Socio-economic Status and Self-Rated Health Among Older Canadians

Family income and health in Canada: a longitudinal study of stability and change

BACKGROUND

Extensive research has shown strong associations between income and health. However, the health effects of income dynamics over time are less known. We investigated how stability, volatility and trajectory in family incomes from 2002 to 2011 predicted (1) fair/poor self-rated health and (2) the presence of a longstanding illness or health problem in 2012.

METHODS

The data came from the 2012 wave of the Longitudinal and International Study of Adults linked to annual family income data for 2002 to 2011 from the Canada Revenue Agency. We executed a series of binary logistic regressions to examine associations between health and average family income over the decade (Model 1), number of years in the bottom quartile (Model 2) and top quartile (Model 3) of family incomes, standard deviation of family incomes (Model 4), absolute difference between family income at the end and start of the period (Model 5), and number of years in which inflation-adjusted family income went down by more than 1% (Model 6) and up by more than 1% (Model 7) from 1 year to the next. The analyses were conducted separately for women and men.

RESULTS

Average family income over the decade was strongly associated with both self-rated health and the presence of a longstanding illness or health problem. More years spent in the bottom quartile of family incomes corresponded to elevated odds of fair/poor self-rated health and the presence of a longstanding illness or health problem. Steady decreases in family income over the decade corresponded to elevated odds of fair/poor self-rated health for men and more years spent in the top quartile of family incomes over the decade corresponded to elevated odds of fair/poor self-rated health for women.

CONCLUSION

Previous studies of the association between family income and health in Canada may have overlooked important issues pertaining to family income stability and change that are impactful for health.

Does household income mediate the association between education and health in Canada?

Objectives: The study aim was to investigate whether household income mediates the association between education and health in a nationally representative sample of Canadian adults. Methods: The data came from the Longitudinal and International Study of Adults linked to income data from the Canada Revenue Agency. Odds ratios and predicted probabilities from binary logistic regression models were used to describe associations between education and (a) self-rated health, (b) longstanding illness or health problem, (c) emotional, psychological or mental health problem and (d) symptoms of psychological distress. The Karlson-Holm-Breen decomposition method was used to investigate the potentially mediating role of household income in these associations. The analyses were conducted separately for women and men. Results: Education was significantly associated with all four health indicators for both women and men. Of the four health indicators, education was most strongly associated with self-rated health for both women and men. Education was more strongly associated with self-rated health and the presence of an emotional, psychological or mental health problem for women than for men. Curiously, men with a postgraduate degree were significantly more likely than men with a bachelor degree to report symptoms of psychological distress. Only modest proportions of the associations between education and health could be attributed to differences in household income. Education and household income manifested independent associations with all four health indicators among women and with three of four health indicators among men. Conclusions: Education and household income are joint and independent predictors of health in Canada. Accordingly, both should be included in research on socioeconomic health inequalities in this context.

Family income and self-rated health in Canada: Using fixed effects models to control for unobserved confounders and investigate causal temporality

The objective of this study was to investigate whether the association between family income and adult self-rated health in Canada is causal in nature. The data came from the 2012, 2014 and 2016 waves of the Longitudinal and International Study of Adults linked to current and historical family income data from the Canada Revenue Agency. We used fixed effects models to describe associations between changes in self-rated health between 2012, 2014 and 2016 and changes in equivalized family income between (i) 2011, 2013 and 2015, (ii) 2008, 2009 and 2010, (iii) 2005, 2006 and 2007, (iv) 2002, 2003 and 2004 and (v) 1999, 2000 and 2001. We identified weak negative associations between family income and self-rated health operative over fourteen years or so for both women and men. These associations may be causal in nature. In addition, the implementation of models where changes in income preceded changes in self-rated health suggests that the associations reflect the causal effect of family income on self-rated health rather than the converse. These results make a contribution to the Canadian literature where nearly all previous research on associations between income and self-rated health is cross-sectional in nature and therefore incapable of establishing causal directionality.

An analysis of depressive symptoms in stroke survivors: verification of a moderating effect of demographic characteristics

BACKGROUND

The rehabilitation of depressed stroke patients is more difficult because poststroke depression is associated with disruption of daily activities, functioning, and quality of life. However, research on depression in stroke patients is limited. The aim of our study was to evaluate the interaction of demographic characteristics including gender, age, education level, the presence of a spouse, and income status on depressive symptoms in stroke patients and to identify groups that may need more attention with respect to depressive symptoms.

METHODS

We completed a secondary data analysis using data from a completed cross-sectional study of people with stroke. Depression was measured using the Center for Epidemiologic Studies Depression Scale.

RESULTS

In this study, depressive symptoms in women living with a spouse were less severe than among those without a spouse. For those with insufficient income, depressive symptom scores were higher in the above high school group than in the below high school group, but were lower in patients who were living with a spouse than in those living without a spouse.

CONCLUSION

Assessing depressive symptoms after stroke should consider the interaction of gender, economic status, education level, and the presence/absence of a spouse. These results would help in comprehensive understanding of the importance of screening for and treating depressive symptoms during rehabilitation after stroke.

Socioeconomic Status, Health Behaviors, Obesity and Self-Rated Health among Older Arabs in Israel

Socioeconomic inequalities in health are well documented. Recently, researchers have shown interest in exploring the mechanisms by which measures of SES operate through it to impact SRH, such as material, psychosocial and behavioral factors. To examine the relationships between SES indicators and self-rated health (SRH); and to determine whether health behaviors and obesity mediate the association between SES indicators and SRH. A secondary analysis of data previously collected through the third survey of socioeconomic and health status of the Arab population in Israel, in which the SRH of 878 Arab-Israelis age 50 or older were analyzed using logistic regression. The results showed that higher education level and current employment in old age are associated with better SRH. However, neither subjective economic status nor family income was associated with SRH. Greater physical activity was found to be related to good\very good SRH, while obesity was associated with less than good SRH. Finally, health behaviors (physical activity) and obesity were revealed as mediators between SES indicators (education and employment status) and SRH. The results highlight the importance of high education level and employment status in old age to reduce health inequalities. The findings also show that the relationship between SES and SRH can operate through behavioral mechanisms (i.e., physical activity) and their consequences (i.e., obesity), that can, however, be changed in old age.

Social determinants of health for older women in Canada: does rural-urban residency matter?

This study provided an exploratory analysis of key social determinants of health for older Canadian women, with a focus on differences between rural and urban residency, given that socio-economic status (SES) and social capital have been shown to differ by rural-urban residence. Secondary analysis was conducted using the 2000/2001 Canadian Community Health Survey. A comparative logistic regression analysis revealed, unexpectedly, that SES and social capital variables were more strongly associated with the health status of urban older women than for the health status of their rural counterparts. Associations between health status measures and household income, food insecurity, and community belonging were largely not supported among rural women, but were for their urban counterparts. Findings are discussed concerning applications of the social-determinants-of-health model for explaining health patterns among older urban and rural women. Cost of living, access to health services, and dimensions of rural culture are discussed as potential explanations.

Contextual Effects on Life Satisfaction of Older Men and Women

Des différences existent entre les sexes dans les variables liées à la démographie, à la santé et aux réseaux sociaux, variables qui sont associés à un vieillissement réussi, mais on n'en trouve généralement pas en ce qui concerne la satisfaction face à la vie. La présente étude avait pour but premier de déterminer s'il y a des différences entre les hommes et les femmes par rapport à leur satisfaction dans des domaines particuliers et en général à l'égard de la vie. Ont également été examinées les différences dans la satisfaction face au parcours de la vie entre les hommes et les femmes. Dans un deuxième temps, nous avons procédé à une analyse de l'ensemble de données recueillies dans l'étudeVieillir dans la communauté(Béland et al., 1989) afin d'évaluer le bien-être des adultes francophones plus âgés (N=958). Des analyses acheminatoires ont révélé une bonne concordance des modèles utilisés pour les échantillons masculins et féminins. Chez les hommes, la satisfaction face à la vie s'explique positivement selon l'âge, le revenu et le contrôle et négativement selon les erreurs de mémoire, la maladie et les limitations fonctionnelles. Chez les femmes, la satisfaction face à la vie s'explique selon l'âge, la scolarité, le revenu, la maladie, les limitations fonctionnelles, le soutien social, le contrô le et le mode de vie. Les résultats ont fait ressortir les aspects positifs et négatifs du soutien social pour les femmes. Tel que nous nous y attendions, les modèles de parcours ont indiqué que, même s'il existe des similitudes dans la satisfaction face au parcours de la vie chez les hommes et chez les femmes plus âgés, on retrouve également des différences importantes.

Perceived income adequacy among older adults in 12 countries: findings from the survey of health, ageing, and retirement in Europe

PURPOSE

To validate a survey research measure of subjective income, as measured by perceived income adequacy, in an international context.

DESIGN AND METHODS

The study population comprised persons aged 50 years and older in 12 countries from the Survey of Health, Ageing and Retirement in Europe (n = 28,939). Perceived difficulty in making ends meet was regressed on sociodemographic variables, economic indicators, health status measures, and expectations regarding one's financial future. Country differences were also controlled.

RESULTS

The findings confirm a multidimensional explanation of perceived income adequacy but also point to the primacy of objective economic indicators in predicting household financial distress. Respondents aged 80 years and older report less financial difficulty. Poor health status and pessimistic financial expectations also predict greater household financial distress but to a lesser degree.

IMPLICATIONS

Self-rated economic status is a robust indicator of financial capacity in older age and can be used by practitioners to gain meaningful information. However, practitioners should keep in mind that the oldest-old may underestimate financial difficulties.

Personality, aging self-perceptions, and subjective health: a mediation model

Since the global item of subjective health has emerged as a strong predictor of important health outcomes such as mortality, there have been many attempts to uncover its correlates. In this study, we tested whether personality as assessed via the five-factor model of personality predicted subjective health when physician-rated health and depression were controlled for. We analyzed a cohort of 362 German community-dwelling 60-year-olds from the first wave of the ongoing Interdisciplinary Longitudinal Study on Aging. We found that neuroticism, but none of the other four personality factors, predicted subjective health. However, the association between neuroticism and subjective health was mediated by aging self-stereotypes (attitudes toward oneself as an aging person), which in recent studies have been shown to influence older individuals' health behaviors and functional health. The results indicate that those high in neuroticism tend to have more negative aging self-stereotypes; these aging self-stereotypes, in turn, seem to affect how those individuals globally perceive their own health. Unlike many predictors of subjective health, such as age, gender, socio-cultural differences, actual health, or personality traits, negative attitudes about one's own aging may be modified through adequate intervention.

Social networks and self-rated health: a cross-cultural examination among older Israelis

OBJECTIVE

This article examines the relationship of social network and self-rated health among different cultural groups.

METHODS

This study examined associations between network structure, interaction, support and social engagement and self-rated health, controlling for sociodemographic background and psychobiological pathways among veteran Jewish-Israelis (n = 2,043), Arab-Israelis (n = 609), and new immigrants from the former Soviet Union (n = 751). Hierarchical multiple regression analysis was performed.

RESULTS

Three different patterns emerged. The association of social network and self-rated health among the majority veteran Jewish culture in Israel was similar to that found in Western societies. Among Arab-Israelis, self-rated health was explained by more traditional, familial, and communal network dynamics. The characteristic association between social network and self-rated health among the new immigrants was explained by migration-induced factors.

DISCUSSION

The findings demonstrate that social networks impact health differently in different cultural groups and under conditions of social change, such as migration in later-life.

Personality is associated with perceived health and functional status in older primary care patients

Using data collected on 265 primary care medical patients 60 years of age and older, the authors examined the personality bases of subjective health (perceived health, functional status) after controlling for observer-rated depression and medical burden. Four hypotheses were tested: High Neuroticism is associated with poorer perceived health, low Extraversion is associated with poorer perceived health, low Openness to Experience is associated with worse functional status, and age moderates the relationships between personality and subjective health. Findings supported the notion that personality is associated with subjective health; moreover, this effect appeared to grow more pronounced with increasing age. This study underscores the conceptual and heuristic value of examining moderators of the links between personality variables and health.