Inequalities in health

Although it is now well established that socioeconomic inequalities in health and mortality prevail into very old age, the patterns and etiologies of these health inequalities are still largely unexplored. In recent studies based on population data from Sweden and Finland, we have shown that education is significantly associated with physical and cognitive functioning as well as with rheumatoid arthritis. Individuals with lower education are more likely to have all of these conditions than individuals with a higher education1,2. Health inequalities during old age are likely shaped by lifelong processes. Thus, in order to understand these inequalities, it is necessary to apply a life-course perspective. Using datasets comprising longitudinal survey and registry data, we have explored the association between socioeconomic conditions during different stages of the life course and mortality. The results showed that social class in childhood and adulthood were both independently associated with premature mortality (i.e., before the age of 70)3. Similarly, income in midlife and income during retirement were both independently associated with mortality during retirement4. The mechanisms generating late-life health inequalities are opaque. However, in a new study we have shown that socioeconomic differences in smoking and obesity could partly explain the socioeconomic inequalities in mobility and cognitive impairments observed among elderly Swedes5. Yet another study found that older individuals with higher education were more likely to participate in health-enhancing exercise than individuals with lower education6.

  1. Kåreholt I.  Age and sex differences in the relation between education and physical and cognitive functioning among men and women aged 76 years and older. Int J Behav Med 2012; 19(S1):224.
  2. Wallin K, Solomon S, Kåreholt I, Tuomilehto J, Soininen H, Kivipelto M. Midlife rheumatoid arthritis increases the risk of cognitive impairment two decades later: a population-based study. Alzheimers Dis 2012; 31(3):669-676.
  3. Fors S, Lennartsson C, Lundberg O. Live long and prosper? Childhood living conditions, marital status, social class in adulthood and mortality during mid-life: a cohort study. Scand J Public Health 2011; 39(2):179-186.
  4. Fors S, Modin B, Koupil I, Vågerö D. Socioeconomic inequalities in circulatory and all-cause mortality after retirement – the impact of mid-life income and old age pension: evidence from the Uppsala Birth Cohort Study. J Epidemiol Community Health 2011; 66(7):e16.
  5. Fors S, Agahi N, Shaw BA. Paying the price? The impact of smoking and obesity on health inequalities in later life. Scand J Public Healt 2013; 41(2):134-141.
  6. Rydwik E, Welmer AK, Kåreholt I, Angleman S, Fratiglioni L, Wang HX. Adherence to physical exercise recommendations in people over 65 – The SNAC-Kungsholmen study. Eur J Public Health [In press: online] 2012. Available from: doi: 10.1093/eurpub/cks150.