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Blood on the tracks: Life-course perspectives on health inequalities in later life
Stockholm University, Faculty of Social Sciences, Department of Social Work.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to explore social inequalities in: a) mortality during mid-life, b) health in later life, and c) old-age mortality, from a life-course perspective. The studies are based on longitudinal Swedish survey and registry data.

The results from Study I showed substantial inequalities in health, based on social class and gender, among older adults (aged 55+). Moreover, the magnitude of these inequalities did not change during the period 1991-2002.

The results from Study II revealed social inequalities in cognitive functioning among the oldest old (aged 77+). Social turbulence and social class during childhood, education and social class in adulthood were all independently associated with level of cognitive functioning in later life.

In Study III, social inequalities in mortality during mid-life (i.e., between ages 25 and 69) were explored. The results showed that childhood living conditions were associated with marital status and social class in adulthood and that, in turn, these conditions were associated with mid-life mortality. Thus, the results suggested that childhood disadvantage may serve as a stepping stone to a hazardous life-course trajectory.

Study IV explored the association between income in mid-life, income during retirement and old-age mortality (i.e., mortality during retirement). The results showed that both income during mid-life and income during retirement were associated with old-age mortality. Mutually adjusted models showed that income in mid-life was more important for women’s mortality and that income during retirement was more important for men’s.

Thus, the results of the present thesis suggest that there are substantial social inequalities in the likelihood of reaching old age, as well as in health and mortality among older adults. These inequalities are shaped by differential exposures throughout the life-course that affect health in later life both through direct effects and through processes of accumulation.

Place, publisher, year, edition, pages
Stockholm: Department of Social Work, Stockholm University , 2010. , 67 p.
Series
Stockholm studies in social work, ISSN 0281-2851 ; 27
Keyword [en]
Sweden, life-course, health, socioeconomic, childhood
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-38848ISBN: 978-91-7447-062-8 (print)OAI: oai:DiVA.org:su-38848DiVA: diva2:316273
Public defence
2010-06-14, Aula Svea, Socialhögskolan, Sveaplan, Stockholm, 13:00 (Swedish)
Opponent
Supervisors
Note
At the time of the doctoral defense, the following papers were unpublished  and had a status as follows: Paper 3: Manuscript. Paper 4: Manuscript.Available from: 2010-05-22 Created: 2010-04-30 Last updated: 2012-03-07Bibliographically approved
List of papers
1. Health inequalities among older adults in Sweden 1991–2002
Open this publication in new window or tab >>Health inequalities among older adults in Sweden 1991–2002
2008 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 18, no 2, 138-143 p.Article in journal (Refereed) Published
Abstract [en]

Current research has shown a decline in health amongolder adults in Sweden. This study examines health inequalitiesamong older adults in Sweden in 1991–1992 and 2000–2002and explores the development of these inequalities during thisperiod.

Methods: A data set was constructed out of four levelsof living surveys, comprising 4085 individuals aged 55 and above.Multivariate logistic regressions were used to assess the associationbetween social class, sex, age and four different domains ofself-reported health: global self-rated health, impaired mobility,musculoskeletal pain and psychological distress. Adjustmentswere made for period of interview. Interaction terms were alsoused to assess change over time. Levin's attributable risk wasused to assess the magnitude of the health inequalities.

Results:The results indicate an increase in reports of all specifichealth problems, but not in the global health measure duringthe period. Significant sex differences and a clear social gradientin health were discernible during both periods. Women were morelikely than men to report problems with impaired mobility, painand psychological distress. Manual workers were significantlymore likely than non-manuals to report problems in all fourdomains of health. However, both the sex differences and thesocial gradient seemed to remain constant during the period.

Conclusion: Although it seems there are significant differencesin health depending on sex and social class among older adultsin Sweden, these inequalities appear to be unaffected by thegeneral increase in ill health that has been observed in thesegroups over the last decade.

Keyword
health inequalities, health trends, older adults, sweden
National Category
Social Work
Identifiers
urn:nbn:se:su:diva-9390 (URN)10.1093/eurpub/ckm097 (DOI)000254007400010 ()
Available from: 2008-03-14 Created: 2008-03-14 Last updated: 2017-12-13Bibliographically approved
2. Childhood Living Conditions, Socioeconomic Position in Adulthood, and Cognition in Later Life: Exploring the Associations
Open this publication in new window or tab >>Childhood Living Conditions, Socioeconomic Position in Adulthood, and Cognition in Later Life: Exploring the Associations
2009 (English)In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 64, no 6, 750-757 p.Article in journal (Refereed) Published
Abstract [en]

Objectives This study examined the association between childhood living conditions, socioeconomic position in adulthood, and cognition in later life. Two questions were addressed: Is there an association between childhood living conditions and late-life cognition, and if so, is the association modified or mediated by adult socioeconomic position?

Methods Nationally representative data of the Swedish population aged 77 years and older were obtained from the 1992 and 2002 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Cognition was assessed with an abbreviated version of the Mini-Mental State Examination scale. Childhood living conditions were assessed by self-reports of childhood living conditions.

Results The results showed independent associations between conflicts in the household during childhood, father's social class, education, own social class in adulthood, and cognition in later life. Exposure to conflicts during childhood, having a father classified as a manual worker, low education, and/or being classified as a manual worker in adulthood was associated with lower levels of cognition in old age. There seemed to be no modifying effect of adult socioeconomic position on the association between childhood conditions and cognition in later life.

Discussion This suggests the importance of childhood living conditions in maintaining cognitive function even in late life.

Keyword
Childhood conditions, Cognition, Life course, Old age, Socioeconomic position
Identifiers
urn:nbn:se:su:diva-27629 (URN)10.1093/geronb/gbp029 (DOI)000271718200009 ()
Available from: 2009-05-11 Created: 2009-05-11 Last updated: 2017-12-13Bibliographically approved
3. Live long and prosper? Childhood living conditions, marital status, social class in adulthood and mortality during mid-life: A cohort study
Open this publication in new window or tab >>Live long and prosper? Childhood living conditions, marital status, social class in adulthood and mortality during mid-life: A cohort study
2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, 179-186 p.Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of the present study was to investigate the impact of childhood living conditions, marital status, and social class in adulthood on the risk of mortality during mid-life. Two questions were addressed: Is there an effect of childhood living conditions on mortality risk during mid-life and if so, is the effect mediated or modified by social class and/or marital status in adulthood? Methods: A nationally representative, Swedish, level of living survey from 1968 was used as baseline. The study included those aged 25—69 at baseline (n = 4082). Social conditions in childhood and adulthood were assessed using self-reports. These individuals were then followed for 39 years using registry data on mortality. Results: The results showed associations between childhood living conditions, marital status, social class in adulthood and mortality during mid life. Social class and familial conditions during childhood as well as marital status and social class in adulthood all contributed to the risk of mortality during mid-life. Individuals whose father’s were manual workers, who grew up in broken homes, who were unmarried, and/or were manual workers in adulthood had an increased risk of mortality during mid life. The effects of childhood conditions were, in part, both mediated and modified by social class in adulthood. Conclusions: The findings of this study suggest that there are structural, social conditions experienced at different stages of the life course that affect the risk of mortality during mid-life.

Keyword
Childhood, life course, mortality, socioeconomic position, Sweden
National Category
Social Work Health Sciences
Identifiers
urn:nbn:se:su:diva-55444 (URN)10.1177/1403494810395823 (DOI)000288065000009 ()
Available from: 2011-03-15 Created: 2011-03-15 Last updated: 2017-12-11Bibliographically approved
4. Socioeconomic inequalities in circulatory and all-cause mortality after retirement: the impact of mid-life income and old-age pension. Evidence from the Uppsala Birth Cohort Study
Open this publication in new window or tab >>Socioeconomic inequalities in circulatory and all-cause mortality after retirement: the impact of mid-life income and old-age pension. Evidence from the Uppsala Birth Cohort Study
2012 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 7, e16- p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to explore the impact of mid-life income and old-age pensions on the risk of mortality in later life. Furthermore, the study explored whether income inequalities in old-age mortality can be explained by differences in early childhood development, social class during childhood, education or marital status.

Methods: The study sample comprises all individuals born at Uppsala Academic Hospital during the period 1915–1924 who had retired but not died or emigrated by 1991 (n=4156). Information on social and biological conditions was retrieved from national registries.

Results: The results show that income during mid-life and income during retirement were associated with old-age mortality. However, mutually adjusted models showed that income in mid-life was more important for women's late-life mortality and that income during retirement was more important for men's late-life mortality. Furthermore, differences in education and marital status seemed to explain a substantial part of income inequalities in late-life mortality.

Conclusions: It is unlikely that egalitarian social policies aimed at older populations can eradicate health inequalities accumulated over the life course. However, retirement income appears to have an effect on late-life mortality that is independent of the effect of income in mid-life, suggesting that egalitarian pension schemes could affect health inequalities in later life or, at the very least, slow down further accumulation of inequalities.

National Category
Social Work Health Sciences
Identifiers
urn:nbn:se:su:diva-57067 (URN)10.1136/jech.2010.131177 (DOI)000304922600004 ()
Available from: 2011-05-02 Created: 2011-05-02 Last updated: 2017-12-11Bibliographically approved

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