. Considering these knowledge gaps, this research has two main objectives: (1) to reconstruct simultaneous employment, tobacco use, and alcohol consumption trajectories over the life course (from birth to old age) and (2) to measure the association between these trajectories and CVD in old age. Drawing on a rich and comprehensive life history dataset and using multichannel sequence and regression analyses, we analyzed a cohort of individuals aged 65-75 in Chile, a Latin American country with high social inequalities and scarce research on this matter. Our study shows that following a trajectory of formal employment together with no tobacco and alcohol use reduces CVD risk by 36 percentage points relative to a similar employment trajectory but with regular tobacco and alcohol use. Even with an employment trajectory characterized by constant informal employment or permanent inactivity, a life course free of regular tobacco and alcohol use shows protective effects against CVD. This study stresses the importance of health policies that consider CVD as a condition that strongly depends on individual experiences in multiple life domains and across different life stages.

The role of self-reported hearing status in the risk of hospitalisation among Chinese middle-aged and older adults

OBJECTIVE

To determine the association between self-reported hearing status and risk of hospitalisation among Chinese middle-aged and older adults.

DESIGN

Prospective cohort study. Discrete-time hazards models and negative binomial models were fitted to examine the relationship.

STUDY SAMPLE

About 11,902 participants aged 45 years or older with no hospitalisation at baseline.

RESULTS

49.28-62.70% of the participants reported their hearing as fair or poor. For older adults aged 60 and above, compared to people with excellent and very good hearing, those with good, fair or poor hearing reported shorter time to first hospitalisation [hazard ratio (HR) = 1.38, 1.38, 1.63, respectively]. They also manifested greater number of hospitalisations [incident rate ratio (IRR) = 1.21, 1.25, 1.54, respectively], and longer duration of hospitalisation (IRR = 1.36, 1.26, 1.53, respectively). However, there was no significant association between hearing status and hospitalisation for middle-aged adults for none of the hearing categories.

CONCLUSIONS

Although no significant relationship between hearing and hospitalisation was found for middle-aged adults, older adults with poorer hearing experienced greater risk of hospitalisation. Given that hearing impairment is highly prevalent among older adults, future analyses are needed to investigate whether hearing rehabilitative therapies could help mitigate hospitalisations in hearing-impaired older adults.