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Background
People aged 55 years and over account for over two thirds of all
those with a long-term illness or disability and for 90% of those
dying each year. From this it is clear that any strategy to reduce
significantly overall variations in health and mortality must address
the issue of inequalities in adult age groups. However, most studies
of socio-economic differentials in health and mortality focus on
younger groups.
This research
will analyse differentials in health and disability in the population
aged 55 and over according to their social resources, which are
conceptualised as comprising socio-economic and environmental factors;
'social capital', such as interactions with friends and relatives;
and personal capital, such as education.
Aims and
Objectives
The aims of this study are to:
- create an
integrated model which will examine how social resources influence
health variations in later life;
- investigate
changes in health and disability and in social resources using
longitudinal data;
- analyse the
association between the variations in social resources and the
variations in a range of health outcomes;
- identify
pathways between the social resource indicators, health-related
behaviours and health outcomes;
- examine socio-demographic
variations in the agreement between 'subjective' and 'objective'
measures of health.
Study Design
Two complementary data sets, one of them longitudinal, will be used
to address these issues and to develop a model of health variation
in later life in which socio-economic and socio-psychological factors
are integrated.
Two waves of
the ONS Retirement and Retirement Plans Study will be used to analyse
interactions between social resources and levels of and changes
in health and disability. This study of 3,500 55-69 year olds were
first interviewed in 1988/9 and followed up in 1994. The study includes
a wealth of data on job, marital and fertility histories, income
and wealth and exchanges of support with relatives and friends.
In addition, three forms of data on health and disability were collected:
information on self-reported health status, on functional ability
as indicated through responses to questions on activities of daily
living and on 13 areas of disability.
The second part
of the project will be based on an analysis of the Health Surveys
for England (1993-96), which should yield a sample size of 22,200
adults aged 55 years and over. These data sets will be used to examine
how variations in social resources influence both health-related
behaviour and health status. The survey collected detailed information
on self-reported and observational measures of health, health-related
behaviours and 'risk factors.' The data set also contains a measure
of psychological health using the General Health Questionnaire (GHQ)
score, as well as a number of questions on perceived social and
emotional support.
Policy Implications
The results from this research should lead to a better understanding
of the determinants of health in the age groups which make the greatest
use of health and welfare services. The results will be highly relevant
to both national and sub-national health policy makers and planners.
It should also provide information on social variations in the reporting
of ill-health, which will aid both short and long-term planning
and the interpretation of data on trends in the health status of
the older population.
Project Summary
The burden of ill health in the UK, as in other older industrial
societies, is carried by older people. Nearly 90% of deaths in England
and Wales occur among people aged 55 and older, and two thirds of
the population with a limiting long-term illness are in this age
group. This suggests that strategies to tackle poor health and health
inequalities among older people should form a key part of public
health policy. However, most health inequalities research has concentrated
on younger age groups.
The project
is one of three in the Programme concerned with health and health
inequalities among older people (see Blane, phase 1 and phase 2
for details of the other two). The project drew on two data sets,
the Retirement and Retirement Plans Survey and the Health Survey
for England (HSE). The Retirement Survey sheds light on health inequalities
in the 55 to 75 age group; the HSE allowed the team to examine health
inequalities in people aged 75 to 84. Because the HSE does not include
people in institutions and around 1 in 5 of those aged 85 and over
live in institutions, the analyses were not extended beyond age
84.
Conventional
measures of socio-economic status, like education and occupation,
are problematic for older age groups, where most left school at
the minimum school leaving age and without educational qualifications
and only a minority are in paid work. Developing robust alternative
measures is a priority for health inequalities research and for
the evaluation of the effectiveness of policy.
Key findings
- In both surveys,
there were strong associations between socio-economic indicators
and health, particularly for women. The stronger gradient in health
among women (taking account of smoking status) than men is noteworthy,
given the generally-reported weaker gradients among women in studies
of the adult population;
- Analysis
of the Retirement Survey indicated that poorer health and greater
disability at baseline (aged 55 to 69) and at follow-up five years
later were associated with socio-economic disadvantage. Low lifetime
social class, length of time unemployed, no educational qualifications
and low income increased the risks of being in poor health or
having some disability at baseline and follow-up, while owner
occupation was associated with a lower risk, particularly for
women. Area of residence was also associated with health, with
those living outside the southeast of England, particularly men,
having higher odds of poor health or disability.
- However,
other domains were also independent predictors of health. Demographic
history and events - like marrying and having children young,
and experiencing the death of a child - were associated with poorer
health and greater disability. This supports an integrated and
multi-causal model of health inequalities.
- The HSE enabled
the analysis to be extended to the 75 to 84 age group. This pointed
to the importance both of childhood circumstances, as measured
by childhood height and educational qualifications, and of current
circumstances, including socio-economic status and social support.
However, the strongest and most consistent relationship was between
poverty, as measured by receipt of income support, and poor health.
The risks of reporting bad/very bad health among those receiving
income support was over twice that of non-claimants (having taken
account of childhood circumstances, social support, smoking and
age).
- Analyses
were undertaken of variations in health status and disability
using a range of indicators of socio-economic status. These included
social class, income quartile, educational attainment, housing
tenure, lack of car access for financial reasons, number of household
items that could not be afforded, and lack of essential items.
All were associated with differences in self-reported health.
The 'best' pair of indicators was either educational qualifications
or social class, paired with a household-based deprivation indicator.
- There was
a strong concordance between subjective and objective measures
of health, with a higher degree of concordance in younger age
groups. There was also a socio-economic gradient in the concordance
between subjective and objective measures of health. Those who
were more highly educated and in higher social class groups were
more likely to report poor health than others with the same 'objective'
degree of poor health. This suggests that higher socio-economic
groups may have a lower threshold for reporting poor health (or,
to put it another way, have higher health expectations). As a
result, health inequalities may be larger than those captured
in surveys reliant on self-reported measures of health.
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