Future Directions for the Demography of Aging Proceedings of a Workshop (2018) / Chapter Skim
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3 Socioeconomic Status, Health, and Mortality in Aging Populations - Angela M. O'Rand and Scott M. Lynch
3 Socioeconomic Status, Health, and Mortality in Aging Populations - Angela M. O'Rand and Scott M. Lynch
Pages 67-96
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From page 67... ...
By then, the associations between socioeconomic status (SES) and health and mortality were widely reported, although the measurement of these phenomena was not firmly established nor were the causal relationships between them.
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From page 68... ...
with health behaviors and cardiovascular risk. Education's apparent effects were widely attributed to cognitive skills and greater access to information.
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From page 69... ...
for four different educational attainment groups (<12 years of schooling, 12 years, 13–15 years, 16+ years) and by sex and racial/ethnic group (non-Hispanic Whites and non-Hispanic Blacks; hereafter, just "Whites" and "Blacks")
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From page 70... ...
In all cases, there is a clear education gradient in mortality, with persons with a college degree or more (educational attainment ≥ 16 years) evidencing the lowest mortality rates and persons with less than a high school diploma (educational attainment < 12 years)
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From page 71... ...
FIGURE 3-2 Log mortality probabilities by age and period for non-Hispanic White and non-Hispanic Black males. pronounced for Whites than for Blacks, and this is especially so for females.
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From page 72... ...
Persons with educational attainment of a college degree or more have the best health, whereas those with less than a high school diploma have the worst health. Unlike the results from the mortality models, the models for health reveal a clear difference in health for persons with a high school diploma compared to those with some college for all subgroups, with the exception of Black males, ages 65–74, in the earliest period (1986–1995)
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From page 73... ...
That is, while health continues to decline across age for persons with higher levels of schooling, the health decline for persons with low levels of schooling begins to level off at ages beyond midlife, leading toward convergence in health across education groups in later life. The underlying cause of the levelingoff of health for the least educated could be selective survival of the most robust members of the least-educated population, or it could be that health ratings are increasingly made in reference to one's peers at older ages; both arguments have been made in the literature.
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From page 74... ...
Additionally, health for Whites is better than health for Blacks, with the exception that health for Blacks with less than a high school diploma is often better than health for Whites at the same level of schooling. Finally, health appears to have been fairly stable across the three periods within educational attainment groups, in some case even evidencing a slight decline.
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From page 75... ...
. The second line of multidisciplinary convergence is that the differential accumulation of exposures to lower SES and to related successive health risks over time produces differential trajectories of health across adulthood.
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From page 76... ...
And, with the exceptions of automobile accidents, sudden heart attacks, and other health shocks, biological processes dominate social processes and everyone's health eventually declines prior to death. Furthermore, social policies such as Medicare may equalize access to health care, effectively slowing health decline for older persons of lower SES (House et al., 1994)
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From page 77... ...
Research over the last two decades, however, has shown that, although early-life socioeconomic conditions affect later-life health, early-life health also affects cognitive development, thereby playing a major role in influencing educational attainment and therefore occupational status and earnings (Case et al., 2002)
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From page 78... ...
. Random effects methods are commonly used in research outside of economics, in part because of the requirement that variables must be time varying in fixed effects models.
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From page 79... ...
For example, although Mirowsky and Ross (2003) made a strong case for measuring educational attainment as years of schooling, for use in health disparities research, because education's primary effect is via cognitive development, Lynch (2006)
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From page 80... ...
Thus, a study examining "the causal effect" of a policy change affecting educational attainment (for example) on one health outcome may reach a very different conclusion from one investigating a different health outcome, especially if such studies involve different birth cohorts.
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From page 81... ...
2. SES differentials vary for different health outcomes (e.g., on aver age, cardiovascular disease is more influenced by SES than is hypertension)
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From page 82... ...
. Cumulative life stresses associated with lower SES and poverty have been a major focus in the demography of aging research that emphasizes the biology of disadvantage.
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From page 83... ...
. Health behaviors (summarized below)
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From page 84... ...
. Lower SES in childhood, lower education, and lower income in adulthood are associated with high BMI, insulin resistance and diabetes, and death related to these causes (Wolfe et al., 2012)
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From page 85... ...
. This approach has since been applied in other studies reporting findings that suggest that polygenic scores predict adult achievement beyond educational attainment (Belsky et al., 2016)
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From page 86... ...
. Because these health behaviors appear to be most strongly associated with preventable or more socially graded diseases such as cardiovascular disease, educational attainment is the widely advocated explanation for these findings because it is a marker of better access to knowledge, more effective problem solving, and greater self-control, among other cognitive and noncognitive (or personality)
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From page 87... ...
Fewer still have linked them to physiological processes that influence health and life expectancy. One recent study draws on four national surveys (Add Health, the National Health and Nutrition Examination Survey, the Midlife in the United States study, and the National Social Life, Health, and Aging Project)
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From page 88... ...
. The relationship between SES and cognitive development and abilities, through its associations with educational attainment and later adult achievement, is also well established.
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From page 89... ...
have improved over time, probably in part as a result of increases in educational attainment in the population generally, educational differentials in SRH persist. The precise mechanisms by which this is occurring remain puzzles.
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From page 90... ...
In the case of epidemiological and clinical data, the addition of demographically rich data is essential to assist in dealing with selectivity bias. For example, both the critical period and sensitive period hypotheses examined in these studies, which are often tested on limited samples, are difficult to assess empirically in the general population due to limited information on later-life outcomes in clinical studies.
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From page 91... ...
. The genetics of success: How single nucleotide polymorphisms as sociated with educational attainment relate to life-course development.
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From page 92... ...
. Socioeconomic status and health in childhood: The origins of the gradient.
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From page 93... ...
. Trends and group differences in the association between educational attainment and U.S.
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From page 94... ...
. Contextualizing the social deter minants of health: Disparities in disability by educational attainment across U.S.
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From page 95... ...
. GWAS of 126,599 individuals identifies genetic variants associated with educational attainment.
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