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Comparing socio-economic inequalities in healthy ageing in the United States of America, England, China and Japan: evidence from four longitudinal studies of ageing

Published online by Cambridge University Press:  09 December 2019

Wentian Lu Open the ORCID record for Wentian Lu [Opens in a new window] ,
Hynek Pikhart  and
Amanda Sacker
Wentian Lu*
Affiliation:
Research Department of Epidemiology and Public Health, University College London, London, UK
Hynek Pikhart
Affiliation:
Research Department of Epidemiology and Public Health, University College London, London, UK
Amanda Sacker
Affiliation:
Research Department of Epidemiology and Public Health, University College London, London, UK
*
*Corresponding author. Email: wentian.lu.14@ucl.ac.uk
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Abstract

Healthy ageing has become a popular topic worldwide. So far, a consensus measure of healthy ageing has not been reached; and no studies have compared the magnitude of socio-economic inequality in healthy ageing outside Europe. This study aims to create a universal measure of healthy ageing and compare socio-economic inequalities in healthy ageing in the United States of America (USA), England, China and Japan. We included 10,305 American, 6,590 English, 5,930 Chinese and 1,935 Japanese participants for longitudinal analysis. A harmonised healthy ageing index (HAI) was developed to measure healthy ageing multi-dimensionally. Educational, income and wealth rank scores were derived accounting for the entire socio-economic distribution and the sample size of each category of socio-economic indicator. Associations between socio-economic rank scores and HAIs were assessed using multi-level modelling to calculate the Slope Indices of Inequality. Healthy ageing trajectories were predicted based on the full-adjusted age-cohort models. We found that education was a universally influential socio-economic predictor of healthy ageing. Moving from the highest to the lowest educational groups was associated with a 6.7 (5.2–8.2), 8.2 (6.0–10.4), 13.9 (11.4–16.3) and 6.1 per cent (3.9–8.2%) decrease in average HAI at 60 years in the USA, England, China and Japan, respectively. After 60 years, the educational inequality in healthy ageing kept increasing in the USA and China. The educational inequality in healthy ageing in China was also greater than any other socio-economic inequality in the four countries. Wealth was more influential in predicting healthy ageing inequality among American, English and Japanese participants, while income was more influential among Chinese participants. The socio-economic inequality in healthy ageing in Japan was relatively small. Chinese and American participants had worse healthy ageing profiles than Japanese and English participants.

Keywords

USAEnglandChinaJapanhealthy ageingsocio-economic inequality

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Type
Article
Information
Ageing & Society , Volume 41 , Issue 7 , July 2021 , pp. 1495 - 1520
Copyright
Copyright © Cambridge University Press 2019

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References

Baltes, PB and Baltes, MM (1990) Pyschological perspectives on successful aging: the model of selective optimization with compensation. In Baltes, PB and Baltes, MM (eds), Successful Aging: Perspectives from the Behavioral Sciences. New York, NY: Press Syndicate of the University of Cambridge, pp. 1–27.CrossRefGoogle Scholar
Bartley, M (2004) Measuring socio-economic position. In Health Inequality: An Introduction to Theories, Concepts and Methods. Cambridge: Polity Press, pp. 22–34.Google Scholar
Benedict, ME and Shaw, K (1995) The impact of pension benefits on the distribution of earned income. Industrial and Labor Relations Review 48, 740–757.CrossRefGoogle Scholar
Bezruchka, S, Namekata, T and Sistrom, MG (2008) Interplay of politics and law to promote health: improving economic equality and health: the case of postwar Japan. American Journal of Public Health 98, 589–594.CrossRefGoogle ScholarPubMed
Bosworth, B, Burtless, G and Zhang, K (2016) Later retirement, inequality in old age, and the growing gap in longevity between rich and poor . Economic Studies 28.Google Scholar
Cesari, M, Araujo de Carvalho, I, Amuthavalli Thiyagarajan, J, Cooper, C, Martin, FC, Reginster, JY, Vellas, B and Beard, JR (2018) Evidence for the domains supporting the construct of intrinsic capacity. Journals of Gerontology: Biological Sciences and Medical Sciences 73A, 1653–1660.CrossRefGoogle Scholar
Commonwealth Fund (2016) In New Survey of 11 Countries, U.S. Adults Still Struggle with Access to and Affordability of Health Care. Available at http://www.commonwealthfund.org/publications/in-the-literature/2016/nov/2016-international-health-policy-survey-of-adults.Google Scholar
Delgado-Rodríguez, M and Llorca, J (2004) Bias. Journal of Epidemiology and Community Health 58, 635–641.CrossRefGoogle ScholarPubMed
Fang, P, Dong, S, Xiao, J, Liu, C, Feng, X and Wang, Y (2010) Regional inequality in health and its determinants: evidence from China. Health Policy 94, 14–25.CrossRefGoogle ScholarPubMed
Fried, LP, Tangen, CM, Walston, J, Newman, AB, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, WJ, Burke, G, McBurnie, MA and Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: evidence for a phenotype. Journals of Gerontology: Biological Sciences and Medical Sciences 56A, M146–M156.CrossRefGoogle Scholar
Fujino, Y, Tamakoshi, A, Iso, H, Inaba, Y, Kubo, T, Ide, R, Ikeda, A and Yoshimura, T (2005) A nationwide cohort study of educational background and major causes of death among the elderly population in Japan. Preventive Medicine 40, 444–451.CrossRefGoogle ScholarPubMed
Fukuda, Y, Nakao, H, Yahata, Y and Imai, H (2007) Are health inequalities increasing in Japan? The trends of 1955 to 2000. BioScience Trends 1, 38–42.Google ScholarPubMed
GBD Mortality Collaborators (2018) Global, regional, and national age–sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1684–1735.CrossRefGoogle Scholar
Grundy, E and Holt, G (2001) The socioeconomic status of older adults: how should we measure it in studies of health inequalities? Journal of Epidemiology and Community Health 55, 895–904.CrossRefGoogle ScholarPubMed
Hallqvist, J, Lynch, J, Bartley, M, Lang, T and Blane, D (2004) Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program. Social Science & Medicine 58, 1555–1562.CrossRefGoogle ScholarPubMed
Hanmer, MJ and Kalkan, KO (2013) Behind the curve: clarifying the best approach to calculating predicted probabilities and marginal effects from limited dependent variable models. American Journal of Political Science 57, 263–277.CrossRefGoogle Scholar
Hidehiko, I, Satoshi, S and Hideki, H (2010) Japanese Study of Aging and Retirement: JSTAR First Results 2009 Report. Tokyo: Research Institute of Economy, Trade and Industry.Google Scholar
Hirai, H, Kondo, K and Kawachi, I (2012) Social determinants of active aging: differences in mortality and the loss of healthy life between different income levels among older Japanese in the AGES cohort study. Current Gerontology and Geriatrics Research 2012, article no. 701583.CrossRefGoogle ScholarPubMed
Hodes, RJ, Insel, TR, Landis, SC and NIH Blueprint for Neuroscience Research (2013) The NIH toolbox: setting a standard for biomedical research. Neurology 80, supplement 3, S1.CrossRefGoogle ScholarPubMed
Hoffmann, R (2011) Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA. Social Science & Medicine 72, 1986–1992.CrossRefGoogle ScholarPubMed
Hollingshead, AB (2011) Four Factor Index of Social Status. Yale Journal of Sociology 21–51.Google Scholar
Hummer, RA and Hernandez, EM (2013) The effect of educational attainment on adult mortality in the United States. Population Bulletin 68, 1–16.Google ScholarPubMed
International Labour Office (2015) People's Republic of China: universal pension coverage. In Ortiz, L (ed.), Geneva: International Labour Organization, pp. 1–4.Google Scholar
Krieger, N and Fee, E (1994) Social class: the missing link in U.S. health data. International Journal of Health Services 24, 25–44.CrossRefGoogle ScholarPubMed
Kuh, D, Richards, M, Cooper, R, Hardy, R and Ben-Shlomo, Y (2014) The life course perspective on healthy ageing. In Kuh, D, Cooper, R, Hardy, R, Richards, M and Ben-Shlomo, Y (eds), A Life Course Approach to Healthy Ageing. New York, NY: Oxford University Press, pp. 3–15.Google ScholarPubMed
Kunst, AE, Bos, V and Mackenbach, JP (2011) Monitoring Socio-economic Inequalities in Health in the European Union: Guidelines and Illustrations. Rotterdam, The Netherlands: Department of Public Health.Google Scholar
Lara, J, Godfrey, A, Evans, E, Heaven, B, Brown, LJ, Barron, E, Rochester, L, Meyer, TD and Mathers, JC (2013) Towards measurement of the Healthy Ageing Phenotype in lifestyle-based intervention studies. Maturitas 76, 189–199.CrossRefGoogle ScholarPubMed
Li, C, Wu, W, Jin, H, Zhang, X, Xue, H, He, Y, Xiao, S, Jeste, DV and Zhang, M (2006) Successful aging in Shanghai, China: definition, distribution and related factors. International Psychogeriatrics 18, 551–563.CrossRefGoogle ScholarPubMed
Li, L, Liu, J, Xu, H and Zhang, Z (2015 a) Understanding rural–urban differences in depressive symptoms among older adults in China. Journal of Aging and Health 28, 341–362.CrossRefGoogle ScholarPubMed
Li, L, Liu, J, Zhang, Z and Xu, H (2015b) Late-life depression in rural China: do village infrastructure and availability of community resources matter? International Journal of Geriatric Psychiatry 30, 729–736.CrossRefGoogle Scholar
Lu, W, Pikhart, H and Sacker, A (2019) Domains and measurements of healthy aging in epidemiological studies: a review. The Gerontologist 59, e294–e310.CrossRefGoogle ScholarPubMed
Mackenbach, JP, Stirbu, I, Roskam, AJ, Schaap, MM, Menvielle, G, Leinsalu, M, Kunst, AE and European Union Working Group on Socioeconomic Inequalities in Health (2008) Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine 358, 2468–2481.CrossRefGoogle ScholarPubMed
Makaroun, LK, Brown, RT, Diaz-Ramirez, L ,Ahalt, C, Boscardin, WJ, Lang-Brown, S and Lee, S (2017) Wealth-associated disparities in death and disability in the United States and England. JAMA Internal Medicine 177, 1745–1753.CrossRefGoogle ScholarPubMed
Marmot, M (2005) Social determinants of health inequalities. Lancet 365, 1099–1104.CrossRefGoogle ScholarPubMed
McDowell, I (2006) The quality of a measurement: validity and reliability. In Measuring Health: A Guide to Rating Scales and Questionnaires. New York, NY: Oxford University Press, pp. 30–54.CrossRefGoogle Scholar
McLaughlin, SJ, Connell, CM, Heeringa, SG, Li, LW and Roberts, JS (2010) Successful aging in the United States: prevalence estimates from a national sample of older adults. Journals of Gerontology: Psychological Sciences and Social Sciences 65B, 216–226.CrossRefGoogle ScholarPubMed
National Bureau of Statistics of China (2016) China Statistical Yearbook. Beijing: China Statistics Press.Google Scholar
National Health Service (2018) About the NHS. Available at http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx.Google Scholar
Nielsen, B and Nielsen, JP (2014) Identification and forecasting in mortality models. Scientific World Journal 2014, 347043.CrossRefGoogle ScholarPubMed
Organisation for Economic Co-operation Development (OECD) (1995) What Are Equivalence Scales? Available at https://www.oecd.org/eco/growth/OECD-Note-EquivalenceScales.pdf.Google Scholar
Organisation for Economic Co-operation Development (OECD) (1998) Work-force ageing in OECD countries. In Employment Outlook. Paris: OECD Publishing, pp. 123–151.Google Scholar
Organisation for Economic Co-operation Development (OECD) (2015) Health Spending. Available at https://data.oecd.org/healthres/health-spending.htm.Google Scholar
Perales, J, Martin, S, Ayuso-Mateos, JL, Chatterji, S, Garin, N, Koskinen, S, Leonardi, M, Miret, M, Moneta, V, Olaya, B, Tobiasz-Adamczyk, B and Haro, JM (2014) Factors associated with active aging in Finland, Poland, and Spain. International Psychogeriatrics 26, 1363–1375.CrossRefGoogle ScholarPubMed
Raudenbush, SW and Chan, W-S (1992) Growth curve analysis in accelerated longitudinal designs. Journal of Research in Crime and Delinquency 29, 387–411.CrossRefGoogle Scholar
Regidor, E (2004) Measures of health inequalities: part 2. Journal of Epidemiology and Community Health 58, 900–903.CrossRefGoogle ScholarPubMed
Reich, MR and Shibuya, K (2015) The future of Japan's health system – sustaining good health with equity at low cost. New England Journal of Medicine 373, 1793–1797.CrossRefGoogle ScholarPubMed
Rong, XL and Shi, T (2001) Inequality in Chinese education. Journal of Contemporary China 10, 107–124.CrossRefGoogle Scholar
Rowe, JW and Kahn, RL (2015) Successful Aging 2.0: conceptual expansions for the 21st century. Journals of Gerontology: Psychological Sciences and Social Sciences 70B, 593–596.CrossRefGoogle Scholar
Schweiger, M (1997) Questioning the solution: the politics of primary health care and child survival. BMJ 315, 555.CrossRefGoogle Scholar
Sefton, T, Evandrou, M and Falkingham, J (2007) Mapping the incomes of older people in the UK, US and Germany. Centre for Research on Ageing, University of Southamption, Southampton, UK, Discussion Paper 0704.Google Scholar
Sonnega, A, Faul, JD, Ofstedal, MB, Langa, KM, Phillips, JWR and Weir, DR (2014) Cohort profile: the Health and Retirement Study (HRS). International Journal of Epidemiology 43, 576–585.CrossRefGoogle Scholar
Sowa, A, Tobiasz-Adamczyk, B, Topor-Madry, R, Poscia, A and la Milia, DI (2016) Predictors of healthy ageing: public health policy targets. BMC Health Services Ressearch 16, supplement 5, 289.CrossRefGoogle ScholarPubMed
Stanziano, DC, Whitehurst, M, Graham, P and Roos, BA (2010) A review of selected longitudinal studies on aging: past findings and future directions. Journal of American Geriatrics Society 58, supplement 2, S292–S297.CrossRefGoogle ScholarPubMed
Steptoe, A, Breeze, E, Banks, J and Nazroo, J (2013) Cohort profile: the English Longitudinal Study of Ageing. International Journal of Epidemiology 42, 1640–1648.CrossRefGoogle ScholarPubMed
UNESCO Institute for Statistics (2014) ISCED Mappings. Available at https://data.worldbank.org/indicator/SP.POP.DPND.OL?locations=CN-JP-GB-US.Google Scholar
Vogel, EF (1979) Politics: higher interests and fair shares. In Japan as Number One: Lessons for America. Cambridge, MA: Harvard University Press, pp. 97–130.CrossRefGoogle Scholar
Wang, H and Yu, Y (2016) Increasing health inequality in China: an empirical study with ordinal data. Journal of Economic Inequality 14, 41–61.CrossRefGoogle Scholar
Wang, Y, Wang, J, Maitland, E, Zhao, Y, Nicholas, S and Lu, M (2012) Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China. BMC Health Services Research 12, 302.CrossRefGoogle ScholarPubMed
Welch, C, Bartlett, J and Petersen, I (2014) Application of multiple imputation using the two-fold fully conditional specification algorithm in longitudinal clinical data. Stata Journal 14, 418–431.CrossRefGoogle ScholarPubMed
World Bank (2018) Age dependency ratio, old (% of working-age population). https://data.worldbank.org/indicator/SP.POP.DPND.OL.Google Scholar
World Economic Forum (2016) China's Working-age Population Will Fall 23% by 2050. Available at https://www.weforum.org/agenda/2016/07/china-working-ageing-population/.Google Scholar
World Health Organization (WHO) (2002) Active Ageing: A Policy Framework. Geneva: WHO.Google Scholar
World Health Organization (WHO) (2011) Global health and ageing. In National Institute on Aging, National Institutes of Health. https://www.who.int/ageing/publications/global_health.pdf?ua=1.Google Scholar
World Health Organization (WHO) (2015) World Report on Ageing and Health. Geneva: WHO.Google Scholar
Zhao, Y, Hu, Y, Smith, JP, Strauss, J and Yang, G (2014) Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). International Journal of Epidemiology 43, 61–68.CrossRefGoogle Scholar
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