1. Health inequalities in later life: material or psychosocial pathways Anne McMunn & James Nazroo UCL www.ucl.ac.uk/epidemiology

2. Health inequalities in later life Health inequalities research historically based on working age men. Recent work into later life shows mixed results – Do health inequalities weaken with age? Moving from documenting inequalities to considering causal pathways: the psychosocial v. material debate. Research questions: 1. Do class inequalities persist post retirement? 2. If so, do they appear to operate via material or psychosocial pathways or both?

3. The English Longitudinal Study of Ageing (ELSA) A panel study of 11,500 people aged 50 and older, drawn from the Health Survey for England and interviewed every two years (since 2002). Health trajectories, disability and healthy life expectancy The relationship between economic position and health The determinants of economic position in later life Timing of retirement and post retirement labour market activity Social participation, productivity, networks and support Economic, social and health inequalities www.ifs.org.uk/elsa

4. Sample & Dependent Variables ELSA sample members, non-proxy interviews, post state retirement age (Men aged 65+, Women aged 60+). Health outcomes: Poor self-reported health (fair or poor, American version) Reported difficulty with one of more Activity of Daily Living. Mean walking speed – Respondents aged 60+ timed over standardised walk (8’ long). Best of two. Valid sample for self-report measures: N=6,295 One or more valid measure of walking speed, less than 30 seconds: N=5,288

5. Independent Variables and Analytic Technique Independent variables: Class: NS-SEC based on own, main occupation. Material circumstances: Household wealth (inc. housing & financial wealth, but not pension wealth), + income. Subjective social status. Roles: Working status – In paid employment post-SRA (Y/N) Marital status – Married/remarried, divorced/separated, widowed, never married Caring – Non-carers, caring for partner, parent/in-law, child, grandchild, other Volunteering – last month Organisational membership Regression

6. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

7. The unadjusted odds of reporting poor health by occupational class post-retirement age Overall p < 0.001

8. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

9. The odds of reporting poor health by occupational class post-retirement age ADJUSTED FOR WEALTH & INCOME Overall p < 0.001

10. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

11. The odds of reporting poor health by occupational class post-retirement age ADJUSTED FOR PERCEIVED SOCIAL STATUS Overall p < 0.001

12. The model: Class inequalities in health in later life – material or psychosocial pathways? Material circumstances ClassSubjective statusHealth Role occupation

13. The odds of reporting poor health by occupational class post-retirement age ADJUSTED FOR ROLE OCCUPATION Overall p < 0.001

14. The FULLY-ADJUSTED odds of reporting poor health by occupational class post-retirement age Overall p = 0.004

15. Unadjusted odds of reporting difficulty with 1+ ADL by occupational class post-retirement age Overall p < 0.001

16. Fully adjusted odds of reporting difficulty with 1+ ADL by occupational class post-retirement age Overall p = 0.1

17. Unadjusted walking speed (difference in seconds) by occupational class post-retirement age Overall p < 0.001

18. FULLY ADJUSTED walking speed (difference in seconds) by occupational class post-retirement age Overall p < 0.001

19. Conclusions Class inequalities in health persist post-retirement. Class relationship with health largely attenuated by material and psychosocial factors. Neither material, nor psychosocial attenuate independently – only combined effects fully attenuate. Path analysis currently underway. Limitations: Cross-sectional data – we have imposed a theoretical direction. Cohort / period issues