Elsevier

Social Science & Medicine

Volume 62, Issue 8, April 2006, Pages 2046-2060
Social Science & Medicine

A comparative appraisal of the relationship of education, income and housing tenure with less than good health among the elderly in Europe

https://doi.org/10.1016/j.socscimed.2005.09.001Get rights and content

Abstract

The objective of this study was to determine the strength of various socio-economic indicators for predicting less than good health among elderly people aged 60–79 years. Data were obtained from national health surveys from 10 European countries. Education, income and housing tenure were examined in relation to less than good health using standardised prevalence rates and (multiple) logistic regression analyses. The results illustrated that there are substantial health differences among the elderly according to education and income in each country. Both education and income (with men) showed a strong independent relationship with health status. Health differences according to housing tenure were generally somewhat smaller. However, in Great Britain and the Netherlands housing tenure demonstrated large health differences, even after adjustment for education and income. It is recommended that more refined socio-economic measures are developed and that in the meantime both education and income are used when studying socio-economic health differences among the elderly. In some countries, like Great Britain and the Netherlands, however, housing tenure has an additional value.

Introduction

After more than 20 years since the release of the Black Report (Townsend & Davidson, 1988) it is well established that people of lower socio-economic groups have worse health compared to that of higher groups. The focus in this research field has primarily been on the middle aged. The last decade however, the attention has shifted more towards the elderly. Most studies on socio-economic health differences among the elderly have mainly centred on mortality (for example: Amaducci et al., 1998; Breeze, Sloggett, & Fletcher, 1999a; Marmot & Shipley, 1996; Martelin, 1994; Rossum, Mheen, Mackenbach, & Grobbee, 2000), however, the number of studies examining morbidity is increasing (Arber & Ginn, 1993; Breeze et al., 2001; Breeze, Sloggett, & Fletcher, 1999b; Dahl & Birkelund, 1997; Groenou & Deeg, 2000; Grundy & Holt, 2000; House, Kessler, & Herzog, 1990; Liao, McGee, Kaufman, Cao, & Cooper, 1999; Rahkonen & Takala, 1998). Research to date has generally concluded that socio-economic differences persist into the latest stages of life.

Because research in the field of socio-economic health differences among the elderly is relatively new, the concepts and methods are still under development (Bowling, 2004). For descriptive research, an important issue is the measurement of socio-economic status among elderly populations. We will describe below some of the theoretical and practical issues related to socio-economic measures among the elderly.

Section snippets

Theoretical considerations

A basic concept for description is that of social stratification, i.e. the ordering of people from ‘high’ to ‘low’ according to the access to scarce resources (Grusky, 1994). This place in the social hierarchy is called socio-economic position. This differs from the concept ‘social class’, referring to social groups arising from interdependent economic relationships among people (Krieger, 2001). Several socio-economic variables determine the place of persons in the social hierarchy, that is

Practical issues

While there is much experience with the use of the three classic socio-economic indicators (education, income and occupation) among middle-aged men and women, their application is more complicated when used to describe health inequalities among the elderly.

The use of education as socio-economic indicator among the elderly, especially women, is problematic as a high proportion of older men and women belong to the lower education level, because of lack of education opportunities in childhood.

This study

The objective of this study was to determine the power of different socio-economic indicators in predicting less than good health among the elderly. This study utilised survey data from ten European countries, thereby making it possible to study country-specific and geographical patterns. Using data for both men and women made it also possible to detect sex-specific patterns. This is of significance since there are a priori reasons to expect gender differences, such as women having had less

Data source

Data were obtained from national representative health surveys, level of living surveys or similar national surveys from 10 European countries.

Table 1 gives an overview of the characteristics of the survey in our study. All surveys included in this study contained data from the 1990s. The number of respondents aged between 60 and 79 years varied largely and lay between about 900 (in Denmark) to about 10 500 (in Italy). The non-response rate varied also largely between the surveys. It ranged from

Population distribution across socio-economic groups

Table 2 shows the population distribution across the education levels. In general the percentage of elderly persons among the highest education groups was smaller than the percentage among the lower groups. This is especially true for southern European countries. For example, the percentage of women among the lowest education level in Spain was 40.8%. The percentage of Spanish women among the highest education level on the other hand was 3.3%. Also, the percentage of women among the higher

Summary of the results

Substantial socio-economic differences in self-assessed health were found using education and income as socio-economic indicators among both elderly men and women in all European countries. Socio-economic differences according to housing tenure were usually less pronounced.

Education (among both men and women) and income (mainly among men) had a large independent effect on self-reported health. After adjusting for the other socio-economic indicators, large socio-economic differences were still

Conclusion

When studying socio-economic health differences among the elderly, both education and income can be used to describe the magnitude and pattern of these differences. Given the independent effect of each of these indicators, a combined use of both education and income is preferable. Housing tenure seems to be less useful for describing health inequalities among the elderly. In some countries however, particularly Great Britain and the Netherlands housing tenure may have an additional value for

Acknowledgements

Members of the EU Working Group on Socioeconomic Inequalities in Health who contributed to this paper: C. Borrell, Agencia de Salut Publica de Barcelona; E. Breeze, Department of Epidemiology and Public Health, University College London; E. Cambois, Institut National d’Etudes Démographiques (Ined), Paris; G. Costa, Department of Public Health and Microbiology, University of Turin; E. Dahl, Faculty of Economics Public Administration and Social Work, Oslo University College; J.J.M. Geurts,

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