Health inequalities in later life: material or psychosocial pathways Anne McMunn & James Nazroo UCL

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?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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