Childhood Socioeconomic Position and Disability in Later Life: Results of the Health and Retirement Study

Institute of Gerontology, Wayne State University, 87 E Ferry St, 226 Knapp Building, Detroit, MI 48202, USA.
American Journal of Public Health (Impact Factor: 4.55). 09/2009; 100 Suppl 1(S1):S197-203. DOI: 10.2105/AJPH.2009.160986
Source: PubMed

ABSTRACT We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life.
We used longitudinal data from the nationally representative Health and Retirement Study (1998-2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities.
Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life.

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    • "The proposed explanations clearly call for further research that needs to take into account the interconnectivity of social and economic, policy-related and health-related conditions. This analysis is even more challenging as levels of health and functioning among older people are additionally determined by conditions during earlier stages of the life course [52], in particular early life [53] and midlife [54], [55]. Hence, one challenge of future analyses is to focus explicitly on distinct policies and to address life course exposures when explaining later health. "
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    ABSTRACT: To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability.
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    • "Statistical Analyses A major obstacle in examining mental health and marital status is the issue of whether selection factors could influence the observed relationships. For example, adverse life course events have been associated with not only greater likelihood of being nonmarried but also increased risk of physical limitations and mental health problems in adulthood (Amato 1996; Bowen and González 2010; Chartier, Walker, and Naimark 2010; Colman and Widom 2004; Green et al. 2010; Horwitz et al. 2001). If they are not comprehensively taken into account, these time-stable factors could therefore lead to a spurious association in the focal relationships for this research. "
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    ABSTRACT: This research examines how marital status modifies the relationship between functional limitations and two aspects of psychological distress—depression and anger. Analyses of a multiwave national probability survey show that marriage weakens the relationship between functional limitations and depression, but this moderation is specific to older men. Functional limitations are not significantly related to anger once time-stable confounds are comprehensively controlled, and this association does not differ by marital status. This research shows that marriage may benefit mental health by preventing the deleterious effects of chronic stressors, but marital status intersects with additional social statuses and a life course context in creating these modifying effects. In addition, research that does not consider both internalizing and externalizing mental health outcomes and comprehensively take time-stable confounds into account may present an incomplete depiction of the mental health consequences of stress and social arrangements.
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