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Different indicators of socioeconomic status and their relative importance as determinants of health in old age
Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.ORCID iD: 0000-0002-8617-0355
2017 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, no 1, article id 173Article in journal (Refereed) Published
Abstract [en]

Background: Socioeconomic status has been operationalised in a variety of ways, most commonly as education, social class, or income. In this study, we also use occupational complexity and a SES-index as alternative measures of socioeconomic status. Studies show that in analyses of health inequalities in the general population, the choice of indicators influence the magnitude of the observed inequalities. Less is known about the influence of indicator choice in studies of older adults. The aim of this study is twofold: i) to analyse the impact of the choice of socioeconomic status indicator on the observed health inequalities among older adults, ii) to explore whether different indicators of socioeconomic status are independently associated with health in old age.

Methods: We combined data from two nationally representative Swedish surveys, providing more than 20 years of follow-up. Average marginal effects were estimated to compare the association between the five indicators of SES, and three late-life health outcomes: mobility limitations, limitations in activities of daily living (ADL), and psychological distress.

Results: All socioeconomic status indicators were associated with late-life health; there were only minor differences in the effect sizes. Income was most strongly associated to all indicators of late-life health, the associations remained statistically significant when adjusting for the other indicators. In the fully adjusted models, education contributed to the model fits with 0-3% (depending on the outcome), social class with 0-1%, occupational complexity with 1-8%, and income with 3-18%.

Conclusions: Our results indicate overlapping properties between socioeconomic status indicators in relation to late-life health. However, income is associated to late-life health independently of all other variables. Moreover, income did not perform substantially worse than the composite SES-index in capturing health variation. Thus, if the primary objective of including an indicator of socioeconomic status is to adjust the model for socioeconomic differences in late-life health rather than to analyse these inequalities per se, income may be the preferable indicator. If, on the other hand, the primary objective of a study is to analyse specific aspects of health inequalities, or the mechanisms that drive health inequalities, then the choice of indicator should be theoretically guided. 

Place, publisher, year, edition, pages
BioMed Central, 2017. Vol. 16, no 1, article id 173
Keywords [en]
Education, Income, Late-life health, Occupational complexity, SES-index, Social class, Socioeconomic indicators
National Category
Public Health, Global Health, Social Medicine and Epidemiology Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-37608DOI: 10.1186/s12939-017-0670-3ISI: 000411755800001PubMedID: 28950875Scopus ID: 2-s2.0-85029870729OAI: oai:DiVA.org:hj-37608DiVA, id: diva2:1149071
Available from: 2017-10-13 Created: 2017-10-13 Last updated: 2018-01-13Bibliographically approved

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Kåreholt, Ingemar

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Public Health, Global Health, Social Medicine and EpidemiologyGerontology, specialising in Medical and Health Sciences

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