Comparing socio-economic inequalities in healthy ageing in the United States of America, England, China and Japan: evidence from four longitudinal studies of ageing

Abstract

Healthy ageing has become a popular topic worldwide. So far, a consensus measure of healthy ageing has not been reached; and no studies have compared the magnitude of socio-economic inequality in healthy ageing outside Europe. This study aims to create a universal measure of healthy ageing and compare socio-economic inequalities in healthy ageing in the United States of America (USA), England, China and Japan. We included 10,305 American, 6,590 English, 5,930 Chinese and 1,935 Japanese participants for longitudinal analysis. A harmonised healthy ageing index (HAI) was developed to measure healthy ageing multi-dimensionally. Educational, income and wealth rank scores were derived accounting for the entire socio-economic distribution and the sample size of each category of socio-economic indicator. Associations between socio-economic rank scores and HAIs were assessed using multi-level modelling to calculate the Slope Indices of Inequality. Healthy ageing trajectories were predicted based on the full-adjusted age-cohort models. We found that education was a universally influential socio-economic predictor of healthy ageing. Moving from the highest to the lowest educational groups was associated with a 6.7 (5.2–8.2), 8.2 (6.0–10.4), 13.9 (11.4–16.3) and 6.1 per cent (3.9–8.2%) decrease in average HAI at 60 years in the USA, England, China and Japan, respectively. After 60 years, the educational inequality in healthy ageing kept increasing in the USA and China. The educational inequality in healthy ageing in China was also greater than any other socio-economic inequality in the four countries. Wealth was more influential in predicting healthy ageing inequality among American, English and Japanese participants, while income was more influential among Chinese participants. The socio-economic inequality in healthy ageing in Japan was relatively small. Chinese and American participants had worse healthy ageing profiles than Japanese and English participants.

The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids: answers from the English Longitudinal Study of Ageing (ELSA)

“…The early detection of HL by primary care professionals in routine assessments could help prevent or delay the onset of depression, particularly in lower wealth groups. Untreated HL may not only have negative consequences for people's functional ability and mental wellbeing, but also to society as a whole, as our paper showed that HL may widen the socioeconomic inequalities through its graded impact on people's wealth [42]. Taking SEP into account is considered an essential element of depression prevention strategies in the general population [43].…”

Healthy aging index and its link with relative education between individual and neighborhood: a population-based, cohort study

“…On the one hand, fundamental cause theory suggests those with high education levels may choose to live in advantaged neighborhoods [ 20 ]. On the other hand, some participants in the first or second survey died and therefore did not reply to the subsequent surveys [ 14 ]. As such, cohort weight was applied to reduce the bias.…”

“…As People's Republic of China was founded in 1949, the illiteracy rate is as high as 80%. In 1950, the Chinese government promoted literacy education nationwide to gradually reduce illiteracy [ 14 ]. The standard of literacy education is to have preliminary reading, writing, and arithmetic skills.…”

“…Healthy aging assessment starts with disease-based conceptualizations [11][12][13], which have been criticized for their narrow biomedical focus. Following the definition of healthy aging proposed by the WHO, function-based approaches have been developed, and the indicators of healthy aging are extended to include freedom from disability, high physical functioning, sound mental health conditions, freedom from sensory limitations, subjectively rated health, and sound social health [3,5,[14][15][16]. These approaches tend to conceptualize healthy aging as a cumulative score based on the total number of deficits present in a person, leaving open the question of measuring health interlinkages [11][12][13][14][15].…”

Older Adults’ Engagement in Senior University Lectures and the Effect of Individual Motivations

“…A person's participation in education is still affected by social inequalities; this also holds true in old age after retirement (Bjursell et al, 2017;Boeren, 2017). The intersection between age and inequalities can lead to even more severe constraints regarding one's capabilities (Heap et al, 2017;Lu et al, 2019). From semester fees to public transportation, some costs are involved, and these costs can affect older people differently depending on their financial situation.…”