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Health inequalities in later life: material or psychosocial pathways

Health inequalities in later life: material or psychosocial pathways. Anne McMunn & James Nazroo UCL www.ucl.ac.uk/epidemiology. Health inequalities in later life. Health inequalities research historically based on working age men.

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Health inequalities in later life: material or psychosocial pathways

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  1. Health inequalities in later life: material or psychosocial pathways Anne McMunn & James Nazroo UCL www.ucl.ac.uk/epidemiology

  2. Health inequalities in later life • Health inequalities research historically based on working age men. • Recent work into later life shows mixed results – Do health inequalities weaken with age? • Moving from documenting inequalities to considering causal pathways: the psychosocial v. material debate. • Research questions: • Do class inequalities persist post retirement? • If so, do they appear to operate via material or psychosocial pathways or both?

  3. The English Longitudinal Study of Ageing (ELSA) • A panel study of 11,500 people aged 50 and older, drawn from the Health Survey for England and interviewed every two years (since 2002). • Health trajectories, disability and healthy life expectancy • The relationship between economic position and health • The determinants of economic position in later life • Timing of retirement and post retirement labour market activity • Social participation, productivity, networks and support • Economic, social and health inequalities www.ifs.org.uk/elsa

  4. Sample & Dependent Variables • ELSA sample members, non-proxy interviews, post state retirement age (Men aged 65+, Women aged 60+). • Health outcomes: • Poor self-reported health (fair or poor, American version) • Reported difficulty with one of more Activity of Daily Living. • Mean walking speed – Respondents aged 60+ timed over standardised walk (8’ long). Best of two. • Valid sample for self-report measures: N=6,295 • One or more valid measure of walking speed, less than 30 seconds: N=5,288

  5. Independent Variables and Analytic Technique • Independent variables: • Class: NS-SEC based on own, main occupation. • Material circumstances: Household wealth (inc. housing & financial wealth, but not pension wealth), + income. • Subjective social status. • Roles: • Working status – In paid employment post-SRA (Y/N) • Marital status – Married/remarried, divorced/separated, widowed, never married • Caring – Non-carers, caring for partner, parent/in-law, child, grandchild, other • Volunteering – last month • Organisational membership • Regression

  6. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

  7. The unadjusted odds of reporting poor health by occupational class post-retirement age Overall p < 0.001

  8. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

  9. The odds of reporting poor health by occupational class post-retirement age ADJUSTED FOR WEALTH & INCOME Overall p < 0.001

  10. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

  11. The odds of reporting poor health by occupational class post-retirement age ADJUSTED FOR PERCEIVED SOCIAL STATUS Overall p < 0.001

  12. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

  13. The odds of reporting poor health by occupational class post-retirement age ADJUSTED FOR ROLE OCCUPATION Overall p < 0.001

  14. The FULLY-ADJUSTED odds of reporting poor health by occupational class post-retirement age Overall p = 0.004

  15. Unadjusted odds of reporting difficulty with 1+ ADL by occupational class post-retirement age Overall p < 0.001

  16. Fully adjusted odds of reporting difficulty with 1+ ADL by occupational class post-retirement age Overall p = 0.1

  17. Unadjusted walking speed (difference in seconds) by occupational class post-retirement age Overall p < 0.001

  18. FULLY ADJUSTED walking speed (difference in seconds) by occupational class post-retirement age Overall p < 0.001

  19. Conclusions • Class inequalities in health persist post-retirement. • Class relationship with health largely attenuated by material and psychosocial factors. • Neither material, nor psychosocial attenuate independently – only combined effects fully attenuate. • Path analysis currently underway. • Limitations: • Cross-sectional data – we have imposed a theoretical direction. • Cohort / period issues

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