Mortality differentials among Israeli men

Marital Status, Living Arrangements and Mortality at Older Ages in Chile, 2004-2016

The risk of mortality in old age is associated with marital status and living arrangements. There is still little knowledge about this in Latin America. Our objectives are to examine the association between marital status, living arrangements and mortality of older adults (>60 years) in Chile, and to test whether this association varies when demographic, socioeconomic and health factors are included. We used data from the Social Protection Survey, and mortality data were linked to the Civil Registry. We estimate a series of Poisson regression models. Our results show a clear association between marriage and longevity, since even controlling for demographic, socioeconomic and health factors, we found that separated or divorced, widowed, and unmarried people showed higher relative mortality compared to married people (IRR1.24, IRR1.33, IRR1.35, respectively). Considering only living arrangements, the results show that living alone, alone with children, with children and other relatives or in other arrangements is associated with higher mortality (IRR1.22, IRR1.27, IRR1.35, IRR1.35, respectively) compared to those living with their partners and children. However, considering marital status and living arrangements together, we find that survival among older adults was strongly associated with marital status. Marital status continues to be a direct measure of living arrangements among older adults in Chile.

Employment in old age and all-cause mortality: A systematic review

Social participation promotes and maintains the health of older adults. Working is a type of social participation; however, the effect of employment in old age on health outcomes has not been established. This study aimed to review the relationship between employment in old age (≥60 years) and all-cause mortality. For this systematic review, a computerized search was performed using PubMed, CINAHL and PsycINFO for prospective studies published through June 2020. The observational studies were extracted according to the study participants, indicators, follow-up period, statistical approach and main results. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Of the 37 832 records identified, 14 studies were included in the systematic review based on the inclusion and exclusion criteria. Eight studies were derived from Asian countries (four from Japan, two from Taiwan and one from Thailand and South Korea), three were from the United States, two were from Israel and one was from Brazil. The baseline data of 13 studies were collected before 2000. Thirteen of the 14 studies reported any association between employment in later life and a lower risk of mortality. Four studies examined the sex-related differences in the effect of later-life employment on all-cause mortality, but the association was controversial. Overall, we revealed that working in old age would lower mortality risk. Although more findings based on recent data are required, this study indicates that working later in life is beneficial for promoting and maintaining health. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.

Educational level, ethnicity and mortality rates in Israel: national data linkage study

Background

Many studies have shown significant gaps in mortality, and cause specific mortality by educational status. This study investigated these measures in Israel by educational and ethnic status in recent decades.

Method

A mortality follow-up till 2017 was done of a cohort of Israeli residents aged 25–64 in 2000 who remained in Israel and had available educational data, grouped into under 8, 9–11, 12, 13–15 and 16 and above years of education. Indirect age adjustment was used to calculate Standard Mortality Ratios (SMRs) by sex and educational group, and a Cox regression model to assess relative risk of total and cause specific mortality controlling for age and ethnic group (Jews and Others and Arabs).The analysis was repeated for each ethnic group separately.

Results

2,776,422 persons were included of whom 174,792 (6.3%) died till 2017. SMR’s for total mortality of males and females with less than 8 years of education compared to 16 and over were 2.2 and 1.8, respectively. Corresponding HR were 2.13 (95% CI 2.08–2.18) and 1.77 (95% CI 1.72–1.82), respectively.

The highest cause specific hazard ratios in males were for homicide, 4.40 (95% CI 3.19–6.07), respiratory diseases, 4.01 (95% CI 3.61–4.44), infectious diseases, 3.55 (95% CI 3.15–3.19) and diabetes 3.41 (95% CI 3.06–3.79) and in females for diabetes, 4.41 (95% CI 3.76–5.16), infectious diseases, 4.16 (95% CI 3.52–4.91), respiratory diseases, 4.13 (95% CI 3.55–4.81), and heart disease, 2.96 (95% CI 2.66–3.29).

Education-adjusted risk of all-cause mortality for Arab males was 1.07 (1.05–1.09) times that of Jews and Others and non-significant in females. High mortality risk was found for Arab males and females compared to Jews and Others for homicide, diabetes, heart and cerebrovascular disease and for respiratory disease in males. Lower risk was found for suicide and infectious diseases in both sexes and

cancer in females.

Conclusion

We found significant effect of educational level on all-cause and cause specific mortality, particularly respiratory diseases, infectious diseases, diabetes and homicide. Our results highlight the importance of increasing the educational level of all groups in the population and of encouraging healthy behavior in the lower educated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13584-021-00483-9.

Socio-economic disparities and returning to work following an injury

BACKGROUND

Traumatic injury is one of the main reasons for temporary and permanent occupational disability. The objective of this study was to define the role of socio-economic position on post-injury occupational absenteeism.

METHODS

This was a nationwide retrospective cohort study, based on linking The Israeli National Trauma Registry (INTR) and the National Insurance Institute (NII) databases. The study population included 44,740 injured workers (residents of Israel, aged 21-67, hospitalized between 2008 and 2013 and employed prior to injury as salaried workers). Logistic-regression models tested the probability of not returning to work (RTW).

RESULTS

The majority of the study population (61%) RTW within 1 month following the injury event. Income prior to injury was significantly associated with longer out of work stay, explaining 9% variance. A significant interaction (p value < 0.0001) was found between age and income on out of work stay more than 1 month, 1 year and 2 years. Logistic regression models of out of work stay were conducted separately for all age groups. Lower income was associated with greater chance for out of work stay for more than 1 month; and the gap between the lowest and highest income quartiles was greater among older workers (age 55+), where there was an elevenfold increase in probability of not RTW among casualties from the lowest vs. highest income quartile. In comparison to other population groups, Arabs were at greater odds of longer out of work stay following an injury. Among injured persons recognized by the NII as having occupational injuries, the odds for not RTW within a month, a year and 2 years were respectively 3.9, 2.5 and 2.2 times significantly greater in comparison to employees injured outside the workplace.

CONCLUSIONS

This study identified population groups with a high probability of not RTW following an injury requiring hospitalization. Intervention programs for injured employees should promote early rehabilitation and aim to shorten out of work stay. These programs should be ethnically adapted and focus on underprivileged and disadvantaged populations.

Effect of intergenerational educational mobility on health of Indian women

This study aims to analyse the relationship between intergenerational educational mobility and the overall health of the Indian women. It uses a nationally representative survey, India Human Development Survey (IHDS) 2011–12, and logistic regressions to study this relationship. The sample comprises of women aged 45 years and older. We find that the women experiencing upward intergenerational educational mobility (vis-a-vis their mothers) have significantly higher chances of experiencing good overall health compared to the women who are having same or lesser level of education as that of their mothers. Besides, women suffering from short term or major morbidity have remarkably lower chances of having overall good health. Also, women from rural India have significantly lesser chances of having overall good health as compared to that of urban areas. Further, Muslim women have lesser chances of having overall good health as that of women from other religious categories. Moreover, there is a significant variation in the overall health of women as we move from the eastern region to the western region of India.

Socioeconomic Inequality in mortality using 12-year follow-up data from nationally representative surveys in South Korea

Background

Investigations into socioeconomic inequalities in mortality have rarely used long-term mortality follow-up data from nationally representative samples in Asian countries. A limited subset of indicators for socioeconomic position was employed in prior studies on socioeconomic inequalities in mortality. We examined socioeconomic inequalities in mortality using follow-up 12-year mortality data from nationally representative samples of South Koreans.

Methods

A total of 10,137 individuals who took part in the 1998 and 2001 Korea National Health and Nutrition Examination Surveys were linked to mortality data from Statistics Korea. Of those individuals, 1,219 (12.1 %) had died as of December 2012. Cox proportional hazard models were used to estimate the relative risks of mortality according to a wide range of socioeconomic position (SEP) indicators after taking into account primary sampling units, stratification, and sample weights.

Results

Our analysis showed strong evidence that individuals with disadvantaged SEP indicators had greater all-cause mortality risks than their counterparts. The magnitude of the association varied according to gender, age group, and specific SEP indicators. Cause-specific analyses using equivalized income quintiles showed that the magnitude of mortality inequalities tended to be greater for cardiovascular disease and external causes than for cancer.

Conclusion

Inequalities in mortality exist in every aspect of SEP indicators, both genders, and age groups, and four broad causes of deaths. The South Korean economic development, previously described as effective in both economic growth and relatively equitable income distribution, should be scrutinized regarding its impact on socioeconomic mortality inequalities. Policy measures to reduce inequalities in mortality should be implemented in South Korea.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-016-0341-9) contains supplementary material, which is available to authorized users.

Divorce and Death: A Meta-Analysis and Research Agenda for Clinical, Social, and Health Psychology

Divorce is a relatively common stressful life event that is purported to increase risk for all-cause mortality. One problem in the literature on divorce and health is that it is fragmented and spread across many disciplines; most prospective studies of mortality are based in epidemiology and sociology, whereas most mechanistic studies are based in psychology. This review integrates research on divorce and death via meta-analysis and outlines a research agenda for better understanding the potential mechanisms linking marital dissolution and risk for all-cause mortality. Random effects meta-analysis with a sample of 32 prospective studies (involving more than 6.5 million people, 160,000 deaths, and over 755,000 divorces in 11 different countries) revealed a significant increase in risk for early death among separated/divorced adults in comparison to their married counterparts. Men and younger adults evidenced significantly greater risk for early death following marital separation/divorce than did women and older adults. Quantification of the overall effect size linking marital separation/divorce to risk for early death reveals a number of important research questions, and this article discusses what remains to be learned about four plausible mechanisms of action: social selection, resource disruptions, changes in health behaviors, and chronic psychological distress.

Inequalities in mortality at older ages decline with indicators of material wealth but persist with educational level

OBJECTIVE

This study aimed to investigate the relationship between education and different indicators of material wealth with mortality, and to analyze whether this relationship varies with the leading causes of death.

METHODS

All persons aged 65 and older residing in Spain in 2001 were followed up for 7 years to determine their vital status. The relationship between mortality and four indicators of socioeconomic position (education, number of rooms in home, surface area of home and number of vehicles) was estimated in three age groups: 65-74, 75-84 and 85 and older. Rate ratios and relative index of inequality (RII) were calculated for general mortality and for the leading causes of death by Poisson regression.

RESULTS

In women, the mortality rate ratio for low vs. high educational level was 1.48 for persons aged 65-74, 1.43 for those aged 75-84 and 1.40 for those aged 85 and older. The respective rates for men were 1.30, 1.25 and 1.29. For the indicators of material wealth, the differences between morality rates in the lower vs. the higher socioeconomic categories decline with age. Mortality differences by the leading causes of death decline with age, except in the case of cancer in women and cardiovascular and digestive mortality in men according to educational level.

CONCLUSIONS

Relative socioeconomic differences in mortality in the older Spanish population decrease with age using indicators of material wealth but not using educational level. The variation in the pattern of mortality by cause of death by level of education may be responsible for these findings.

Misery loves company? A meta-regression examining aggregate unemployment rates and the unemployment-mortality association

PURPOSE

Individual-level unemployment has been consistently linked to poor health and higher mortality, but some scholars have suggested that the negative effect of job loss may be lower during times and in places where aggregate unemployment rates are high. We review three logics associated with this moderation hypothesis: health selection, social isolation, and unemployment stigma. We then test whether aggregate unemployment rates moderate the individual-level association between unemployment and all-cause mortality.

METHODS

We use six meta-regression models (each using a different measure of the aggregate unemployment rate) based on 62 relative all-cause mortality risk estimates from 36 studies (from 15 nations).

RESULTS

We find that the magnitude of the individual-level unemployment-mortality association is approximately the same during periods of high and low aggregate-level unemployment. Model coefficients (exponentiated) were 1.01 for the crude unemployment rate (P = .27), 0.94 for the change in unemployment rate from the previous year (P = .46), 1.01 for the deviation of the unemployment rate from the 5-year running average (P = .87), 1.01 for the deviation of the unemployment rate from the 10-year running average (P = .73), 1.01 for the deviation of the unemployment rate from the overall average (measured as a continuous variable; P = .61), and showed no variation across unemployment levels when the deviation of the unemployment rate from the overall average was measured categorically. Heterogeneity between studies was significant (P < .001), supporting the use of the random effects model.

CONCLUSIONS

We found no strong evidence to suggest that unemployment experiences change when macroeconomic conditions change. Efforts to ameliorate the negative social and economic consequences of unemployment should continue to focus on the individual and should be maintained regardless of periodic changes in macroeconomic conditions.

Jewish mortality reconsidered

It is known that mortality of Jews is different from the mortality of the populations that surround them. However, the existence of commonalities in mortality of different Jewish communities across the world has not received scholarly attention. This paper aims to identify common features of the evolution of Jewish mortality among Jews living in Israel and the Diaspora. In the paper the mortality of Jews in Israel is systematically compared with the mortality of the populations of developed countries, and the findings from the earlier studies of mortality of Jews in selected Diaspora communities are re-examined. The outcome is a re-formulation and extension of the notion of the 'Jewish pattern of mortality'. The account of this pattern is based on the consistently low level of behaviourally induced mortality, the migration history of Jewish populations and the enduring influence of early-life conditions on mortality at older ages.

The role of different predictors in 20-year mortality among Krakow older citizens

BACKGROUND

The aim of this study was to assess the change in the predictive ability of gender-related 20-year all-cause mortality in community-dwelling older people.

METHODS

The baseline investigation was conducted in 1986-1987 and survival of 2472 subjects aged 65 years and older was followed up for 20 years. The associations of socioeconomic conditions and health measures with mortality were assessed using Cox hazard model with time-dependent covariates.

RESULTS

Our study confirmed that higher education and being employed during the baseline were protective factors in males, but not among females. Healthy lifestyle was a predictive factor for all-cause mortality for both men and women and its predictive value was strong over the whole observation period. The study showed that poor self-rated health (SRH) was a valid predictor of mortality in elderly women, but not in men, and the effect of the length of follow-up on mortality was not observed. Overall, different sets of all-cause mortality predictors were found for men and women. For men the role of socioeconomic status factors was confirmed as well as healthy lifestyle and presence of chronic conditions, especially coronary heart disease (CHD) and asthma. For women the most important predictors were lifestyle factors and the feeling of life-weariness as well as SRH and diabetes mellitus present during the baseline study.

CONCLUSIONS

The impact of most of the examined factors on mortality was found to be stable over the twenty years of observation with the exception of the self-reported CHD, whose predictive value decreased over time.

Social Determinants of Active Aging: Differences in Mortality and the Loss of Healthy Life between Different Income Levels among Older Japanese in the AGES Cohort Study

We examined the relationship between income, mortality, and loss of years of healthy life in a sample of older persons in Japan. We analyzed 22,829 persons aged 65 or older who were functionally independent at baseline as a part of the Aichi Gerontological Evaluation Study (AGES). Two outcome measures were adopted, mortality and loss of healthy life. Independent variables were income level and age. The occurrence of mortality and need for care during these 1,461 days were tracked. Cox regressions were used to calculate the hazard ratio for mortality and loss of healthy life by income level. We found that people with lower incomes were more likely than those with higher incomes to report worse health. For the overall sample, using the governmental administrative data, the hazard ratios of mortality and loss of healthy life-years comparing the lowest to the highest income level were 3.50 for men and 2.48 for women for mortality and 3.71 for men and 2.27 for women for loss of healthy life. When only those who responded to questions about income on the mail survey were included in the analysis, the relationships became weaker and lost statistical significance.

Widowhood and mortality: a meta-analysis and meta-regression

The study of spousal bereavement and mortality has long been a major topic of interest for social scientists, but much remains unknown with respect to important moderating factors, such as age, follow-up duration, and geographic region. The present study examines these factors using meta-analysis. Keyword searches were conducted in multiple electronic databases, supplemented by extensive iterative hand searches. We extracted 1,377 mortality risk estimates from 123 publications, providing data on more than 500 million persons. Compared with married people, widowers had a mean hazard ratio (HR) of 1.23 (95% confidence interval (CI), 1.19-1.28) among HRs adjusted for age and additional covariates and a high subjective quality score. The mean HR was higher for men (HR, 1.27; 95% CI, 1.19-1.35) than for women (HR, 1.15; 95% CI, 1.08-1.22). A significant interaction effect was found between gender and mean age, with HRs decreasing more rapidly for men than for women as age increased. Other significant predictors of HR magnitude included sample size, geographic region, level of statistical adjustment, and study quality.

Meta-analysis of marital dissolution and mortality: reevaluating the intersection of gender and age

The study of marital dissolution (i.e. divorce and separation) and mortality has long been a major topic of interest for social scientists. We conducted meta-analyses and meta-regressions on 625 mortality risk estimates from 104 studies, published between 1955 and 2011, covering 24 countries, and providing data on more than 600 million persons. The mean hazard ratio (HR) for mortality in our meta-analysis was 1.30 (95% confidence interval [CI], 1.23-1.37) among HRs adjusted for age and additional covariates. The mean HR was higher for men (HR, 1.37; 95% CI, 1.27-1.49) than for women (HR, 1.22; 95% CI: 1.13-1.32), but the difference between men and women decreases as the mean age increases. Other significant moderators of HR magnitude included sample size; being from Western Europe, Israel, the United Kingdom and former Commonwealth nations; and statistical adjustment for general health status.

Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality

Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10 years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.

Physical Versus Mental Predictors of Mortality Among the Old-Old in Israel: The CALAS Study

When risk factors are examined concurrently, they tend to show mixed results in predicting mortality among the old-old. The purpose of this study was to compare a set of physical predictors with a set of mental predictors, all considered as most common and predictive in the literature, to assess their relative dominance in predicting mortality at old-old age. Based on Baltes’s incomplete architecture model and the disablement process, the authors postulated that physical predictors of mortality would diminish the impact of mental predictors of mortality. The database used for this study was the multidimensional survey of the Cross-Sectional and Longitudinal Aging Study conducted from 1989 to 1992 with a follow-up of mortality after 10 years. Participants ( N = 1,369) were drawn from a national sample of the Jewish Israeli population aged 75 to 94. The mean age of the sample was 83.52 ( SD = 5.42). Results of hierarchical Cox regression models showed that besides sociodemographic effects (mainly age, gender, and marital status), physical disability, physician visits, and medication consumption predicted mortality. Mental predictors (cognitive impairment and life evaluation) lost their predictive power when the physical predictors were introduced. Hence, biological and physical risk factors predominated over mental risk factors when examining prediction of mortality among the old-old age population.

Health inequalities in Israel: explanatory factors of socio-economic inequalities in self-rated health and limiting longstanding illness

We examined an integrated multi-level model of psychosocial, community and behavioral factors as explanatory pathways to socio-economic inequalities in health in Israel. Using a random national sample of 1328 individuals aged 30-70 and measurements of socio-economic position (education, number of cars), health outcomes-self-rated health, limiting longstanding illness (LLI), we evaluated the contribution of psychosocial factors (stressors and psychosocial resources), community factors (individual and aggregate-level social participation and social capital) and health behaviors, to the explanation of health inequalities. Community factors contributed more than psychosocial factors or health behaviors. The integrative model provided an explanation of social inequalities in both health outcomes and a full explanation for the education-LLI association.

Network type and mortality risk in later life

PURPOSE

The purpose of this study was to examine the association of baseline network type and 7-year mortality risk in later life.

DESIGN AND METHODS

We executed secondary analysis of all-cause mortality in Israel using data from a 1997 national survey of adults aged 60 and older (N=5,055) that was linked to records from the National Death Registry up to 2004. We considered six network types--diverse, friend focused, neighbor focused, family focused, community-clan, and restricted--in the analysis, controlling for population group, sociodemographic background, and health factors. We carried out Cox proportional hazards regressions for the entire sample and separately by age group at baseline: 60-69, 70-79, and 80 and older.

RESULTS

Network types were associated with mortality in the 70-79 and 80 and older age groups. Respondents located in diverse and friend-focused network types, and to a lesser degree those located in community-clan network types, had a lower risk of mortality compared to individuals belonging to restricted networks.

IMPLICATIONS

Gerontological practitioners should address older adults' social networks in their assessments of clients. The parameters used to derive network types in this study can serve toward the development of practical network type inventories. Moreover, practitioners should tailor the interventions they implement to the different network types in which their elderly clients are embedded.

Do socioeconomic effects on health diminish with age? A Singapore case study

This paper examines the effects of socioeconomic characteristics on older adult health and investigates whether these socioeconomic effects carry through from the young-old to the oldest-old ages among Singaporean adults. Previous research shows little consensus over whether the impact of socioeconomic factors on health diminish with age. The variation in these results may be due to different definitions of socio-economic status, or the use of different health indicators. We use a comprehensive set of socioeconomic indicators (income, education level, homeownership, asset possession, and perceived income adequacy) to predict three health outcomes; poor self-assessed health, the presence of chronic illness, and functional disability. We find that while socioeconomic differentials in health status exist, the associations are not as consistent, nor as strong, as those reported for Western settings. Health inequalities related with socioeconomic status decline slightly but do not disappear with old age in Singapore.

Does early retirement lead to longer life?

It has been claimed, but not empirically supported, that early retirement leads to longer life. The present investigation addressed this question using data from a 1997 Israeli national household survey of adults aged 60 or more years linked to mortality records from the national death registry, for 2004. The study examined the association between early retirement and seven-year all-cause mortality among the population of older Jewish Israelis who were employed prior to or at baseline (N=2,374). Both the timing of retirement and the reasons for exit from the labour force were considered in the analysis. The initial hazard regression models, adjusted by gender and reason for retirement including poor health, showed that early retirees indeed had lower mortality risk ratios than respondents who had retired ‘on time’. When additional variables were controlled in the final analytic model, however, the association between early retirement and mortality was not supported. Older age, male gender, and having been diagnosed with one or more of five major illnesses were all associated with greater risk for mortality. Medium level education and being employed at baseline were associated with lesser mortality risk. Nevertheless, the timing of retirement, viz. early versus normative exit from the workforce, was not related to survival. In sum, the respondents who had prematurely exited the labour force did not benefit from disproportionately longer lives when compared with the respondents who retired ‘on time’.

The Protective Effect of Marriage on Mortality in a Dynamic Society

PURPOSE

We sought to assess whether the protective effect of marriage on overall and cause-specific mortality has changed over time in a dynamic society.

METHODS

Data from the census-based Israel Longitudinal Studies (ILMS) I (1983-1992) and II (1995-2004) were analyzed. Cox proportional hazard modeling adjusting for sociodemographic factors was applied to 152,150 and 209,125 individuals, ages 45-89 years from the ILMS I and II, respectively. During each study period 31,749 (ILMS I) and 37,656 (ILMS II) deaths were reported.

RESULTS

Mortality inequalities by marital status remained significant and widened over time for middle-aged and elderly men and women. Changes in cause-specific mortality indicated a widening of cardiovascular disease mortality inequalities by marital status. An increasing trend was also noted for deaths from cancer (+25%) and other causes (+38%, p < 0.05) in middle-aged men, but not women (cancer = 0%; other causes = -3%).

CONCLUSIONS

The stronger beneficial effect of marriage over time may reflect societal changes that have differentially affected men and women.

What really matters in the social network-mortality association? A multivariate examination among older Jewish-Israelis

The aim of the inquiry was to examine the social network-mortality association within a wider multivariate context that accounts for the effects of background framing forces and psychobiological pathways. The inquiry was based upon the Berkman et al. (2000) conceptual model of the determinants of health. Its main purpose was to identify the salient network correlates of 7-year all cause mortality among Jewish men and women, aged 70 and over, in Israel (n = 1,811). The investigation utilized baseline data from a national household survey of older adults from 1997 that was linked to records from the National Death Registry, updated through 2004. At the time of the study, 38% of the sample had died. Multivariate Cox hazard regressions identified two main network-related components as predictors of survival: contact with friends, a social network interaction variable, and attendance at a synagogue, a social engagement variable. Friendship ties are seen to uniquely reduce mortality risk because they are based on choice in nature, and reflect a sense of personal control. Synagogue attendance is seen to promote survival mainly through its function as a source of communal attachment and, perhaps, as a reflection of spirituality as well. Other possibly network-related correlates of mortality were also noted in the current analysis-the receipt of instrumental support and the state of childlessness.

Socioeconomic position and incident mobility impairment in the Cardiovascular Health Study

BACKGROUND

We investigated if personal socioeconomic position (SEP) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly.

METHODS

We used data from the Cardiovascular Health Study, a longitudinal, population-based examination of coronary heart disease and stroke among persons aged 65 and older in the United States.

RESULTS

Among 3,684 persons without baseline mobility impairment, lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period, although the strengths of these associations varied by socioeconomic indicator and race/sex group.

CONCLUSION

Among independent-living elderly, SEP affected development of mobility impairment into later life. Particular effort should be made to prevent or delay its onset among the elderly with low income, education, and/or who live in economically disadvantaged neighborhoods.

Marital status and mortality in the elderly: a systematic review and meta-analysis

Although a relationship between marital status and mortality has long been recognized, no summary estimates of the strength of the association are available. A meta-analysis of cohort studies was conducted to produce an overall estimate of the excess mortality associated with being unmarried in aged individuals as well as to evaluate whether and to what degree the effect of marriage differs with respect to gender, geographical/cultural context, type of non-married condition and study methodological quality. All included studies were published after the year 1994, used multivariate analyses and were written in English. Pooling 53 independent comparisons, consisting of more than 250,000 elderly subjects, the overall relative risk (RR) for married versus non-married individuals (including widowed, divorced/separated and never married) was 0.88 (95% Confidence Interval: 0.85-0.91). This estimate did not vary by gender, study quality, or between Europe and North America. Compared to married individuals, the widowed had a RR of death of 1.11 (1.08-1.14), divorced/separated 1.16 (1.09-1.23), never married 1.11 (1.07-1.15). Although some evidence of publication bias was found, the overall estimate of the effect of marriage was robust to several statistical approaches and sensitivity analyses. When the overall meta-analysis was repeated with an extremely conservative approach and including eight non-significant comparisons, which were initially excluded because of data unavailable, the marriage protective influence remained significant, although the effect size was reduced (RR=0.94; 0.92-0.95). Despite some methodological and conceptual limitations, these findings might be important to support health care providers in identifying individuals "at risk" and could be integrated into the current programs of mortality risk estimation for the elderly.

Does one's own and one's spouse's education affect overall and cause-specific mortality in the elderly?

OBJECTIVES

To examine educational gradients in overall and cause-specific mortality among elderly married men and women and their spouses.

METHODS

Using the census-based Israel Longitudinal Mortality Study (1983-92), 13 573 married men and 6563 married women were identified who were aged 70-89 years at baseline. Cox proportional hazard models were used to assess the strength of the association between education and overall and cause-specific mortality.

RESULTS

Educational gradients for own and spouse's mortality varied by gender and cause of death. In particular, in relation to cardiovascular disease, men married to uneducated wives experienced elevated mortality risks [hazard ratio (HR) = 1.30; 95% confidence interval (95% CI) 1.11-1.52]. Women were generally unaffected by their husband's education, except for those who died from non-breast cancer, for whom husband's low education had a harmful effect (HR = 1.98; 95% CI 1.26-3.11).

CONCLUSIONS

Mortality among elderly married persons is associated with one's own and one's spouse's educational achievement. Research using partner's education as a proxy for one's own attainment may be omitting valuable information regarding these and other health risks.

Individual, household and neighborhood socioeconomic status and mortality: a study of absolute and relative deprivation

Our objectives were twofold (1) to examine the effects of neighborhood socioeconomic status (SES) on mortality by gender and age and (2) to assess the impact of individual's household SES relative to one's neighborhood on mortality. Data were taken from the Israel Longitudinal Mortality Study, which linked a 20% sample of the 1983 census to mortality records through 1992. Multilevel modeling was performed on 131,156 men and women aged 45-89 years living in approximately 880 neighborhoods. Overall, 27,334 deaths were reported during the 9.5 year study period. Independent of individual characteristics, mortality risks increased 1-2% (p < 0.05) per unit increase in area deprivation. Results did not vary by age or gender. Household deprivation relative to that of one's neighborhood and adjusted for absolute SES affected mortality in men only. Specifically, men living in relative disadvantage to their neighbors had lower risks of mortality than those living in concordance with their area (OR 0.86, 95% CI 0.80-0.92).

Educational differentials in mortality from cardiovascular disease among men and women: the Israel Longitudinal Mortality Study

PURPOSE

While socioeconomic inequalities in cardiovascular disease have been observed in most industrialized countries, available information in Israel centers on ethnic variations and the role of education has yet to be investigated. This study examines educational differentials in cardiovascular mortality in Israel for both men and women aged 45 to 69 and 70 to 89 years.

METHODS

Data are based on a linkage of records from a 20% sample of the 1983 census with the records of deaths occurring until the end of 1992. The study population includes 152,150 individuals and the number of cardiovascular deaths was 14,651. Educational differentials were assessed for mortality of diseases of the circulatory system, ischemic heart diseases, cerebrovascular diseases, hypertensive diseases, and sudden death.

RESULTS

Substantial mortality differentials were found among individuals aged 45 to 69 years, with larger inequalities among women. The age-adjusted relative risk for mortality of cardiovascular diseases among those with elementary education (< or =8 years) compared with those with high education (> or=13 years) was 1.46 (95% CI: 1.32-1.61) for men and 2.06 (95% CI: 1.76-2.41) for women. Differentials among the elderly were markedly narrower than those for younger adults. Similar trends were observed for mortality of subgroups of causes including cerebrovascular diseases and ischemic heart diseases. Educational differentials were not affected by adjustment for ethnic origin and car ownership.

CONCLUSIONS

Those with 8 years of education or less suffer higher risk of cardiovascular mortality compared with adults with 13 or more years of education. Young, less educated women are more vulnerable, and health and social policies oriented towards this group are needed.

Prediction of survival: a comparison between two subjective health measures in an elderly population

A large amount of evidence shows that the subjective evaluation of health is a predictor of survival in many different populations. Subjective health (SH) is measured using different types of measures such as a general evaluation of health or a comparative evaluation of health. The aim of this study was to compare the prediction of survival by two measures of SH (a general measure and an age-related measure) and evaluate the association with other variables in an elderly population. The baseline survey was conducted during 1994, covering 1138 men and women aged over 70. The survival status was ascertained 7 years later. After adjustment for age, sex, education, marital status, perceived socioeconomic status and presence of diseases the two SH measures were found to be predictors of mortality, but only in men. In men, there was no significant difference between the two types of SH measures in their prediction of mortality. Also in men, when there was only one or no disease, being married had a protective effect compared with not being married when both types of SH measures were used. In elderly women, the association between the two types of SH and survival diminished after adjusting for the various variables. However, the general SH measure may be the preferable measure to use when needed. Education in women was associated with mortality only via the age-related SH measure.

Socioeconomic status and health among the aged in the United States and Germany: a comparative cross-sectional study

This study investigates socioeconomic status (SES) differences in health among the aged in Germany and the United States. Intra-elderly age differences in the SES-health gradient are also examined. The study uses data from two national telephone surveys conducted in Germany (N=682) and the United States (N=608) using probability samples of non-institutionalised persons 60 years or older. In addition to the traditional indicators of SES (education, income and occupational status), two alternative indicators (assets and home ownership) are utilised. Self-rated health, depression (CES-D) and functional limitations are introduced as health indicators. Results of multiple logistic regression analyses show that income is the best SES predictor of the three health measures among the aged in Germany, whereas education, occupational prestige, assets, and home ownership are not consistently related to health. Respective analyses of the US data demonstrate weaker and less consistent associations of health measures with SES indicators. Consequently, there is a higher percentage of explained variance in health by SES among the aged in Germany compared to the United States. The data also show that social inequalities in health tend to diminish at older ages in the United States, but such disparities vary only slightly by age in Germany. In conclusion, although SES health differences are observed among the elderly in both countries, they are more pronounced in Germany than in the United States where effects are restricted to younger old age. One interpretation of this finding points to higher selective mortality of middle and early old age groups with a low SES in the United States due to stronger health-related deprivation.

Mortality after spousal loss: are there socio-demographic differences?

This study evaluates the effect of spousal death on mortality among Israeli adults and examines differences in this effect by duration of bereavement, age, sex, education, ethnic origin, household size, and number of children. Data are taken from the Israel Longitudinal Mortality Study which is based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring during the period 1983-1992. The study population comprised 49,566 men and 41,264 women, of whom 4,402 (9%) and 11,114 (27%), respectively, were bereaved during the follow-up period. Excess mortality among the bereaved was evident among both men and women, especially after bereavement of short duration. During the first 6 months, the excess mortality was about 50% among women and about 40% among men. For men, the effect of bereavement on mortality decreased linearly with age, with a relative risk of 3 among younger men during early widowhood. Bereavement had a greater impact on the more educated men. The effect of bereavement did not vary by ethnic origin or household size.

Mortality differentials among women: the Israel Longitudinal Mortality Study

The first aim of this study was to examine differentials in mortality among Israeli adult women with respect to ethnic origin, marital status, number of children and several measures of socio-economic status; the second was to compare mortality differentials among women with those found for Israeli men. Data are based on a linkage of records from a 20% sample of the 1983 census with the records of deaths occurring until the end of 1992. The study population includes 79,623 women and the number of deaths was 14,332. Measures of SES included education, number of rooms, household amenities and possession of a car. Results indicated higher mortality among women originating from North Africa compared with Asian and European women. Adjustment to SES eliminated the excess mortality among North African women and revealed a lower mortality of Asian women, relative to Europeans. Among women aged 45-69, substantial and consistent mortality differentials were evident for all SES indicators examined where mortality declined with improved socio-economic position. Mortality was related to women's childbearing history, with the highest mortality among childless women. Mortality differentials among women aged 70+ were generally narrower than those found for younger women. Gender differences in mortality differentials varied by the socio-demographic indicator and age.