Bildung und Gesundheitsungleichheit im Alter: Divergenz, Konvergenz oder Kontinuität?

Eine Längsschnittuntersuchung mit SHARE
Abhandlungen

Zusammenfassung

Dass die in frühen Lebensphasen erworbene Bildung die Gesundheit im Alter beeinflusst, ist unbestritten. Zum Ausmaß des bildungsspezifischen gesundheitlichen Abbaus liegen jedoch heterogene Ergebnisse vor. So bleibt unklar, ob sich gesundheitliche Unterschiede zwischen verschiedenen Bildungsgruppen im Alter vergrößern (Divergenz), verkleinern (Konvergenz) oder ob sie konstant bleiben (Kontinuität). Die vorliegende Studie untersucht den bildungsbedingten Alterseffekt auf die Veränderung der Gesundheit mit zwei Wellen (2004, 2007) des Survey of Health, Ageing and Retirement in Europe (SHARE) für Personen im Alter zwischen 50 und 80 Jahren. Mit einheitlichen statistischen Verfahren (OLS-Regressionen) wird die Veränderung der körperlichen, psychischen und kognitiven Gesundheit anhand von 12 Indikatoren multivariat analysiert. Das Ziel ist, generalisierbare Ergebnisse über die altersspezifischen Verläufe der Gesundheitsungleichheit zu erhalten. Insgesamt zeigen die Ergebnisse, dass Divergenz als das Hauptmuster bildungsbedingter Veränderungen der Gesundheit im Alter angesehen werden kann: Die gesundheitlichen Unterschiede zwischen Hoch- und Niedriggebildeten vergrößern sich im Alter für die Indikatoren Greifkraft, Einschränkungen bei Aktivitäten und instrumentellen Aktivitäten des täglichen Lebens sowie in der Mobilität, depressiven Symptomen, numerischen Fähigkeiten und zeitlicher Orientierung. Für vereinzelte Indikatoren sind jedoch auch kontinuierliche Muster (Anzahl chronischer Krankheiten, subjektive Gesundheitseinschätzung, Gedächtnis) und konvergierende Verläufe (Sprechgeschwindigkeit) bildungsbedingter Gesundheitsunterschiede zu beobachten.

Schlüsselwörter

Bildung Gesundheit Gesundheitsungleichheit Kumulationsthese Hohes Lebensalter 

Education and health inequality in old age: divergence, convergence or continuity?

A longitudinal study with SHARE

Abstract

It is well established that health at an old age is influenced by education acquired earlier in life. Empirical evidence on the extent of health decline across educational levels, however, is heterogeneous. It remains unclear whether the health gap between individuals with high and low levels of education increases in old age (divergence), decreases (convergence), or whether it remains constant (continuity). In the present study, we investigate the effects of education on health changes with data from two waves (2004, 2007) of the Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents aged 50–80. We estimate OLS regression models drawing on 12 indicators of physical, mental and cognitive health. Our aim is to obtain more generalizable results about the age trajectories of health inequality. We find that divergence is the main pattern of health decline across educational levels: The health gap between individuals with high and low educational levels increases for the indicators of grip strength, limitations of general and of instrumental activities of daily living, mobility limitations, depressive symptoms, numerical ability, and time orientation. For single indicators, however, we also observe continuous (chronic diseases, subjective health assessment, memory) and convergent (fluency of speaking) patterns.

Keywords

Education Health decline Health inequality Cumulative advantage Old age 

Literatur

  1. Alley, Dawn, Kristen Suthers, und Eileen Crimmins. 2007. Education and cognitive decline in older Americans: Results from the AHEAD Sample. Research on Aging 29:73–94.CrossRefGoogle Scholar
  2. Aneshensel, C. S. 1992. Social stress: Theory and research. Annual Review of Sociology 18:15–38.CrossRefGoogle Scholar
  3. Avendano, Mauricio, Hendrik Jürges, und Johan P. Mackenbach. 2009. Educational level and changes in health across Europe: Longitudinal results from SHARE. Journal of European Social Policy 19:301–316.CrossRefGoogle Scholar
  4. Beckett, Megan. 2000. Converging health inequalities in later life-an artifact of mortality selection? Journal of Health & Social Behavior 41:106–119.CrossRefGoogle Scholar
  5. Blau, Peter M., und Otis D. Duncan. 1967. American occupational structure. New York: Wiley.Google Scholar
  6. Börsch-Supan, Axel, Agar Brugiavini, Hendrik Jürges, Arie Kapteyn, Johan P. Mackenbach, Johannes Siegrist, und Guglielmo Weber. 2008. First results from the survey of health, ageing and retirement in Europe (2004–2007). Starting the longitudinal dimension. Mannheim: Druckerei Schwörer.Google Scholar
  7. Chandola, Tarani, Paul Clarke, J. N. Moris, und David Blane. 2006. Pathways between education and health: A causal modelling approach. Journal of Royal Statistical Society Series A 116:337–359.Google Scholar
  8. Chen, Feinian, Yang Yang, und Guangya Liu. 2010. Social change and socioeconomic disparities in health over the life course in China: A cohort analysis. American Sociological Review 75:126–150.CrossRefGoogle Scholar
  9. Compton, David M., Lara D. Bachman, Darren Brand, und Traci L. Avet. 2000. Age-associated changes in cognitive function in higher educated adults: Emerging myths and realities. International Journal of Geriatric Psychiatry 15:75–85.CrossRefGoogle Scholar
  10. Dannefer, Dale. 1987. Aging as intracohort differentiation: Accentuation, the Matthew effect, and the life course. Sociological Forum 2:211–237.CrossRefGoogle Scholar
  11. Dannefer, Dale. 2003. Cumulative advantage/disadvantage and the life course: Cross fertilising age and social science theory. Journals of Gerontology Series B: Psychological Sciences & Social Sciences 58:327–337.Google Scholar
  12. DiPrete, Thomas A., Gregory M. Erich, Karen S. Cook, und Douglas S. Massey. 2006. Cumulative advantage as a mechanism for inequality: A review of theoretical and empirical developments. Annual Review of Sociology 32:271–297.Google Scholar
  13. Dupre, Matthew E. 2007. Educational differences in age-related patterns of disease: Reconsidering the cumulative disadvantage and age-as-leveler hypotheses. Journal of Health & Social Behavior 48:1–15.CrossRefGoogle Scholar
  14. Elman, Cheryl, und Angela M. O’Rand. 2004. The race is to the swift: Socioeconomic origins, adult education, and wage attainment. American Journal of Sociology 110:123–160.CrossRefGoogle Scholar
  15. Goldman, Dana, und James P. Smith. 2002. Can patient self-management help explain the SES health gradient? Proceedings of the National Academy of Sciences 99:10929–10934.CrossRefGoogle Scholar
  16. Hank, Karsten, Hendrik Jürges, Jürgen Schupp, und Gert G. Wagner. 2006. Die Messung der Greifkraft als objektives Gesundheitsmaß in sozialwissenschaftlichen Bevölkerungsumfragen. DIW Discussion Papers. http://www.diw.de/documents/publikationen/73/diw_01.c.44221.de/dp577.pdf. Zugegriffen: 29. Juni 2010.Google Scholar
  17. Henretta, John C., und Richard T. Campbell. 1976. Status attainment and status maintenance: A study of stratification in old age. American Sociological Review 41:981–992.CrossRefGoogle Scholar
  18. Herd, Pamela. 2006. Do functional health inequalities decrease in old age? Educational status and functional decline among the 1931–1941 birth cohort. Research on Aging 28:375–392.CrossRefGoogle Scholar
  19. House, James S., Ronald C. Kessler, Regula A. Herzog, Richard P. Mero, Ann M. Kinney, und Martha J. Breslow. 1990. Age, socioeconomic status, and health. Milbank Quarterley 68:383–411.Google Scholar
  20. House, James S., James M. Lepkowski, Ann M. Kinney, Richard P. Mero, Ronald C. Kessler, und Regula A. Herzog. 1994. The social stratification of aging and health. Journal of Health & Social Behavior 35:213–234.CrossRefGoogle Scholar
  21. House, James S., Paula M. Lantz, und Pamela Herd. 2005. Continuity and change in the social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (American’s Changing Lives Study). Journals of Gerontology Series 60B:15–26.Google Scholar
  22. Huisman, Martijn, Anton E. Kunst, und Johan P. Mackenbach. 2003. Socioeconomic inequalities in morbidity among the elderly; a European overview. Social Science & Medicine 57:861–873.CrossRefGoogle Scholar
  23. Hungerford, Thomas L. 2007. The persistence of hardship over the life course. Research on Aging 29:491–511.CrossRefGoogle Scholar
  24. Jungbauer-Gans, Monika. 2006. Soziale und kulturelle Einflüsse auf Krankheit und Gesundheit. Theoretische Überlegungen. Kölner Zeitschrift für Soziologie und Sozialpsychologie Sonderheft 46:86–108.Google Scholar
  25. Kippersluis, Hans van, Owen O’Donnell, Eddy van Doorslaer, und Tom van Ourti. 2010. Socioeconomic differences in health over the life cycle in an Egalitarian country. Social Science & Medicine 70:428–438.CrossRefGoogle Scholar
  26. Knesebeck, Olaf von dem. 2005. Soziale Einflüsse auf die Gesundheit alter Menschen. Eine deutsch-amerikanische Vergleichsstudie. Bern: Huber.Google Scholar
  27. Knesebeck, Olaf von dem, Pablo E. Verde, und Nico Dragano. 2006. Education and health in 22 European countries. Social Science & Medicine 63:1344–1351.CrossRefGoogle Scholar
  28. Lauderdale, Diane S. 2001. Education and survival: Birth cohort, period, and age effects. Demography 38:551–561.CrossRefGoogle Scholar
  29. Lynch, Scott M. 2003. Cohort and life-course patterns in the relationship between education and health: A hierarchical approach. Demography 40:309–331.CrossRefGoogle Scholar
  30. Mackenbach, John P., I. Stirbu, A.-J. R. Roskam, M. M. Schaap, und G. Menvielle. 2008. Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine 358:2468–2481.CrossRefGoogle Scholar
  31. Mannheim Research Institute for the Economics of Aging (MEA). 2009. Guide to release 2.3.0. Waves 1 & 2. http://www.shareproject.org/t3/share/fileadmin/pdf_documentation/SHARE_guide_release_-3-0_update_10.12.2009.pdf. Zugegriffen: 29. Juni 2010.Google Scholar
  32. Marmot, Michael G., Carol D. Ryff, Larry L. Bumpass, Martin Shipley, und Nadine F. Marks. 1997. Social inequalities in health: Next questions and converging evidence. Social Science & Medicine 44:901–910.CrossRefGoogle Scholar
  33. Marmot, Michael G., R. Fuhrer, S. L. Ettner, Nadine F. Marks, Larry L. Bumpass, und Carol D. Ryff. 1998. Contribution of psychosocial factors to socioeconomic differences in health. The Milbank Quarterly 76:403–448.CrossRefGoogle Scholar
  34. Merton, Robert K. 1968. The Matthew effekt in science. Science 159:56–63.CrossRefGoogle Scholar
  35. Miech, Richard A., und Michael J. Shanahan. 2000. Socioeconomic status and depression over the life course. Journal of Health and Social Behavior 41:162–176.CrossRefGoogle Scholar
  36. Mirowsky, John, und Catherine E. Ross. 2003. Education, social status and health. New Brunswick: Adline Transaction.Google Scholar
  37. Mirowsky, John, und Catherine E. Ross. 2008. Education and self-rated health: Cumulative advantage and its rising importance. Research on Aging 30:93–122.CrossRefGoogle Scholar
  38. O’Rand, Angela M. 1996. The precious and precocious: Understanding cumulative disadvantage and cumulative advantage over the life course. The Gerontologist 36:230–238.Google Scholar
  39. O’Rand, Angela M., und Jenifer Hamil-Luker. 2005. Process of cumulative adversity linking childhood disadvantage to increased risk of heart attack across the life course. Specaial Issue of Journal of Gerontology B 60:117–124.Google Scholar
  40. Pampel, Fred C., und Melissa Hardy. 1994. Status maintenance and change during old age. Social Forces 73:289–314.CrossRefGoogle Scholar
  41. Ross, Catherine E., und Chia-Ling Wu. 1995. The links between education and health. American Sociological Review 60:719–745.CrossRefGoogle Scholar
  42. Ross, Catherine E., und Chia-Ling Wu. 1996. Education, age, and the cumulative advantage in health. Journal of Health & Social Behavior 37:104–120.CrossRefGoogle Scholar
  43. Sacker, Amanda, Diana Worts, und Peggy McDonough. 2011. Social influences on trajectories of self-rated health: Evidence from Britain, Germany, Denmark and the USA. Journal of Epidemiology and Community Health 65:130–136.Google Scholar
  44. Siegrist, Johannes, und Nico Dragano. 2006. Berufliche Belastungen und Gesundheit. Kölner Zeitschrift für Soziologie und Sozialpsychologie Sonderheft 46:109–124.Google Scholar
  45. Schöllgen, Ina, Oliver Huxhold, und Clemens Tesch-Römer. 2010. Socioeconomic status and health in the second half of life: Findings from the German Ageing Survey. European Journal of Ageing 7:17–28.CrossRefGoogle Scholar
  46. Smith J. P. 1999. Healthy bodies and thick wallets: The dual relation between health and economic status. The Journal of Economic Perspectives 13:145–166.CrossRefGoogle Scholar
  47. Smith, Kirsten P., und Nicholas A. Christakis. 2008. Social networks and health. Annual Review of Sociology 34:405–429.CrossRefGoogle Scholar
  48. Stern, Yaakov. 2002. What is cognitive reserve? Theory and research application of the reserve concept. Journal of International Neuropsychological Association 8:448–460.Google Scholar
  49. Walsemann, Katrina M., Arline T. Geronimus, und Gilbert C. Gee. 2008. Accumulating disadvantage over the life course: Evidence from a longitudinal study investigating the relationship between educational advantage in youth and health in middle age. Research on Aging 30:169–199.CrossRefGoogle Scholar
  50. Williams, D. R., und C. Collins. 1995. U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology 21:349–386.CrossRefGoogle Scholar
  51. Willson, Andrea E., Kim M. Shuey, und Glen H. Elder Jr. 2007. Cumulative advantage processes as mechanisms of inequality in life course health. American Journal of Sociology 112:1886–1924.CrossRefGoogle Scholar
  52. Wang, Wei-Pang. 2010. Educational disparity in life course patterns of depression in Taiwan. Diskussionspapier von der Konferenz RC28 in Haifa. http://soc.haifa.ac.il/~haifa2010/wp-content/uploads/Wei-Pang_Wang.pdf. Zugegriffen: 17. Jan. 2011.Google Scholar
  53. Zeng, Y., Danon Gu, und K. C. Land. 2007. The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China. Demography 44:497–518.CrossRefGoogle Scholar

Copyright information

© VS Verlag für Sozialwissenschaften 2011

Authors and Affiliations

  1. 1.Otto-Friedrich-Universität BambergBambergDeutschland

Personalised recommendations