Socioeconomic Differences in Adult Mortality and Health Status

Citation: Preston, Samuel H., Taubman Socioeconomic Differences in Adult Mortality and Health Status. Demography of Aging (RSS)
Internet Archive Scholar (search for fulltext): Socioeconomic Differences in Adult Mortality and Health Status
Tagged: uw-madison (RSS), wisconsin (RSS), sociology (RSS), demography (RSS), prelim (RSS), qual (RSS), WisconsinDemographyPrelimAugust2009 (RSS)

Summary

This chapter reviews recent evidence (from the 1970s and 1980s) using data from the National Health and Nutrition Examination Survey (NHANES), which includes the National Health Epidemiologic Follow-up Survey (NHEFS), and the National Longitudinal Mortality Study (NLMS), about the extent and sources of socioeconomic differences in mortality and health among older persons in the United States, with some reference to other countries. Mortality rates and the prevalence of ill health are higher among groups of lower social standing (measured by income, occupation, and educational attainment) in all contemporary Western countries, including the United States. In most countries where evidence is available, social disparities in mortality have widened during the past 2 decades, although inconsistencies among data sources in the United States make this conclusion uncertain. Heart disease is the principal cause of death responsible for social class differences in mortality from all causes combined. The principal approaches used to identify the sources of theses differences are economic and social-psychological. The former focuses on choice under constraints including the relationships between income/wage/education, prices, levels of medical knowledge and technique, personal endowments, environmental factors, and tastes on health. Social-psychological approaches focus on predispositions of unknown origin, stressors, and coping mechanisms. While evidence has been found for both socioeconomic and social-psychological factors, in neither case are individuals' personal histories well integrated into the analytic apparatus, which seems essential for a full appreciation of the sources of health differentials at any moment in time. A blending of the approaches would be more useful. Poverty and low status exact a health toll not only through absolute deprivation of material resources but also through interpersonal stresses and impaired relationships, some of which may reflect relative deprivation as much as absolute deprivation. These influences cumulate over a lifetime. Efforts to ascribe class differences in mortality or health status to various intervening biomedical variables such as smoking or elevated blood pressure have not been entirely successful. Although some reduction in class differences typically results from controlling these variables, the bulk of the differences remains. Whether this result reflects a deficiency in the array of variables considered, the activity of unidentified factors, or important cognitive, affective, and motivational elements, is not clear. In contrast, the bulk of black-white differences in mortality and health status are explicable in terms of the unequal distribution of the groups on variables such as education and income.