Lifetime socioeconomic determinants of health trajectories among older adults

Social Mobility and Health-Related Quality of Life Trajectory Classes Among Older Women and Men

OBJECTIVES

Changes in socioeconomic status (SES) during life may impact health in old age. We investigated whether social mobility and childhood and adulthood SES are associated with trajectories of health-related quality of life (HrQoL) over a 17-year period.

METHODS

We used data from the Helsinki Birth Cohort Study (n = 2003, 46% men, mean age 61.5 years). Social mobility was derived from childhood SES, obtained from healthcare records, and register-based adulthood SES.

RESULTS

Logistic regression models showed that lower adulthood SES was associated with lower physical HrQoL trajectories. Among men low (OR 3.95, p < .001), middle (OR 2.20, p = .006), and declining lifetime SES (OR 2.41, p = .001) were associated with lower physical HrQoL trajectories compared to men with high SES. Socioeconomic status was not associated with mental HrQoL trajectories.

DISCUSSION

Declining SES during life course may have negative health consequences, while improving SES is potentially as beneficial as high SES to later-life health among men.

Sociodemographic and work-related determinants of self-rated health trajectories: a collaborative meta-analysis of cohort studies from Europe and the US

Self-rated health is a major indicator of an individual's overall health status, but its development during midlife to old age, as well as influence of sociodemographic and work-related factors on it, are poorly understood. We used longitudinal individual-level data to examine trajectories of self-rated health and their determinants in 38,163 participants (median age 50 (range 36-66) years at baseline) of the English Longitudinal Study of Ageing, the Finnish Longitudinal Study on Aging Municipal Employees, and the French GAZ and ELectricité study from Europe and the Health and Retirement Study from the US. A group-based latent trajectory analysis showed that self-rated health was constantly good for over half of the participants, constantly suboptimal for about 11-21%, and it was changing, either improving or declining, for the rest. Pooled evidence suggests that being single (summary odds ratio 1.20, 95% confidence interval 1.07-1.35), medium educational attainment (1.26, 1.16-1.37), medium occupational class (1.22, 1.10-1.34), and exposure to high physical job demands (1.18, 1.08-1.29) were associated with declining self-rated health. Suboptimal self-rated health was more prevalent among those in low occupational class (1.81, 1.56-2.10), and those who experienced high physical job demands (1.52, 1.33-1.74). In these European and US populations, 23-40% of people experienced suboptimal or declining health trajectories. In conclusion, large variation in development of self-rated health from midlife to old age was observed and it was partly determined by sociodemographic and work-related factors.

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.