title: Material vs. psychosocial explanations of old-age educational differences in physical and mental functioning.
abstract: BACKGROUND
  Taking into account our rapidly ageing population, older people are of particular interest in studying health inequalities. The aim of the present study is to examine the relation between socio-economic status and health-related functioning in older people and to find out how material factors (e.g. the lack of basic goods) and psychosocial factors (e.g. low self-efficacy) compare regarding the explanation of these socio-economic differences.
  
  
  METHODS
  Data came from 5061 Dutch men and women aged ≥ 55 years who participated in the longitudinal Study on Medical Information and Lifestyles Eindhoven (SMILE) study. Baseline data were collected between November 2002 and May 2004 and respondents were followed until May 2009 (follow-up range: 0-5 years). Multilevel analyses were used to study the association between educational level and longitudinal changes in physical and mental functioning (i.e. two subscales of the SF-36) and to study the relative contribution of material and psychosocial factors to this relation.
  
  
  RESULTS
  Low educational level was associated with poor initial physical and mental functioning. However, no further widening of these gradients was found during follow-up. Material factors reduced the initial educational differences by an average of 29%, whereas psychosocial factors, mastery and self-efficacy in particular, reduced these differences by an average of 60%.
  
  
  CONCLUSIONS
  More than material factors, psychosocial factors, mastery and self-efficacy in particular, explained a large part of the educational differences in physical and mental functioning in older people. Further research is recommended to explore the amenability to change of characteristics that hamper people from taking control over their lives.
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands. D.Groffen@maastrichtuniversity.nl
authors.forename: Daniëlle A I
authors.initials: DA
authors.lastname: Groffen
authors.forename: Hans
authors.initials: H
authors.lastname: Bosma
authors.forename: Frans E S
authors.initials: FE
authors.lastname: Tan
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.forename: Jacques Th M
authors.initials: JT
authors.lastname: van Eijk
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands; D020377:Self Efficacy; D012923:Social Class; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires