Socioeconomic inequalities in health after age 50: are health risk behaviors to blame?

Soc Sci Med. 2014 Jan:101:52-60. doi: 10.1016/j.socscimed.2013.10.040. Epub 2013 Nov 16.


Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N = 19,245), this study examined the degree to which four behavioral risk factors - smoking, obesity, physical inactivity, and heavy drinking - are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998 to 2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23 and 45% of the mortality disparities among men and middle aged women, but only about 5% of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33% of the disparities in disability onset found among women survivors, and about 9-14% among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities.

Keywords: Aging; Disability; Mortality; Obesity; Smoking; physical activity; socioeconomic status.

MeSH terms

  • Age Distribution
  • Aged
  • Alcoholism / epidemiology*
  • Disabled Persons / statistics & numerical data
  • Female
  • Health Behavior*
  • Health Status Disparities*
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Obesity / epidemiology*
  • Risk-Taking*
  • Sedentary Behavior*
  • Sex Distribution
  • Smoking / epidemiology*
  • Socioeconomic Factors
  • United States / epidemiology