Zusammenfassung
Der Beitrag gibt einen Überblick über aktuelle Entwicklungen in Bezug auf theoretische Perspektiven und methodische Herausforderungen in der Erforschung gesundheitlicher Ungleichheiten im Alter. Dabei zeigt sich, dass Forschungsarbeiten zur Erklärung des sozialen Gradienten rar und insbesondere Ansatzpunkte zur Reduzierung gesundheitlicher Ungleichheiten noch nicht ausreichend erforscht sind. Bei der Interpretation der vorliegenden Studien ist zu berücksichtigen, dass die Aussagekraft im Hinblick auf kausale Mechanismen und Veränderungen im Lebenslauf aufgrund selektiver Stichproben und der oftmals querschnittlichen Betrachtungsweise eingeschränkt ist.
Abstract
While it has been long known that health inequalities persist until higher ages, less is known about the underlying mechanisms and health trajectories over the life course. This article gives an overview on recent developments regarding theoretical concepts and methodological considerations in this field of research. It can be concluded that studies on the explanation of the social gradient in health are scarce and even less is known about societal contexts that enable healthy aging irrespective of the socioeconomic position. The existing evidence on causal mechanisms and developments over the life course warrants cautious interpretation due to selective study samples and cross-sectional study designs.
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Literatur
Andreß H‑J, Hörstermann K (2012) Lebensstandard und Deprivation im Alter in Deutschland. Stand und Entwicklungsperspektiven. Z Sozialreform 58:209–234
Asada Y, Hurley J, Grignon M, Kirkland S (2018) Health inequalities and inequities by age. Stability for the Health Utilities Index and divergence for the Frailty Index. SSM Popul Health 5:17–32
Bambra C, Netuveli G, Eikemo TA (2010) Wefare state regime life courses: The development of western European welfare state regimes and age-related patterns of educational inequalities in self-reported health. Int J Health Serv 40:399–420
Behrens J (2009) Meso-soziologische Ansätze und die Bedeutung gesundheitlicher Unterschiede für die allgemeine Soziologie sozialer Ungleichheit. In: Richter M, Hurrelmann K (Hrsg) Gesundheitliche Ungleichheit. Grundlagen, Probleme, Perspektiven. Springer VS, Wiesbaden, S 55–76
Borrell C, Palencia L, Muntaner C, Urquia M, Malmusi D, O’Campo P (2014) Influence of macrosocial policies on women’s health and gender inequalities in health. Epidemiol Rev 36:31–48
Brandt M, Kaschowitz J, Lazarevic P (2016) Gesundheit im Alter. Ein Überblick über den Stand der sozialwissenschaftlichen Forschung. In: Jungbauer-Gans M, Kriwy P (Hrsg) Handbuch Gesundheitssoziologie. Springer, Wiesbaden, S 1–18
Esser I, Palme J (2010) Do public pensions matter for health and wellbeing among retired persons? Basic and income security pensions across 13 Western European countries. Int J Soc Welfare 19:S103–S120
Farrants K (2017) Recommodification and the social determinants of health. Unemployment benefits, pensions and health inequalities in Sweden and England, 1991–2011. J Public Health 39:661–667
Galea S, Tracy M (2007) Participation rates in epidemiologic studies. Ann Epidemiol 17:643–653
Grundy E, Holt G (2001) The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health 55:895–904
Halfon N, Hochstein M (2000) Life course and health development: an integrated framework for developing health, policy, and research. Milbank Q 80:433–479
Heiss F (2011) Dynamics of self-rated health and selective mortality. Empir Econ 40:119–140
Herd P (2006) Do functional health inequalities decrease in old age? Educational status and functional decline among the 1931–1941 birth cohort. Res Aging 28:375–392
Hoffmann R, Kröger H, Pakpahan E (2018) Pathways between socioeconomic status and health: does health selection or social causation dominate in europe? Adv Life Course Res 36:23–36
House JS, Lepkowski JM, Kinney AM et al (1994) The social stratification of aging and health. J Health Soc Behav 35:213–234
Jürges H (2007) True health vs response styles: exploring cross-country differences in self-reported health. Health Econ 16:163–178
Kelfve S (2017) Underestimated health inequalities among older people—A consequence of excluding the most disabled and disadvantaged. J Gerontol B Psychol Sci Soc Sci. https://doi.org/10.1093/geronb/gbx032
Kelfve S, Thorslund M, Lennartsson C (2013) Sampling and non-response bias on health-outcomes in surveys of the oldest old. Eur J Ageing 10:237–245
Kröger H, Pakpahan E, Hoffmann R (2015) What causes health inequality? A systematic review on the relative importance of social causation and health selection. Eur J Public Health 25:951–960
Lampert T (2009) Soziale Ungleichheit und Gesundheit im höheren Lebensalter. In: Böhm K, Tesch-Römer C, Ziese T (Hrsg) Gesundheit und Krankheit im Alter. Beiträge zur Gesundheitsberichterstattung des Bundes. Robert Koch Institut, Berlin, S 121–133
Lampert T, Hoebel J (2018) Soziale Ungleichheit und Gesundheit im höheren Lebensalter. Z Gerontol Geriatr 52:91. https://doi.org/10.1007/s00391-018-01487-y
Leopold L (2018) Education and physical health trajectories in later life: a comparative study. Demography 55:901–927
Leopold L, Engelhardt H (2013) Education and physical health trajectories in old age. Evidence from the survey of health, ageing and retirement in europe (SHARE). Int J Public Health 58:23–31
McMunn A, Nazroo J, Breeze E (2009) Inequalities in health at older ages: a longitudinal investigation of the onset of illness and survival effects in England. Age Ageing 38:11–18
Mielck A (2000) Soziale Ungleichheit und Gesundheit: Empirische Ergebnisse, Erklärungsansätze, Interventionsmöglichkeiten. Huber, Bern
Moor I, Spallek J, Richter M (2017) Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors. J Epidemiol Community Health 71:565–575
Oksuzyan A, Gumà J, Doblhammer G (2018) Sex differences in health and survival. In: Doblhammer G, Gumà J (Hrsg) A demographic perspective on gender, family and health in Europe. Springer, Cham, S 65–100
van Oort F, van Lenthe FJ, Mackenbach JP (2005) Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in the Netherlands. J Epidemiol Community Health 59:214–220
Pampel FC, Krueger PM, Denney JT (2010) Socioeconomic disparities in health behaviors. Annu Rev Sociol 36:1–23
Pförtner TK, Schmidt-Catran A (2017) Lebensstandard und Gesundheit. In: Giesselmann M, Golsch K, Lohmann H, Schmidt-Catran A (Hrsg) Lebensbedingungen in Deutschland in der Längsschnittperspektive. Springer, Wiesbaden, S 17–32
Richter M, Hurrelmann K (2009) Gesundheitliche Ungleichheit: Ausgangsfragen und Herausforderungen. In: Richter M, Hurrelmann K (Hrsg) Gesundheitliche Ungleichheit. Grundlagen, Probleme, Perspektiven. Springer VS, Wiesbaden, S 13–33
Ross CE, Wu CL (1996) Education, age, and the cumulative disadvantage in health. J Health Soc Behav 37:104–120
Schmitz AL, Pförtner T‑K (2018) Health inequalities in old age. The relative contribution of material, behavioral and psychosocial factors in a German sample. J Public Health 40: e235–e243. https://doi.org/10.1093/pubmed/fdx180
Schöllgen I, Huxhold O, Tesch-Römer C (2010) Socioeconomic status and health in the second half of life: findings from the German Ageing Survey. Eur J Ageing 7:17–28
Schröder H, Steinwede J, Schäfers M, Kersting A, Harand J (2017) 1. Zwischenbericht. Repräsentativbefragung zur Teilhabe von Menschen mit Behinderungen. infas, Bonn.
Skalická V, van Lenthe F, Bambra C, Krokstad S, Mackenbach JP (2009) Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: Evidence from the HUNT study. Int J Epidemiol 38:1272–1284
Stolz E, Mayerl H, Waxenegger A, Freidl W (2017) Explaining the impact of poverty on old-age frailty in Europe: material, psychosocial and behavioural factors. Eur J Public Health 27:1003–1009
Stolz E, Mayerl H, Waxenegger A, Rásky É, Freidl W (2017) Impact of socioeconomic position on frailty trajectories in 10 European countries: evidence from the Survey of Health, Ageing and Retirement in Europe (2004–2013). J Epidemiol Community Health 71:73–80
Tesch-Römer C, Wurm S (2009) Wer sind die die Alten? Theoretische Positionen zu Gesundheit und Alter. In: Böhm K, Tesch-Römer C, Ziese T (Hrsg) Gesundheit und Krankheit im Alter. Beiträge zur Gesundheitsberichterstattung des Bundes. Robert Koch Institut, Berlin, S 7–20
d’Uva T, O’Donnell O, van Doorslaer E (2008) Differential health reporting by education level and its impact on the measurement of health inequalities among older Europeans. Int J Epidemiol 37:1375–1383
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Schmitz, A. Gesundheitliche Ungleichheiten im Alter. Z Gerontol Geriat 52, 116–121 (2019). https://doi.org/10.1007/s00391-019-01518-2
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DOI: https://doi.org/10.1007/s00391-019-01518-2