Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-08T04:59:33.707Z Has data issue: false hasContentIssue false

Socio-economic inequalities in mortality persist into old age in New Zealand: study of all 65 years plus, 2001–04

Published online by Cambridge University Press:  11 January 2013

SANTOSH JATRANA*
Affiliation:
Alfred Deakin Research Institute, Deakin University Waterfront Campus, Geelong, Australia.
TONY BLAKELY
Affiliation:
Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
*
Address for correspondence: Santosh Jatrana, Alfred Deakin Research Institute, Deakin University Waterfront Campus, Geelong, Victoria 3220, Australia. E-mail: [email protected]

Abstract

A number of studies have explored the relationship between socio-economic status and mortality, although these have mostly been based on the working-age population, despite the fact that the burden of mortality is highest in older people. Using Poisson regression on linked New Zealand census and mortality data (2001–04, 1.3 million person years) with a comprehensive set of socio-economic indicators (education, income, car access, housing tenure, neighourhood deprivation), we examined the association of socio-economic characteristics and older adult mortality (65+ years) in New Zealand. We found that socio-economic mortality gradients persist into old age. Substantial relative risks of mortality were observed for all socio-economic factors, except housing tenure. Most relative risk associations decreased in strength with ageing [e.g. most deprived compared to least deprived rate ratio for males reducing from 1.40 (95% confidence interval (CI) 1.28–1.53) for 65–74-year-olds to 1.13 (CI 1.00–1.28) for 85 + -year-olds], except for income and education among women where the rate ratios changed little with increasing age. This suggests individual-level measures of socio-economic status are more closely related to mortality in older women than older men. Comparing across genders, the only statistically significantly different association between men and women was for a weaker association for women for car access.

Type
Articles
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arber, S. 1987. Social class, non-employment, and chronic illness: continuing the inequalities in health debate. British Medical Journal, 294, 1069–73.Google Scholar
Arber, S. and Ginn, J. 1993. Gender and inequalities in health in later life. Social Science & Medicine, 36, 1, 425–36.Google Scholar
Backlund, E., Sorlie, P. D. and Johnson, N. J. 1999. A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study. Social Science & Medicine, 49, 10, 1373–84.CrossRefGoogle ScholarPubMed
Bassuk, S. S., Berkman, L. F. and Amick, B. C. 2002. Socioeconomic status and mortality among the elderly: findings from four US communities. American Journal of Epidemiology, 155, 6, 520–33.Google Scholar
Berkman, L. F. 1988. The changing and heterogeneous nature of ageing and longevity: a social and biological perspective. Annual Review of Gerontology and Geriatrics, 8, 1, 3768.Google Scholar
Berkman, L. F. and Macintyre, S. 1997. The measurement of social class in health studies: old measures and new formulations. In Kogevinas, M., Pearce, N and Boffetta, P. (eds), Social Inequalities and Cancer. International Agency for Research on Cancer, Lyon, France, 5164.Google Scholar
Blakely, T, Atkinson, J., Ivory, V., Collings, S., Wilton, J. and Howden-Chapman, P. 2006. No association of neighbourhood volunteerism with mortality in New Zealand: a national multilevel cohort study. International Journal of Epidemiology, 35, 4, 981–9.CrossRefGoogle ScholarPubMed
Blakely, T., Fawcett, J., Atkinson, J., Tobias, M. and Cheung, J. 2005. Decades of Disparity II: Socioeconomic Mortality Trends in New Zealand 1981–1999. Ministry of Health, Wellington.Google Scholar
Blakely, T. and Subramanian, S. V. 2006. Multilevel studies. In Oakes, J. and Kaufman, J. (eds), Methods in Social Epidemiology. Jossey Bass, San Francisco, 316–40.Google Scholar
Blakely, T., Tobias, M. and Atkinson, J. 2008. Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies. British Medical Journal, 336, 371–5.CrossRefGoogle ScholarPubMed
Christenson, B. A. and Johnson, N. E. 1995. Educational inequality in adult mortality: an assessment with death certificate data from Michigan. Demography, 32, 2, 215–29.CrossRefGoogle ScholarPubMed
Connolly, S., O'Reilly, D. and Rosato, M. 2010. House value as an indicator of cumulative wealth is strongly related to morbidity and mortality risk in older people: a census-based cross-sectional and longitudinal study. International Journal of Epidemiology, 39, 2, 383–91.Google Scholar
Davey, J. 2007. Older people and transport: coping without a car. Ageing & Society, 27, 1, 4965.CrossRefGoogle Scholar
Davey, J. and Nimmo, K. 2003. Older People and Transport: Scoping Paper. Ministry of Transport, Wellington.Google Scholar
Fawcett, J., Atkinson, J. and Blakely, T. 2007. Anonymous Record Linkage of Census and Mortality Records, 2001–04: Methods, Unlock Ratios, and Linkage Weights. Department of Public Health, University of Otago, Wellington. Available online at http://www.otago.ac.nz/wellington/research/hirp/projects/otago023986.html.Google Scholar
Fawcett, J. and Blakely, T. 2007. Cancer is overtaking cardiovascular disease as the main driver of socioeconomic inequalities in mortality: New Zealand (1981–99). Journal of Epidemiology & Community Health, 61, 1, 5966.CrossRefGoogle ScholarPubMed
Fawcett, J., Blakely, T. and Atkinson, J. 2002. Weighting the 81, 86, 91 & 96 census–mortality cohorts to adjust for linkage bias. NZCMS Technical Report No. 5, University of Otago, Wellington. Available online at http://www.otago.ac.nz/wellington/research/hirp/projects/otago023986.html.Google Scholar
Gallo, J. J., Rebok, G. W. and Lesikar, S. E. 1999. The driving habits of adults aged 60 years and older. Journal of the American Geriatrics Society, 47, 3, 335–41.Google Scholar
Geyer, S. and Peter, R. 2000. Income, occupational position, qualification and health inequalities – competing risks? Journal of Epidemiology and Community Health, 54, 4, 299305.CrossRefGoogle ScholarPubMed
Gilhooly, M., Hamilton, K., O'Neill, M., Gow, J., Webster, N. and Pike, F. 2003. Transport and Ageing: Extending Quality of Life via Public and Private Transport. ESRC Research Findings from the Growing Older Programme 16, Economic and Social Research Council, Swindon, UK.Google Scholar
Goldthrope, J. 1983. Women and class analysis: in defence of conventional view. Sociology, 17, 4, 465–88.Google Scholar
Grundy, E. and Halt, G. 2001. The socioeconomic status of older adults: how should we measure it in studies of health inequalities? Journal of Epidemiology & Community Health, 55, 12, 895904.CrossRefGoogle ScholarPubMed
Grundy, E. and Sloggett, A. 2003. Health inequalities in the older population: the role of personal capital, social resources and socio-economicc circumstances. Social Science & Medicine, 56, 5, 935–47.CrossRefGoogle ScholarPubMed
Hakamies-Blomqvist, L. and Wahlstrom, B. 1998. Why do older drivers give up driving? Accident Analysis & Prevention, 30, 3, 305–12.Google Scholar
Hoffman, R. 2005. Do socioeconomic mortality differences decrease with rising age? Demographic Research, 13, 2, 3562.Google Scholar
Huisman, H., Kunst, A. E., Andersen, O., Bopp, M., Borgan, J. K., Borrell, C., Costa, G., Deboosere, P., Desplanques, G., Donkin, A., Gadeyne, S., Minder, C., Regidor, E., Spadea, T., Valkonen, T. and Mackenbach, J. P. 2004. Socioeconomic inequalities in mortality among elderly people in 11 European populations. Journal of Epidemiology & Community Health, 58, 6, 468–75.CrossRefGoogle ScholarPubMed
Huisman, H., Kunst, A. E. and Mackenbach, J. P. 2003. Socioeconomic inequalities in mortbidity among the elderly: a European overview. Social Science & Medicine, 57, 5, 861–73.CrossRefGoogle ScholarPubMed
Jatrana, S. and Blakely, T. 2008. Ethnic inequalities in mortality among the elderly in New Zealand. Australian and New Zealand Journal of Public Health, 32, 5, 437–43.CrossRefGoogle ScholarPubMed
Kitagawa, E. M. and Hauser, P. M. 1973. Differential Mortality in the United Sates: A Study of Socio-economic Epidemiology. Harvard University Press, Cambridge, Massachusetts.Google Scholar
Knesebeck, O., Luschen, G., Cockerham, W. C. and Siegrist, J. 2003. Socioeconomic status and health among the aged in the United States and Germany: a comparative cross-sectional study. Social Science & Medicine, 57, 9, 1643–52.CrossRefGoogle Scholar
Liang, J., Bennett, J., Krause, N., Kobayashi, E., Kim, H., Brown, J. W., Akiyama, H., Sugisawa, H. and Jain, A. 2002. Old age mortality in Japan: does the socioeconomic gradient interact with gender and age? Journals of Gerontology: Psychological Science and Social Science, 57B, S294307.Google Scholar
Lynch, J. W., Smith, G. D. and Kaplan, G. A. 2000. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320, 1200–4.CrossRefGoogle ScholarPubMed
Macintyre, S., Ellaway, A., Der, G., Ford, G. and Hunt, K. 1998. Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study. Journal of Epidemiology & Community Health, 52, 10, 657–64.Google Scholar
Macintyre, S., Hiscock, R., Kearns, A. and Ellaway, A. 2001. Housing tenure and car access: further exploration of the nature of their relations with health in a UK setting. Journal of Epidemiology & Community Health, 55, 5, 330–1.Google Scholar
Mackenbach, J. P. and Kunst, A. E. 1997. Measuring the magnitude of socio-economic inequalities in health: At overview of available measures illustrated with two examples from Europe. Social Science & Medicine, 44, 6, 757–71.Google Scholar
Mackenbach, J. P., Kunst, A. E., Cavelaars, A. E., Groenhof, F. and Geurts, J. J. 1997. Socioeconomic inequalities in morbidity and mortality in Western Europe. Lancet, 349, 1655–9.CrossRefGoogle ScholarPubMed
Mackenbach, J. P., Kunst, A. E., Groenhof, F., Borgan, J. K., Costa, G., Faggiano, F., Józan, P., Leinsalu, M., Martikainen, P., Rychtarikova, J. and Valkonen, T. 1999. Socioeconomic inequalities in mortality among women and among men: an international study. American Journal of Public Health, 89, 12, 1800–6.Google Scholar
Marmot, M. G. and Shipley, M. J. 1996. Do socio-economic differences in mortality persist after retirement? 25 Year follow up of civil servants from the first Whitehall study. British Medical Journal, 313, 1170–80.Google Scholar
Marmot, M. and Wilkinson, R. G. (eds) 1999. Social Determinants of Health. Oxford University Press, Oxford.Google Scholar
Martelin, T. 1994. Mortality by indicators of socio-economic status among the Finnish elderly. Social Science & Medicine, 38, 9, 1257–78.CrossRefGoogle ScholarPubMed
Martelin, T. 1996. Socio-demographic differentials in mortality at older ages in Finland. In Caselli, G. and Lopaz, A. D. (eds), Health and Mortality Among Elderly Populations. Clarendon Press, New York, 112–34.CrossRefGoogle Scholar
Martelin, T., Koskinen, S. and Valkonen, T. 1998. Sociodemographic mortality differences among the oldest old in Finland. Journal of Gerontology, Health Module, 53, 2, S8390.Google Scholar
Martikainen, P., Makela, P., Koskinen, S. and Valkonen, T. 2001. Income differences in mortality: a register-based follow-up study of three million men and women. International Journal of Epidemiology, 30, 6, 1497–505.CrossRefGoogle ScholarPubMed
Martin, L. G. 1988. The aging of Asia. Journal of Gerontology, 43, 4, 100–13.Google Scholar
McNiece, R. and Majeed, A. 1999. Socioeconomic differences in general practice consultation rates in patients aged 65 and over: prospective cohort study. British Medical Journal, 319, 26–8.CrossRefGoogle ScholarPubMed
Oxley, O. 2000. Transport and Ageing of the Population, Report to the 112th Round Table on Transport Economics, European Ministers of Transport. Organisation for Economic Co-operation and Development, Paris, 211–54.Google Scholar
Power, C. and Matthews, S. 1997. Origins of health inequalities in a national population sample. Lancet, 350, 1584–9.Google Scholar
Rabbit, P., Carmichael, A., Jones, S. and Holland, C. 1996. When and Why Older Drivers Give Up Driving. AA Foundation for Road Safety Research, Manchester, UK.Google Scholar
Robert, S. A. and House, J. S. 1996. SES differentials in health by age and alternative indicators of SES. Journal of Aging & Health, 8, 3, 359–88.Google Scholar
Rothe, J. 1994. Beyond Traffic Safety. Transaction, New Brunswick, New Jersey.Google Scholar
Sacker, A., Firth, D., Fitzpatrick, R., Lynch, K. and Bartley, M. 2000. Comparing health inequalities in men and women: perspective study of mortality 1986–96. British Medical Journal, 320, 1303–7.Google Scholar
Salmond, C. and Crampton, P. 2002. NZDep2001 Index of Deprivation. Ministry of Health, Wellington.Google Scholar
Siren, A., Hakamies-Blomqvist, L. and Lindeman, M. 2004. Driving cessation and health in older women. Journal of Applied Gerontology, 23, 1, 5869.CrossRefGoogle Scholar
Sorlie, P. D., Backlund, E. and Keller, J. B. 1995. US mortality by economic, demographic and social characteristics: the National Longitudinal Mortality Study. American Journal of Public Health, 85, 7, 949–56.CrossRefGoogle ScholarPubMed
Stanworth, M. 1984. Women and class analysis: a reply to John Goldthrope. Sociology, 18, 2, 159–70.CrossRefGoogle Scholar