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Salinas-Rodríguez A, Rojas-Botero ML, Rivera-Almaraz A, Fernández-Niño JA, Montañez-Hernández JC, Manrique-Espinoza B. Long-term inequalities in health among older Mexican adults: An outcome-wide analysis. SSM Popul Health 2024; 26:101684. [PMID: 38881818 PMCID: PMC11179325 DOI: 10.1016/j.ssmph.2024.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/22/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
The relationship between socioeconomic level and health outcomes in older people has been widely studied, but less information about health inequalities associated with gender and place of residence exists. Also, there is scarce evidence of longitudinal inequalities, particularly in countries from the global south. This study aimed to describe the longitudinal patterns of health inequalities associated with wealth, gender, and residence area among older Mexican adults. We used data from two longitudinal studies in Mexico: The Study on Global AGEing and Adult Health (SAGE) and the Mexican Health and Aging Study (MHAS). Three domains to characterize health inequities were used: wealth, gender, and rurality. We conducted an outcome-wide analysis with nine health indicators assessing older adults' physical and cognitive function. The Slope Index of Inequality and the Relative Index of Inequality were used as inequality measurements. Our results indicate that the greatest inequalities are observed in relation to wealth and gender. Older adults with lower socioeconomic status demonstrated higher rates of depression, sarcopenia, falls, and limitations in both basic and instrumental activities of daily living compared to their wealthier counterparts, with increasing trends in physical functionality over time. Furthermore, women experienced higher rates of depression, sarcopenia, frailty, and physical limitations compared to men. The only significant difference related to rurality was a lower rate of frailty among rural older adults. Longitudinal trajectories revealed an increase in the gap of inequality for various health indicators, especially in terms of wealth and gender. Health inequalities in old age are one of the greatest challenges facing health systems globally. Actions like universal coverage of health services for older people and the empowerment of individuals and their communities to have control over their lives and circumstances must be guaranteed.
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Affiliation(s)
- Aarón Salinas-Rodríguez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Ana Rivera-Almaraz
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | - Betty Manrique-Espinoza
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Pfund GN, Willroth EC, Mroczek DK, Hill PL. Valuing versus having: The contrary roles of valuing and having money and prestige on well-being. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2024; 15:275-287. [PMID: 38435845 PMCID: PMC10904030 DOI: 10.1177/19485506231166048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Using data from Midlife in the United States (N=3,767), this study investigates how believing having money or occupational prestige is important for a good life is associated with different aspects of well-being. Actual income was positively associated with sense of purpose, personal growth, self-acceptance, environmental mastery, and life satisfaction, negatively associated with negative affect, and was not associated with autonomy, positive relations with others, or positive affect. Meanwhile, perceiving having enough money or extra money as important for a good life predicted poorer well-being across all nine well-being indicators. Occupational prestige was positively associated with sense of purpose, autonomy, personal growth, self-acceptance, environmental mastery, and life satisfaction, while perceiving having occupational prestige as important was negatively associated with autonomy, personal growth, self-acceptance, positive relations with others, and positively with negative affect. The discussion focuses on how desiring money or prestige can influence well-being beyond having-or not having-those desires.
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Affiliation(s)
- Gabrielle N. Pfund
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis; MO, USA
| | - Emily C. Willroth
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; Chicago, IL, USA
| | - Daniel K. Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; Chicago, IL, USA
| | - Patrick L. Hill
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis; MO, USA
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Zhao M, Huang CC, Mendoza M, Tovar X, Lecca L, Murray M. Subjective socioeconomic status: an alternative to objective socioeconomic status. BMC Med Res Methodol 2023; 23:73. [PMID: 36977997 PMCID: PMC10044732 DOI: 10.1186/s12874-023-01890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Subjective "ladder" measurements of socio-economic status (SES) are easy-to-administer tools that ask respondents to rate their own SES, allowing them to evaluate their own material resources and determine where it places them relative to their community. Here, we sought to compare the MacArthur Scale of Subjective Social status to the WAMI, an objective measure of SES that includes data on water and sanitation, asset ownership, education, and income. METHODS Leveraging a study of 595 tuberculosis patients in Lima, Peru, we compared the MacArthur ladder score to the WAMI score using weighted Kappa scores and Spearman's rank correlation coefficient. We identified outliers that fell outside the 95th percentile and assessed the durability of the inconsistencies between scores by re-testing a subset of participants. We then used Akaike information criterion (AIC) to compare the predictability of logistic regression models evaluating the association between the two SES scoring systems and history of asthma. RESULTS The correlation coefficient between the MacArthur ladder and WAMI scores was 0.37 and the weighted Kappa was 0.26. The correlation coefficients differed by less than 0.04 and the Kappa ranged from 0.26 to 0.34, indicating fair agreement. When we replaced the initial MacArthur ladder scores with retest scores, the number of individuals with disagreements between the two scores decreased from 21 to 10 and the correlation coefficient and weighted Kappa both increased by at least 0.03. Lastly, we found that when we categorized WAMI and MacArthur ladder scores into three groups, both had a linear trend association with history of asthma with effect sizes and AICs that differed by less than 15% and 2 points, respectively. CONCLUSION Our findings demonstrated fair agreement between the MacArthur ladder and WAMI scores. The agreement between the two SES measurements increased when they were further categorized into 3-5 categories, the form in which SES is often used in epidemiologic studies. The MacArthur score also performed similarly to WAMI in predicting a socio-economically sensitive health outcome. Researchers should consider subjective SES tools as an alternative method for measuring SES, particularly in large health studies where data collection is a burden.
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Affiliation(s)
- Maryann Zhao
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
| | - Chuan-Chin Huang
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | | | - Ximena Tovar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
| | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Socios En Salud, Lima, 15001, Peru
| | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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Schuch HS, Peres KG, Haag DG, Boing AF, Peres MA. The independent and joint contribution of objective and subjective socioeconomic status on oral health indicators. Community Dent Oral Epidemiol 2022; 50:570-578. [PMID: 34882815 DOI: 10.1111/cdoe.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The understanding of how subjective socioeconomic status (SSS) relates to objective socioeconomic status (OSS), and how both conditions act together in oral health outcomes is still unclear. This study aims to test the independent and joint association between OSS and SSS with oral health, to assess the role of socioeconomic status discrepancies, and to evaluate the role of SSS in the association between OSS and oral health. METHODS Data from 1140 adults from a population-based study in Southern Brazil were used. We applied diagonal reference models DRM to disentangle the effects of OSS (education) and SSS (MacArthur Scale) to oral health outcomes. The outcomes were functional dentition clinically evaluated (FD ≥20 teeth) and self-reported oral health SROH. We also examined the discrepancy between OSS and SSS to oral health indicators and the effect measure modification (EMM) of SSS on the association between OSS and oral health. RESULTS Subjective socioeconomic status and OSS contributed equally to SROH, while OSS explained a substantially higher amount of FD than SSS (0.85 vs 0.15). An EMM of SSS was found on the association between OSS and fair/poor SROH, with a relative excess risk due to interaction (RERI) of 1.08. Less evidence of EMM was found for FD (RERI = 0.14). Individuals with lower SSS and OSS had four times the risk of the outcomes than the reference group. CONCLUSIONS Adults with concordant lower SSS and OSS have a worse oral health than those with concordant higher status. There was evidence that the association between OSS and SROH is modified by SSS.
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Affiliation(s)
- Helena S Schuch
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Karen G Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore.,Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Dandara G Haag
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Antonio F Boing
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore.,Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
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Varghese JS, Hall RW, Adair LS, Patel SA, Martorell R, Belleza DE, Kroker-Lobos MF, Lee NR, Nyati LH, Ramirez-Zea M, Richter LM, Stein AD. Subjective social status is associated with happiness but not weight status or psychological distress: An analysis of three prospective birth cohorts from low- and middle-income countries. WELLBEING, SPACE AND SOCIETY 2022; 3:None. [PMID: 36518911 PMCID: PMC9732742 DOI: 10.1016/j.wss.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Subjective social status (SSS, perception of social position relative to a frame of reference) has been associated with physical, mental and socio-emotional wellbeing. However, these associations may be susceptible to unmeasured confounding by life course objective socio-economic position (SEP; such as wealth, education and employment) and life satisfaction. PURPOSE To estimate the association of position on ladders of perceived community respect and perceived economic status with weight, distress and wellbeing, independent of objective SEP in cohorts from three low and middle-income countries. METHODS We used data from birth cohorts in Guatemala (n = 1258), Philippines (n = 1323) and South Africa (n = 1393). We estimated the association of perceived community respect and perceived economic status with body mass index (kg/m2), the World Health Organization's Self-Reported Questionnaire-20 (SRQ-20) for psychological distress, and Lyubomirsky's Subjective Happiness Scale. We estimated these associations using robust linear regression models adjusting for indicators of life course objective SEP, early life characteristics, adult covariates, and life satisfaction. RESULTS Participants in South Africa (age 27-28y) rated themselves higher on average for both the respect (7 vs 5 in Guatemala and 6 in Philippines) and economic (5 vs 3 in Guatemala and 4 in Philippines) ladder measures. Position on neither community respect nor economic ladders were associated with BMI or psychological distress. Higher position on community respect (Guatemala: 0.03, 95%CI: 0.01, 0.04; Philippines: 0.03, 95% CI: 0.02, 0.05; South Africa: 0.07, 95%CI: 0.04, 0.09) and economic (Guatemala: 0.02, 95%CI: 0, 0.04; Philippines: 0.04, 95%CI: 0.02, 0.07; South Africa: 0.07, 95%CI: 0.04, 0.10) ladders were associated with greater happiness. CONCLUSIONS Subjective social status showed small but consistent associations with happiness in birth cohorts independent of life-course SEP.
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel Waford Hall
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Delia E. Belleza
- Department of Psychology, University of San Carlos, Cebu City, Philippines
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
| | - Lukhanyo H. Nyati
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh D. Stein
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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