Evolution of the income-related gap in health with old age: evidence from 20 countries in European and Chinese panel datasets.

IF 3.7 2区 社会学 Q1 GERONTOLOGY
Mengling Cheng, Nicolas Sommet, Daniela S Jopp, Dario Spini
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Abstract

Some studies show that the protective effect of higher income on health weakens with old age (age-as-leveller pattern), whereas others show that it strengthens with old age (cumulative advantage/disadvantage pattern). Many existing studies are limited in that they use single-country and/or single-timepoint designs. To overcome these limitations and better understand how the income-health gradient evolves in older age, we used cross-national and longitudinal data of the Survey of Health, Ageing and Retirement in Europe (2004-2019, N = 73,407) and the China Health and Retirement Longitudinal Study (2011-2018, N = 10,067). We operationalised health using multimorbidity and three alternative indicators (functional disability, mobility disability, and memory). We performed Poisson growth curve modelling to capture the between-participant effects of age and the within-participant effects of aging. We obtained three consistent and robust findings for Europe (patterns were observed in most countries) and China. First, the protective effect of higher income on multimorbidity, functional disability, and mobility disability was weaker for older than for younger adults (between-participant age-as-leveller pattern). Second, only the protective effect of higher income on mobility disability weakened over the later life course (within-participant age-as-leveller pattern). Third, the protective effect of higher income on memory was stronger for older than for younger adults and strengthened over the later life course (between-participant and within-participant cumulative advantage/disadvantage pattern). Longitudinal data, growth curve modelling distinguishing the between-participant from within-participant effect, and adjustments for potential confounders based on the hypothesised causal structure enabled us to better navigate the landscape of causal inference. Findings suggest that the income-related gap in physical health but not in cognitive health narrows in old age for both Europe and China.

Abstract Image

老年健康方面收入相关差距的演变:来自欧洲和中国20个国家面板数据集的证据
一些研究表明,高收入对健康的保护作用随着年龄的增长而减弱(年龄平衡模式),而另一些研究表明,高收入对健康的保护作用随着年龄的增长而增强(累积优势/劣势模式)。许多现有研究的局限性在于它们使用单一国家和/或单一时间点设计。为了克服这些局限性,更好地了解老年人收入健康梯度的演变,我们使用了欧洲健康、老龄化和退休调查(2004-2019年,N = 73,407)和中国健康与退休纵向研究(2011-2018年,N = 10,067)的跨国和纵向数据。我们使用多病和三个替代指标(功能性残疾、行动能力残疾和记忆)对健康进行了操作。我们进行了泊松生长曲线建模,以捕捉年龄的参与者之间效应和年龄的参与者内部效应。我们在欧洲(大多数国家都观察到这种模式)和中国获得了三个一致而有力的发现。首先,高收入对多病、功能性残疾和行动障碍的保护作用在老年人中弱于年轻人(参与者年龄-平衡模式)。其次,只有高收入对行动障碍的保护作用在晚年过程中减弱(在参与者年龄作为均衡器模式内)。第三,高收入对记忆的保护作用在老年人中强于年轻人,并在以后的生活过程中增强(参与者之间和参与者内部的累积优势/劣势模式)。纵向数据、区分参与者间效应和参与者内效应的增长曲线模型,以及基于假设因果结构对潜在混杂因素的调整,使我们能够更好地驾驭因果推理的图景。研究结果表明,欧洲和中国老年人在身体健康(而非认知健康)方面的收入相关差距在缩小。
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来源期刊
CiteScore
6.50
自引率
7.90%
发文量
72
期刊介绍: The European Journal of Ageing: Social, Behavioural and Health Perspectives is an interdisciplinary journal devoted to the understanding of ageing in European societies and the world over. EJA publishes original articles on the social, behavioral and population health aspects of ageing and encourages an integrated approach between these aspects. Emphasis is put on publishing empirical research (including meta-analyses), but conceptual papers (including narrative reviews) and methodological contributions will also be considered. EJA welcomes expert opinions on critical issues in ageing. By stimulating communication between researchers and those using research findings, it aims to contribute to the formulation of better policies and the development of better practice in serving older adults. To further specify, with the term ''social'' is meant the full scope of social science of ageing related research from the micro to the macro level of analysis. With the term ''behavioural'' the full scope of psychological ageing research including life span approaches based on a range of age groups from young to old is envisaged. The term ''population health-related'' denotes social-epidemiological and public health oriented research including research on functional health in the widest possible sense.
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