The impact of socioeconomic status on the association between biomedical and psychosocial well-being and all-cause mortality in older Spanish adults

Soc Psychiatry Psychiatr Epidemiol. 2018 Mar;53(3):259-268. doi: 10.1007/s00127-018-1480-7. Epub 2018 Jan 10.


Purpose: The aim of this paper was to analyze the effect of biomedical and psychosocial well-being, based on distinct successful aging models (SA), on time to mortality, and determine whether this effect was modified by socioeconomic status (SES) in a nationally representative sample of older Spanish adults.

Methods: Data were taken from a 3-year follow-up study with 2783 participants aged 50 or over. Vital status was ascertained using national registers or asking participants' relatives. Kaplan-Meier curves were used to estimate the time to death by SES, and levels of biomedical and psychosocial SA. Cox proportional hazard regression models were conducted to explore interactions between SES and SA models while adjusting for gender, age, and marital status.

Results: Lower levels of SES and biomedical and psychosocial SA were associated with low probability of survival. Only the interaction between SES and biomedical SA was significant. Biomedical SA impacted on mortality rates among individuals with low SES but not on those with medium or high SES, whereas psychosocial SA affected mortality regardless of SES.

Conclusions: Promoting equal access to health care system and improved psychosocial well-being could be a protective factor against premature mortality in older Spanish adults with low SES.

Keywords: Biomedical well-being; Psychosocial well-being; Socioeconomic status; Spain; Successful aging; Survival analysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cause of Death*
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Mortality, Premature*
  • Proportional Hazards Models
  • Regression Analysis
  • Social Class*
  • Spain