Social determinants, health status and 10-year mortality among 10,906 older adults from the English longitudinal study of aging: the ATHLOS project

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Abstract

Background

In either rich or poor countries, people’s health widely depends on the social conditions in which they live and work – the social determinants of health. The aim of the present work was to explore the association of educational and financial status with healthy aging and mortality.

Methods

Data from the English Longitudinal Study of Aging (ELSA) were studied ( n = 10,906 participants, 64 ± 11 years, 55% women). A set of 45 self-reported health items and measured tests were used to generate a latent health metric reflecting levels of functioning referred to as health metric (higher values indicated better health status). Overall mortality after 10-years of follow-up (2002–2012) was recorded.

Results

Both education and household wealth over time were positively associated with the health metric ( p < 0.001) and negatively with overall mortality ( p < 0.001). Lifestyle behaviors (i.e., physical activity, smoking habits and alcohol consumption) mediated the effect of education and household wealth on the health metric and the latter mediated their effect on overall mortality.

Conclusions

In conclusion, reducing socioeconomic disparities in health by improving the access to education and by providing financial opportunities should be among the priorities in improving the health of older adults.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6288-6) contains supplementary material, which is available to authorized users.

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Most cited references 18

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Socioeconomic Disparities in Health Behaviors.

Fred Pampel, Patrick M. Krueger, Justin Denney (2010)

The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.

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Macroeconomic implications of population ageing and selected policy responses.

David Bloom, Somnath Chatterji, Paul Kowal … (2015)

Between now and 2030, every country will experience population ageing-a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population-a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries' economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties.

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Healthy ageing, resilience and wellbeing.

T D Cosco, K. Howse, C. Brayne (2017)

The extension of life does not appear to be slowing, representing a great achievement for mankind as well as a challenge for ageing populations. As we move towards an increasingly older population we will need to find novel ways for individuals to make the best of the challenges they face, as the likelihood of encountering some form of adversity increases with age. Resilience theories share a common idea that individuals who manage to navigate adversity and maintain high levels of functioning demonstrate resilience. Traditional models of healthy ageing suggest that having a high level of functioning across a number of domains is a requirement. The addition of adversity to the healthy ageing model via resilience makes this concept much more accessible and more amenable to the ageing population. Through asset-based approaches, such as the invoking of individual, social and environmental resources, it is hoped that greater resilience can be fostered at a population level. Interventions aimed at fostering greater resilience may take many forms; however, there is great potential to increase social and environmental resources through public policy interventions. The wellbeing of the individual must be the focus of these efforts; quality of life is an integral component to the enjoyment of additional years and should not be overlooked. Therefore, it will become increasingly important to use resilience as a public health concept and to intervene through policy to foster greater resilience by increasing resources available to older people. Fostering wellbeing in the face of increasing adversity has significant implications for ageing individuals and society as a whole.

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Author and article information

Contributors

Natasa Kollia: natkollia@yahoo.gr

Francisco Félix Caballero: felix.caballero@uam.es

Albert Sánchez-Niubó: albert.sanchez@pssjd.org

Stefanos Tyrovolas: s.tyrovolas@pssjd.org

José Luis Ayuso-Mateos: joseluis.ayuso@uam.es

Josep Maria Haro: jmharo@pssjd.org

Somnath Chatterji: chatterjis@who.int

Demosthenes B. Panagiotakos:

ORCID: http://orcid.org/0000-0001-8583-153X

+30 210-9549332 , dbpanag@hua.gr , d.b.panagiotakos@usa.net

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 10 December 2018

Publication date PMC-release: 10 December 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 1357

Affiliations

[1 ]ISNI 0000 0004 0622 2843, GRID grid.15823.3d, Department of Nutrition and Dietetics, School of Health Science and Education, , Harokopio University, ; 70 Eleftheriou Venizelou Ave, 176 61 Attica, Athens Greece

[2 ]ISNI 0000000119578126, GRID grid.5515.4, Department of Preventive Medicine, Public Health and Microbiology, , Universidad Autónoma de Madrid, ; Madrid, Spain

[3 ]GRID grid.469673.9, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, ; Monforte de Lemos 3-5. Pabellón 11, 28029 Madrid, Spain

[4 ]ISNI 0000 0004 1767 647X, GRID grid.411251.2, Hospital Universitario de La Princesa, , Instituto de Investigación Sanitaria Princesa (IP), ; Madrid, Spain

[5 ]ISNI 0000 0004 1771 0789, GRID grid.466982.7, Parc Sanitari Sant Joan de Déu, ; Barcelona, Spain

[6 ]CIBER of Epidemiology and Public Health, Madrid, Spain

[7 ]ISNI 0000000121633745, GRID grid.3575.4, Department of Health Metrics and Measurement, , World Health Organization, ; Geneva, Switzerland

Author information

Demosthenes B. Panagiotakos http://orcid.org/0000-0001-8583-153X

Article

Publisher ID: 6288

DOI: 10.1186/s12889-018-6288-6

PMC ID: 6288914

PubMed ID: 30526556

SO-VID: 01807f64-9517-4b45-84b8-a2cc60258bb6

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 June 2018

Date accepted : 30 November 2018

Funding

Funded by: European Union's Horizon 2020

Award ID: 635316

Custom metadata

ScienceOpen disciplines: Public health

Keywords: health,healthy aging,education,financial status,social determinants,socioeconomic,mortality

Data availability:

ScienceOpen disciplines: Public health

Keywords: health, healthy aging, education, financial status, social determinants, socioeconomic, mortality

Social determinants, health status and 10-year mortality among 10,906 older adults from the English longitudinal study of aging: the ATHLOS project

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Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

Related collections

Global Health Next Generation Network

Most cited references 18

Socioeconomic Disparities in Health Behaviors.

Macroeconomic implications of population ageing and selected policy responses.

Healthy ageing, resilience and wellbeing.

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