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The Reciprocal Relationship between Socioeconomic Status and Health and the Influence of Sex: A European SHARE-Analysis Based on Structural Equation Modeling

Author

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  • Linda Juel Ahrenfeldt

    (Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark)

  • Sören Möller

    (OPEN–Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
    Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark)

Abstract

It is well recognized that socioeconomic status (SES) is an important determinant of health, but many studies fail to address the possibility of reverse causation. We aim to investigate the reciprocal relationship between trajectories of SES and health, and how these associations differ by sex. We performed a longitudinal study including 29,824 men and 37,263 women aged 50+ participating in at least two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using structural equation modeling, we found that baseline household income and wealth led to improvements in cognitive function, grip strength, quality of life and depressive symptoms, and a better initial health led to higher income and wealth for both sexes. However, the results indicated that the relative effect of cognitive function and grip strength on SES trajectories was overall greater than the corresponding effect of SES on health changes, particularly regarding income among women, but for quality of life and depressive symptoms, the reverse was indicated, though most pronounced for the associations with wealth. The reciprocal associations between SES and physical function were stronger for men than for women, whereas most associations with cognitive function and mental health were similar between sexes. This study demonstrates that both social causation and health selection contribute to social inequalities in health, but the influence of each direction and the importance of sex differences may vary according to the health outcomes investigated.

Suggested Citation

  • Linda Juel Ahrenfeldt & Sören Möller, 2021. "The Reciprocal Relationship between Socioeconomic Status and Health and the Influence of Sex: A European SHARE-Analysis Based on Structural Equation Modeling," IJERPH, MDPI, vol. 18(9), pages 1-13, May.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:9:p:5045-:d:551594
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    References listed on IDEAS

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    1. Anne Case & Christina Paxson, 2005. "Sex differences in morbidity and mortality," Demography, Springer;Population Association of America (PAA), vol. 42(2), pages 189-214, May.
    2. Chandola, Tarani & Bartley, Mel & Sacker, Amanda & Jenkinson, Crispin & Marmot, Michael, 2003. "Health selection in the Whitehall II study, UK," Social Science & Medicine, Elsevier, vol. 56(10), pages 2059-2072, May.
    3. Silvana Miceli & Laura Maniscalco & Domenica Matranga, 2019. "Social networks and social activities promote cognitive functioning in both concurrent and prospective time: evidence from the SHARE survey," European Journal of Ageing, Springer, vol. 16(2), pages 145-154, June.
    4. Rasmus Hoffmann, 2011. "Illness, Not Age, Is the Leveler of Social Mortality Differences in Old Age," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 66(3), pages 374-379.
    5. Elo, Irma T. & Preston, Samuel H., 1996. "Educational differentials in mortality: United States, 1979-1985," Social Science & Medicine, Elsevier, vol. 42(1), pages 47-57, January.
    6. Linda Juel Ahrenfeldt & Sören Möller & Mikael Thinggaard & Kaare Christensen & Rune Lindahl-Jacobsen, 2019. "Sex Differences in Comorbidity and Frailty in Europe," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(7), pages 1025-1036, September.
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    1. Rafael Llorens-Ortega & Carmen Bertran-Noguer & Dolors Juvinyà-Canals & Josep Garre-Olmo & Cristina Bosch-Farré, 2024. "Influence of social determinants of health in the evolution of the quality of life of older adults in Europe: A comparative analysis between men and women," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-13, December.

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