Thursday 11 September 2003, 2pm, U Lounge
The effects of socio-economic determinants on survival at old ages in England and Wales: findings from the 1% Longitudinal Study for England and Wales
Edlira Gjonca, University College London
Some of the differentiation that occurs throughout the life span is a result of exposure to favourable and unfavourable environmental influences. Social class, education, wealth, income and its distribution, work and occupation could be considered as possible determinants.
Social class differences in mortality have been the subject of debate and intensive studies in demography, sociology, epidemiology and public health research for at least the past 20 years. Research has consistently shown that health and mortality are strongly related to social class. However, the research on class differences in mortality has often excluded the elderly or has only included them to a very limited extent. As a result we have little evidence of class differences in mortality of the elderly population and even less of the mechanisms and processes by which these socio-economic factors affect longevity.
The aim of this paper is to examine whether socio-economic factors play a role in determining these differences and if so what is the mechanism. The paper uses data from the Longitudinal Study for England and Wales.
For the purposes of our analysis we are only using the data for people aged 50 and over at April 1971, giving a total of 161,532 people. The central variables used in this work are social class, education, wealth, income and occupation. However the data allows the consideration of other variables such as deprivation of the area of residence, and car and house ownership.
The paper aims to address questions like the effect of social class differences in mortality of the elderly, and the temporal change in this effect. It also aims to look at the effect of other socio-economic determinants like education, occupation and material situation in mortality at old age. Lastly, an attempt is made to look at the mechanisms by which different socio-economic factors affect longevity.
Department of Epidemiology and Public Health
University College London
1-19 Torrington Place
London WC1E 6BT
Tel: +44 (0)207679 1794
Fax: +44 (0)207813 0280
Email: edlira@public-health.ucl.ac.uk
Growing old in London: inequalities in health
Maria Evandrou, King's College London
This paper maps inequalities in health and access to health care services amongst older people in London. The discussion of inequality amongst London's elders is located within the broader context of inequalities in later life in Britain as a whole.
Data from the 2001 census is used to map differences in the health status of the older population (percentage reporting limiting long term illness) across London. As the micro data files from the 2001 census will not be publicly available until 2004, the census analysis on health inequalities is supplemented by examining data for London from the General Household Survey (GHS). GHS data are pooled over three years (1998, 2000 and 2001) in order to provide sufficiently large sub-samples.
The GHS is particularly useful for research on health inequalities as it collects information on three major self-reported indicators of health status (general health status over the last year, limiting long-standing illness and acute ill health in the last two weeks), as well as indicators of socio-economic status including income. The paper investigates how these outcome measures vary by age, gender and socio-economic status amongst older people in both London and Britain using bi-variate and multi-variate techniques.
The GHS is also used to examine patterns of health care utilisation (GP consultations, outpatient visits and inpatient stays) amongst older people in London and how these vary by age, gender and socio-economic status. The paper concludes with a discussion of the particular challenges facing policy makers from the diversity of London's elders.
Institute of Gerontology
King's College London
Frankin-Wilkins Building
Waterloo Road
London SE1 9NN
Tel: +44 (0)20 7848 3038
Email: maria.evandrou@kcl.ac.uk
Decreasing influence of socio-economic status on mortality in old age?
Rasmus Hoffmann, Max-Planck-Institute for Demographic Research
The impact of socioeconomic status (SES) on mortality has been observed many times in mortality research. However, it is unclear if this impact decreases in old age. Our study aims to answer the question: do mortality differences between SES groups converge in old age because biological ageing works as a leveller that neutralises social differences, or do these differences increase because social (dis)advantages and their postponed consequences for health accumulate during life? Possible pathways for the impact of SES on mortality are material factors, behaviour, (early) life events and social support.
Our data come from the US Health and Retirement Study. This representative survey covers about 10,000 persons born before 1934 from 1992/93 to 2000. The data allow a detailed measurement of the socio-economic status (including income/ pension and wealth), health behaviour and parent's characteristics. Event-history-analysis is applied to analyse the risk of death and its socio-economic determinants. By including health as a time varying variable, this method is able to reduce the health selection bias.
We expect results showing that socio-economic status clearly influences old age mortality and that material factors work through behaviour so that the latter cannot be regarded as free choice. We expect increasing absolute mortality differences between socio-economic groups with age, but decreasing relative differences. These two ways of measuring leave room for interpretation about the change of the impact of socio-economic status on mortality with age. Besides the above mentioned 'biological ageing' vs accumulation, another explanation is that the observed converging of mortality differentials is based on mortality selection, ie subgroups surviving into high ages are positively selected and thus more homogeneous.
Max-Planck-Institute for Demographic Research
Rostock
Germany
Tel: +49 381 2081248
Email: hoffmann@demogr.mpg.de