title: Surprising SES Gradients in mortality, health, and biomarkers in a Latin American population of adults.
abstract: BACKGROUND
  To determine socioeconomic status (SES) gradients in the different dimensions of health among elderly Costa Ricans.
  
  
  OBJECTIVE
  SES disparities in adult health are minimal in Costa Rican society.
  
  
  METHODS
  Data from the Costa Rican Study on Longevity and Healthy Aging study: 8,000 elderly Costa Ricans to determine mortality in the period 2000-2007 and a subsample of 3,000 to determine prevalence of several health conditions and biomarkers from anthropometry and blood and urine specimens.
  
  
  RESULTS
  The ultimate health indicator, mortality, as well as the metabolic syndrome, reveals that better educated and wealthier individuals are worse off. In contrast, quality of life-related measures such as functional and cognitive disabilities, physical frailty, and depression all clearly worsen with lower SES. Overall self-reported health (SRH) also shows a strong positive SES gradient. Traditional cardiovascular risk factors such as diabetes and cholesterol are not significantly related to SES, but hypertension and obesity are worse among high-SES individuals. Reflecting mixed SES gradients in behaviors, smoking and lack of exercise are more common among low SES, but high calorie diets are more common among high SES.
  
  
  CONCLUSIONS
  Negative modern behaviors among high-SES groups may be reversing cardiovascular risks across SES groups, hence reversing mortality risks. But negative SES gradients in healthy years of life persist.
authors.affiliation: Central American Population Center and Institute for Health Research, University of Costa Rica, San Pedro, San José, Costa Rica. lrosero@ccp.ucr.ac.cr
authors.forename: Luis
authors.initials: L
authors.lastname: Rosero-Bixby
authors.forename: William H
authors.initials: WH
authors.lastname: Dow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality*; D002784:Cholesterol / Q000097:blood; D003364:Costa Rica; D003431:Cross-Cultural Comparison; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000401:mortality; D004185:Disability Evaluation; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006305:Health Status Indicators; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000208:ethnology / Q000401:mortality; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology / Q000401:mortality; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014280:Triglycerides / Q000097:blood; D049629:Waist-Hip Ratio
chemical_list: D015415:Biomarkers; D014280:Triglycerides; D002784:Cholesterol