title: Socioeconomic inequalities in health after age 50: are health risk behaviors to blame?
abstract: Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N = 19,245), this study examined the degree to which four behavioral risk factors - smoking, obesity, physical inactivity, and heavy drinking - are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998 to 2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23 and 45% of the mortality disparities among men and middle aged women, but only about 5% of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33% of the disparities in disability onset found among women survivors, and about 9-14% among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities.
authors.affiliation: School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA. Electronic address: bashaw@albany.edu.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Shaw
authors.affiliation: School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA. Electronic address: kmcgeever@albany.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: McGeever
authors.affiliation: School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA. Electronic address: egrubert@albany.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Vasquez
authors.affiliation: Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden. Electronic address: Neda.Agahi@ki.se.
authors.forename: Neda
authors.initials: N
authors.lastname: Agahi
authors.affiliation: Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden. Electronic address: Stefan.Fors@ki.se.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fors
mesh_terms: D017677:Age Distribution; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009765:Obesity / Q000453:epidemiology*; D012309:Risk-Taking; D057185:Sedentary Behavior; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Aging; Disability; Mortality; Obesity; Smoking; physical activity; socioeconomic status