International Journal of Public Health

, Volume 58, Issue 1, pp 33–41 | Cite as

On age-specific variations in income-related inequalities in diabetes, hypertension and obesity

  • Martin SiegelEmail author
  • Markus Luengen
  • Stephanie Stock
Original Article



This article examines whether the social health gradients in diabetes, hypertension and obesity for men and women vary significantly across different age groups.


We use a pooled sample of German survey data from the years 2002 and 2006 with a total of 87,601 observations. We employ a varying Wagstaff index derived from the class of Gini-type concentration indices to estimate age-specific income-related health inequalities.


We find significant health disadvantages among poor women in mid-age, but no significant age-specific income-related health inequalities among men. Some leveling of inequalities in diabetes is observed.


The results suggest that variations in age-specific inequalities are unlikely to be a purely artificial result of health-related selection into retirement or mortality.


Germany Life course perspective Age-specific inequality Obesity Hypertension Diabetes 


  1. Balia S, Jones AM (2008) Mortality, lifestyle and socio-economic status. J Health Econ 27(1):1–26. doi: 10.1016/j.jhealeco.2007.03.001 PubMedCrossRefGoogle Scholar
  2. Banks J, Marmot M, Oldfield Z, Smith JP (2007) The SES health gradient on both sides of the Atlantic. IZA Discussion Papers 2539, Institute for the Study of Labor (IZA)Google Scholar
  3. Beckett M (2000) Converging health inequalities in later life—an artifact of mortality selection. J Health Soc Behav 41(1):106–119PubMedCrossRefGoogle Scholar
  4. Boersch-Supan A, Wilke CB (2004) The German public pension system: how it was, how it will be. Working Paper 10525, National Bureau of Economic ResearchGoogle Scholar
  5. Brockmann H, Müller R, Helmert U (2009) Time to retire—time to die? A prospective cohort study of the effects of early retirement on long-term survival. Soc Sci Med 69(2):160–164. doi: 10.1016/j.socscimed.2009.04.009 PubMedCrossRefGoogle Scholar
  6. Case AC, Deaton A (2005) Broken down by work and sex: how our health declines. In: Wise DA (ed) Analyses in the economics of aging, chap 6. Chicago University Press, Chicago, pp 185–205Google Scholar
  7. Deaton AS, Paxson CH (1998) Aging and inequality in income and health. Am Econ Rev 88(2):248–253Google Scholar
  8. Dupre ME (2007) Educational differences in age-related patterns of disease: reconsidering the cumulative disadvantage and age-as-leveler hypotheses. J Health Soc Behav 48(1):1–15PubMedCrossRefGoogle Scholar
  9. Haffner SM (2006) Relationship of metabolic risk factors and development of cardiovascular disease and diabetes. Obesity (Silver Spring) 14 Suppl 3:121S–127S. doi: 10.1038/oby.2006.291 CrossRefGoogle Scholar
  10. Harati H, Hadaegh F, Momenan AA, Ghanei L, Bozorgmanesh MR, Ghanbarian A, Mirmiran P, Azizi F (2010) Reduction in incidence of type 2 diabetes by lifestyle intervention in a middle eastern community. Am J Prev Med 38(6):628.e1–636.e1. doi: 10.1016/j.amepre.2010.03.003 CrossRefGoogle Scholar
  11. Hastie T, Tibshirani R (1993) Varying-coefficient models. J R Stat Soc Ser B Stat Methodol 55(4):757–796Google Scholar
  12. Human Mortality Database (2011) University of California, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany). or (data downloaded on October 13th, 2011)
  13. Islam MK, Gerdtham UG, Clarke P, Burström K (2010) Does income-related health inequality change as the population ages? Evidence from Swedish panel data. Health Econ 19(3):334–349. doi: 10.1002/hec.1479 PubMedCrossRefGoogle Scholar
  14. Kakwani N, Wagstaff A, van Doorslaer E (1997) Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econom 77(1):87–103CrossRefGoogle Scholar
  15. Kelly-Irving M, Delpierre C, Schieber AC, Lepage B, Rolland C, Afrité A, Pascal J, Cases C, Lombrail P, Thierry L (2011) Do general practitioners overestimate the health of their patients with lower education? Soc Sci Med 73(9):1416–1421. doi: 10.1016/j.socscimed.2011.07.031 PubMedCrossRefGoogle Scholar
  16. Kim J, Durden E (2007) Socioeconomic status and age trajectories of health. Soc Sci Med 65(12):2489–2502. doi: 10.1016/j.socscimed.2007.07.022 PubMedCrossRefGoogle Scholar
  17. Kim J, Miech R (2009) The Black-White difference in age trajectories of functional health over the life course. Soc Sci Med 68(4):717–725. doi: 10.1016/j.socscimed.2008.12.021 PubMedCrossRefGoogle Scholar
  18. Konings P, Harper S, Lynch J, Hosseinpoor AR, Berkvens D, Lorant V, Geckova A, Speybroeck N (2010) Analysis of socioeconomic health inequalities using the concentration index. Int J Public Health 55(1):71–74. doi: 10.1007/s00038-009-0078-y PubMedCrossRefGoogle Scholar
  19. Kunst AE, Mackenbach JP (1994) The size of mortality differences associated with educational level in nine industrialized countries. Am J Public Health 84(6):932–937PubMedCrossRefGoogle Scholar
  20. Li Q, Huang CJ, Li D, Fu TT (2002) Semiparametric smooth coefficient models. J Bus Econ Stat 20(3):412–422CrossRefGoogle Scholar
  21. Lynch SM (2003) Cohort and life-course patterns in the relationship between education and health: a hierarchical approach. Demography 40(2):309–331PubMedCrossRefGoogle Scholar
  22. McKinnon B, Harper S, Moore S (2011) Decomposing income-related inequality in cervical screening in 67 countries. Int J Public Health 56(2):139–152. doi: 10.1007/s00038-010-0224-6 PubMedCrossRefGoogle Scholar
  23. Mirowsky J, Ross CE (2005) Education, cumulative advantage, and health. Aging Int 30:27–62CrossRefGoogle Scholar
  24. Potthoff P, Heinemann LAJ, Güther B (2004) A household panel as a tool for cost-effective health-related population surveys: validity of the "Healthcare Access Panel". Ger Med Sci 2(Doc05):1–8Google Scholar
  25. Prus SG (2004) A life course perspective on the relationship between socio-economic status and health: testing the divergence hypothesis. Can J Aging 23 Suppl 1:S145–S153PubMedCrossRefGoogle Scholar
  26. Puska P (2010) From Framingham to North Karelia: from descriptive epidemiology to public health action. Prog Cardiovasc Dis 53(1):15–20. doi: 10.1016/j.pcad.2010.01.003 PubMedCrossRefGoogle Scholar
  27. Ross CE, Wu CL (1996) Education, age, and the cumulative advantage in health. J Health Soc Behav 37(1):104–120PubMedCrossRefGoogle Scholar
  28. Siegel M, Mosler K (2010) On the life course perspective in income related health inequalities: a semiparametric approach. Discussion Papers in Statistics and Econometrics 3/2010Google Scholar
  29. van Doorslaer E, Koolman X, Jones AM (2004) Explaining income-related inequalities in doctor utilisation in Europe. Health Econ 13(7):629–647. doi: 10.1002/hec.919 PubMedCrossRefGoogle Scholar
  30. van Doorslaer E, Masseria C, Koolman X, OECD Health Equity Research Group (2006) Inequalities in access to medical care by income in developed countries. CMAJ 174(2):177–183PubMedGoogle Scholar
  31. van Kippersluis H, van Ourti T, O’Donnell O, van Doorslaer E (2009) Health and income across the life cycle and generations in Europe. J Health Econ 28(4):818–830. doi: 10.1016/j.jhealeco.2009.04.001 PubMedCrossRefGoogle Scholar
  32. van Kippersluis H, O’Donnell O, van Doorslaer E, van Ourti T (2010) Socioeconomic differences in health over the life cycle in an Egalitarian country. Soc Sci Med 70(3):428–438. doi: 10.1016/j.socscimed.2009.10.020 PubMedCrossRefGoogle Scholar
  33. von Weizsäcker RK (1996) Distributive implications of an aging society. Eur Econ Rev 40(3–5):729–746. doi: 10.1016/0014-2921(95)00085-2 CrossRefGoogle Scholar
  34. Wagstaff A (2005) The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ 14(4):429–432. doi: 10.1002/hec.953 PubMedCrossRefGoogle Scholar
  35. Wagstaff A (2011) The concentration index of a binary outcome revisited. Health Econ 20(10):1155–1160. doi: 10.1002/hec.1752 PubMedCrossRefGoogle Scholar
  36. Wagstaff A, Paci P, van Doorslaer E (1991) On the measurement of inequalities in health. Soc Sci Med 33(5):545–557PubMedCrossRefGoogle Scholar
  37. WHO (2003) Obesity and overweight: global strategy on diet, physical activity and health. World Health Organization Fact SheetGoogle Scholar
  38. WHO (2009) Global database on body mass index: BMI classification. The World Health Organization. Accessed 15 Sept 2009
  39. Wildman J (2003) Income related inequalities in mental health in Great Britain: analysing the causes of health inequality over time. J Health Econ 22(2):295–312. doi: 10.1016/S0167-6296(02)00101-7 PubMedCrossRefGoogle Scholar
  40. Wingerter C (2010) Später in den ruhestand? Tech. rep., German Federal Statistical Office, WiesbadenGoogle Scholar

Copyright information

© Swiss School of Public Health 2012

Authors and Affiliations

  • Martin Siegel
    • 1
    Email author
  • Markus Luengen
    • 2
  • Stephanie Stock
    • 1
  1. 1.Institute of Health Economics and Clinical Epidemiology University Hospital of CologneCologneGermany
  2. 2.Department of Economics and Social SciencesUniversity of OsnabrückOsnabrückGermany

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