Age, socioeconomic status and obesity growth

We use panel data from the National Longitudinal Survey of Youth (NLSY) to examine how body weight changes with age for a cohort moving through early adulthood, to investigate how the age-obesity gradient differs with socioeconomic status (SES) and to study channels for these SES disparities. Our results show first that weight increases with age and is inversely related to SES during childhood. Second, the obesity gradient widens over the lifecycle, consistent with research on other health outcomes. Third, a substantial portion of the “effect” of early life conditions operates through race/ethnicity and the translation of advantaged family backgrounds during childhood into higher levels of subsequent education. By contrast, little of the SES gap appears to propagate through household composition, family income or health behaviors. Fourth, adult SES has independent effects after controlling for childhood status.     

The duration and timing of exposure: effects of socioeconomic environment on adult health

OBJECTIVES: This study investigated timing and duration effects of socioeconomic status (SES) on self-rated health at 33 years of age and established whether health risks are modified by changing SES and whether cumulative SES operates through education. METHODS: Data were from the 1958 British birth cohort. Occupational class at birth and at 16, 23, and 33 years of age was used to generate a lifetime SES score. RESULTS: At 33 years of age, 12% of men and women reported poor health. SES at birth and at 16, 23, and 33 years of age was significantly associated with poor health: all ages except 16 years in men made an additional contribution to the prediction of poor health. No large differences in effect sizes emerged, suggesting that timing was not a major factor. Odds of poor health increased by 15% (men) and 18% (women) with a 1-unit increase in the lifetime SES score. Strong effects of lifetime SES persisted after adjustment for education level. CONCLUSIONS: SES from birth to 33 years of age had a cumulative effect on poor health in early adulthood. This highlights the importance of duration of exposure to socioeconomic conditions for adult health.     

Socioeconomic status and age trajectories of health

The cumulative advantage hypothesis suggests diverging socioeconomic status (SES) based gaps in health with age. However, previous studies yield inconsistent findings regarding the association between SES and health across the adult life span. Dealing with the issue of mortality selection bias, this study utilizes latent growth-curve modeling to comprehensively examine age trajectories of both physical and mental health by SES using panel data based on a national probability sample of 3617 US adults. We find that education- and income-based gaps in physical impairment and the education-based gap in depression diverge over time for all adult age groups, supporting the hypothesis of cumulative advantage. In contrast, we find that the income-based gap in depression converges in older age, supporting the hypothesis of age-as-leveler. Mortality selection bias is unlikely to be a major part of the explanation for the convergence. These results indicate that age-related patterns in health trajectories may differ by various dimensions of SES and health. Finally, we take into account persistence or change in income over time to examine the relationship between trajectories of income and health across adulthood, highlighting the importance of considering the temporal patterns of income in understanding age trajectories of health.     

Do socioeconomic gradients in women's health widen over time and with age?

A population-based study was conducted to investigate changes over time in women's well-being and health service use by socio-economic status and whether these varied by age. Data from 12,328 mid-age women (aged 45-50 years in 1996) and 10,430 older women (aged 70-75 years) from the Australian Longitudinal Study on Women's Health were analysed. The main outcome measures were changes in the eight dimensions of the Short Form General Health Survey (SF-36) adjusted for baseline scores, lifestyle and behavioural factors; health care utilisation at Survey 2; and rate of deaths (older cohort only). Cross-sectional analyses showed clear socioeconomic differentials in well-being for both cohorts. Differential changes in health across tertiles of socioeconomic status (SES) were more evident in the mid-age cohort than in the older cohort. For the mid-aged women in the low SES tertile, declines in physical functioning (adjusted mean change of -2.4, standard error (SE) 1.1) and general health perceptions (-1.5, SE 1.1) were larger than the high SES group (physical functioning -0.8 SE 1.1, general health perceptions -0.8 SE 1.2). In the older cohort, changes in SF-36 scores over time were similar for all SES groups but women in the high SES group had lower death rates than women in the low SES group (relative risk: 0.79, 95% confidence interval 0.64-0.98). Findings suggest that SES differentials in physical health seem to widen during women's mid-adult years but narrow in older age. Nevertheless, SES remains an important predictor of health, health service use and mortality in older Australian women.     

Municipal socioeconomic status and mortality in Japan: sex and age differences, and trends in 1973-1998

The purpose of this study was to examine the sex and age differences and the time trends in the association between municipal socioeconomic status (SES) and all-cause mortality across Japan from 1973 to 1998. Sex-specific mortality of municipalities (N=3319 in 1995) by age groups (total, under 75-year, and over 75-year populations) was linked to municipal SES indicators related to income, education, unemployment and living space, and two SES composite indices formulated by principle component analysis (Index 1 related to lower income and education, and Index 2 related to unemployment and overcrowding). The relation was assessed using mortality gradients by SES quintiles and Bayesian hierarchical Poisson regression. The results showed that a lower SES was related to higher mortality for all SES indicators and composite indices. The mortality gradient was steeper for the under 75-year population than the total and over 75-year populations, and the relation between mortality and income- and education-related indicators/index was stronger for males than for females. The time trend showed an increase in the relation for Index 2, while a decrease for Index 1. This study demonstrated that lower municipal SES had an adverse influence on population health, and the influence was marked for males and premature death. Although a substantial health disadvantage still remained in lower SES areas, the impact of SES factors on geographical health variation changed over time; the association with mortality has weakened for income and education, while it has strengthened for unemployment and living space.     

Childhood and adult socioeconomic position, cumulative lead levels, and pessimism in later life: the VA Normative Aging Study

Pessimism, a general tendency toward negative expectancies, is a risk factor for depression and also heart disease, stroke, and reduced cancer survival. There is evidence that individuals with higher lead exposure have poorer health. However, low socioeconomic status (SES) is linked with higher lead levels and greater pessimism, and it is unclear whether lead influences psychological functioning independently of other social factors. The authors considered interrelations among childhood and adult SES, lead levels, and psychological functioning in data collected on 412 Boston area men between 1991 and 2002 in a subgroup of the VA Normative Aging Study. Pessimism was measured by using the Life Orientation Test. Cumulative (tibia) lead was measured by x-ray fluorescence. Structural equation modeling was used to quantify the relations as mediated by childhood and adult SES, controlling for age, health behaviors, and health status. An interquartile range increase in lead quartile was associated with a 0.37 increase in pessimism score (P < 0.05). Low childhood and adult SES were related to higher tibia lead levels, and both were also independently associated with higher pessimism. Lead maintained an independent association with pessimism even after childhood and adult SES were considered. Results demonstrate an interrelated role of lead burden and SES over the life course in relation to psychological functioning in older age.     

Early childhood health,reproduction of economic inequalities and the persistence of health and mortality differentials

The persistence of adult health and mortality socioeconomic inequalities and the equally stubborn reproduction of social class inequalities are salient features in modern societies that puzzle researchers in seemingly unconnected research fields. Neither can be satisfactorily explained with standard theoretical frameworks. In the domain of health and mortality, it is unclear if and to what an extent adult health and mortality disparities across socioeconomic status (SES) are the product of attributes of the positions themselves, the partial result of health conditions established earlier in life that influence both adult health and economic success, or the outcome of the reverse impact of health status on SES. In the domain of social stratification, the transmission of inequalities across generations has been remarkably resistant to satisfactory explanations. Although the literature on social stratification is by and large silent about the role played by early health status in shaping adult socioeconomic opportunities, new research on human capital formation suggests this is a serious error of omission. In this paper we propose to investigate the connections between these two domains. We use data from male respondents of the 1958 British Cohort to estimate (a) the influence of early health conditions on adult SES and (b) the contribution of early health status to observed adult health differentials. The model incorporates early conditions as determinants of traits that enhance (inhibit) social mobility and also conventional and unconventional factors that affect adult health and socioeconomic status. Our findings reveal that early childhood health plays a small, but non-trivial role as a determinant of adult SES and the adult socioeconomic gradient in health. These findings enrich current explanations of SES inequalities and of adult health and mortality disparities.     

Factors influencing health behaviors in the National Health and Nutritional Examination Survey, III (NHANES III)

This study investigated the influence of age, gender, race, place of residence, social networks, and socioeconomic status (SES) on health behaviors in the NHANES III, a large public domain database of approximately 16,000 subjects. Multiple regression analysis indicated that age, gender, social networks, and SES were statistically significant predictors of both positive and negative health behaviors, while race and place of residence were not. These results suggest an influence of age, gender, SES, and social support factors on health behaviors and reinforce the need for social work to take into account these factors at both the individual and public policy levels.     

Socioeconomic differences in health among older adults in Mexico

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES-health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education-obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES-health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US.     

Socioeconomic risk, parenting during the preschool years and child health age 6 years

BACKGROUND: Parent child relationships and parenting processes are emerging as potential life course determinants of health. Parenting is socially patterned and could be one of the factors responsible for the negative effects of social inequalities on health, both in childhood and adulthood. This study tests the hypothesis that some of the effect of socioeconomic risk on health in mid childhood is transmitted via early parenting. METHODS: Prospective cohort study in 10 USA communities involving 1041 mother/child pairs, selected at birth at random with conditional sampling. Exposures: income, maternal education, maternal age, lone parenthood, ethnic status and objective assessments of mother child interaction in the first 4 years of life covering warmth, negativity and positive control. Outcomes: mother's report of child's health in general at 6 years. Modelling: multiple regression analyses with statistical testing of mediational processes. RESULTS: All five indicators of socioeconomic status (SES) were correlated with all three measures of parenting, such that low SES was associated with poor parenting. Among the measures of parenting maternal warmth was independently predictive of future health, and among the socioeconomic variables maternal education, partner presence and 'other ethnic group' proved predictive. Measures of parenting significantly mediated the impact of measures of SES on child health. CONCLUSIONS: Parenting mediates some, but not all of the detectable effects of socioeconomic risk on health in childhood. As part of a package of measures that address other determinants, interventions to support parenting are likely to make a useful contribution to reducing childhood inequalities in health.     

Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale

Socioeconomic inequalities in adolescent health have been little studied until recently, partly due to the lack of appropriate and agreed upon measures for this age group. The difficulties of measuring adolescent socioeconomic status (SES) are both conceptual and methodological. Conceptually, it is unclear whether parental SES should be used as a proxy, and if so, which aspect of SES is most relevant. Methodologically, parental SES information is difficult to obtain from adolescents resulting in high levels of missing data. These issues led to the development of a new measure, the Family Affluence Scale (FAS), in the context of an international study on adolescent health, the Health Behaviour in School-Aged Children (HBSC) Study. The paper reviews the evolution of the measure over the past 10 years and its utility in examining and explaining health related inequalities at national and cross-national levels in over 30 countries in Europe and North America. We present an overview of HBSC papers published to date that examine FAS-related socioeconomic inequalities in health and health behaviour, using data from the HBSC study. Findings suggest consistent inequalities in self-reported health, psychosomatic symptoms, physical activity and aspects of eating habits at both the individual and country level. FAS has recently been adopted, and in some cases adapted, by other research and policy related studies and this work is also reviewed. Finally, ongoing FAS validation work is described together with ideas for future development of the measure.     

Changes in the sociodemographic composition of the lowest socioeconomic group over time, 1987–2001

Background  

When comparing health differences of groups with equal socioeconomic status (SES) over time, the sociodemographic composition of such a SES group is considered to be constant. However, when the periods are sufficiently spaced in time, sociodemographic changes may have occurred. The aim of this study is to examine in which respects the sociodemographic composition of lowest SES group changed between 1987 and 2001.     

Can subjective and objective socioeconomic status explain minority health disparities in Israel?

Disparities in health exist between the three main population groups in Israel, non-immigrant Jews, immigrants from the former Soviet Union (arriving in Israel since 1990) and Arabs. This study examines the relationship between health and socioeconomic status in this multicultural population and assesses to what extent subjective and objective socioeconomic measures may explain the disparities in health. A random cross sectional telephone survey of 1004 Israelis aged 35–65 was performed. The questionnaire measured physical and mental health-related quality of life using the Short Form 12. Information regarding subjective socioeconomic status (SSS) and objective socioeconomic status (SES) was collected.Arabs and immigrant women from the former Soviet Union had worse physical health compared to non-immigrant Jews. Immigrant and Arab men and women had worse mental health compared to non-immigrant Jews. Multivariable log-linear regression analysis adjusting for age, SSS or SES explained the disparities in physical health between Arab and non-immigrant Jewish men. However, SSS and SES did not explain the disparities in physical health between the three groups of women. The disparities in mental health between immigrants and non-immigrant Jews can be explained by SSS for both men and women, whereas the disparities between Arabs and Jews can be explained by objective SES only among women. Employed men reported better physical and mental health. Part of the disparities in mental health in Israel can be attributed to differences in SSS and SES in the different groups. However, there is a need to identify additional factors that may add to the disparities in both physical and mental health. The disparities due to socioeconomic status vary by health measure and population group.     

The effects of income, education and age on health

We use the core interviews of the US Health Interview Survey for the years 1987-1994, to study the effects of socioeconomic status (SES) on mortality and self-reported health. We find, consistent with previous studies, that the relationship between mortality and indicators such as education and income diminishes with age. We consider new explanations for this result and conclude that general biological deterioration at old age is probably the principal one. One important piece of evidence for this conclusion is the finding that there is no relationship at all between mortality and SES for people whose self-reported health status at baseline is either fair or poor.     

Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study

The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972-1973, who were followed from birth to age 32 years (2004-2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55-67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial.     

A multilevel analysis of race, community disadvantage, and body mass index among adults in the US

This study examined the contributions of both individual socioeconomic status (SES) and community disadvantage in explaining the higher body mass index (BMI) of black adults in the US. Data from a national survey of adults (1986 American's Changing Lives Study) were combined with tract-level community data from the 1980 census. Results of multilevel regression analyses showed that black women had an age-adjusted BMI score three points higher than non-black women. Individual SES (income, education, assets) was negatively associated with BMI in women, but it only reduced the association between race and BMI from 2.99 to 2.50. Adding community socioeconomic disadvantage index further reduced the race coefficient slightly from 2.50 to 2.21. Nevertheless, living in communities with higher socioeconomic disadvantage was associated with higher BMI net of age, race, individual SES, smoking, physical activity, stress, and social support. Community income inequality (Gini) had an independent positive association with BMI, but did not substantially reduce racial differences among women. Community percent black was not associated with BMI. Results for men demonstrated no statistically significant racial differences in BMI, and no association between BMI and either individual SES or community disadvantage. Although individual SES and community socioeconomic disadvantage each partly explained the higher average BMI among black women, clear racial disparities persisted. Moreover, race, individual SES, community socioeconomic disadvantage, and individual health behaviors were each independent predictors of BMI among women. Unexplained within- and between-community variance in BMI remained among both women and men, with most unexplained variation due to within-community variance. Because our evidence for women suggests that the determinants of obesity are multiple and multilevel, attempts to address this growing social problem will similarly require a multi-faceted and multilevel approach.     

Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents.

The aim of the study was to examine the effect of socioeconomic status (SES), age, weight and gender on the body image and weight control practices of children and adolescents, and to investigate whether health education about weight issues should target low socioeconomic groups. The study participants were a randomly selected group of school children who completed a questionnaire, and had their height and weight measured. Participants (n = 1131) were aged 6-19 years from 12 schools in New South Wales. SES, age, gender, body weight, body image, skipping breakfast, physical self-esteem, attempts to lose or gain weight, and dietary and weight control advice received from others were examined. Log-linear, chi 2 and MANOVA analyses were used to determine interactions between variables. Low SES children were more likely to be overweight, to skip breakfast, to perceive themselves as 'too thin', to be trying to gain weight and less likely to receive dietary or weight control advice. Physical self-esteem was lowest among overweight girls of middle/upper SES and greatest among boys of low SES, despite the latter being more likely to be overweight. Being overweight does not appear to adversely affect the physical self-esteem of children of low SES, particularly boys. Health educators should examine these issues with young people to help make health education and nutrition education most relevant and appropriate.     

Socioeconomic status and health among the aged in the United States and Germany: a comparative cross-sectional study

This study investigates socioeconomic status (SES) differences in health among the aged in Germany and the United States. Intra-elderly age differences in the SES-health gradient are also examined. The study uses data from two national telephone surveys conducted in Germany (N=682) and the United States (N=608) using probability samples of non-institutionalised persons 60 years or older. In addition to the traditional indicators of SES (education, income and occupational status), two alternative indicators (assets and home ownership) are utilised. Self-rated health, depression (CES-D) and functional limitations are introduced as health indicators. Results of multiple logistic regression analyses show that income is the best SES predictor of the three health measures among the aged in Germany, whereas education, occupational prestige, assets, and home ownership are not consistently related to health. Respective analyses of the US data demonstrate weaker and less consistent associations of health measures with SES indicators. Consequently, there is a higher percentage of explained variance in health by SES among the aged in Germany compared to the United States. The data also show that social inequalities in health tend to diminish at older ages in the United States, but such disparities vary only slightly by age in Germany. In conclusion, although SES health differences are observed among the elderly in both countries, they are more pronounced in Germany than in the United States where effects are restricted to younger old age. One interpretation of this finding points to higher selective mortality of middle and early old age groups with a low SES in the United States due to stronger health-related deprivation.     

Evidence on equalisation in health in youth from the West of Scotland

Many studies report few socioeconomic (SES) differences in health in youth, a pattern contrasting with that of health inequalities in childhood and adulthood. This paper focuses on the child-youth transition to examine the hypothesis of equalisation in health over this period. Specifically, we test two hypotheses: (a) that equalisation is more likely for health state measures (physical and malaise symptoms and accidents) than health status ([limiting] longstanding illness and self-rated health) or health potential (height), and (b) that the patterning of health over this period is similar between occupational (social class) and non-occupational (deprivation, housing tenure and family affluence) SES measures. Data are derived from the West of Scotland 11 to 16 cohort, followed from late childhood (aged 11) through early (13) to mid (15) adolescence. The results showed very little evidence of SES differences in (limiting) longstanding illness at any age for both sexes, while self-rated health exhibited some differentiation, and height (as expected) consistent gradients throughout. By contrast, among males evidence of equalisation was found for both physical and malaise symptoms and pedestrian road traffic accidents (RTAs). Among females, equalisation was confined to specific physical symptoms, pedestrian RTAs, sports injuries and burns/scalds, while for malaise symptoms a reverse gradient at age 11 strengthened with age. These patterns were generally unaffected by the SES measure used. We conclude that while some of the evidence is consistent with the equalisation hypothesis, it needs extending to accommodate patterns of no SES differences, and particularly reverse gradients, in childhood. These patterns may reflect the increasingly pervasive influence of youth culture, suggesting that in the UK the boundary between childhood and youth should be set at an earlier age. This in turn suggests that international comparisons have considerable analytic potential for identifying the conditions under which equalisation does and does not occur.     

Socioeconomic status, depression, and health service utilization among adolescent women.

This article examines relationships among socioeconomic status (SES), depression, and health services utilization among 5,735 adolescent women. In cross-sectional analyses, effects of SES on having obtained a routine physical examination and use of psychological/emotional counseling in the past year are examined. Then, longitudinal analyses determine the effects of health service utilization on depression at 1 year follow-up (T2) controlling for baseline depression and SES. SES was associated with medical but not mental health service use. SES and health service use independently predicted T2 depression and an income x baseline depression interaction was noted. The findings and their implications are discussed.