Skip to main content

Advertisement

SpringerLink
Log in

An assessment of socio-economic inequalities in health among elderly in Greece, Italy and Spain

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objective

This study explores socio-economic inequalities in health among Mediterranean people aged 50 or higher.

Methods

The data used in the analysis come from the Survey of Health, Ageing and Retirement in Europe, wave 1, release 2; the sample includes 2,671 Greek, 2,502 Italian and 2,343 Spanish persons. Seven health indicators are examined using age-sex standardized prevalence rates and logistic regression models. Concentration indices are also computed for self-rated health (SRH).

Results

Socio-economic position of individuals declines with age. Persons of lower socio-economic position experience worse health in all instances. Independently of education and gender, Greek persons display the lowest prevalence rates for SRH and physical and depressive symptoms, Spanish exhibit the highest rates for chronic conditions, and Italians perform better regarding functional limitations. Within-country analysis shows that the magnitude of socio-economic inequalities in SRH is greatest in Greece, followed by Spain and lastly by Italy.

Conclusions

The analysis reconfirms the advantage of high over low socio-economic position for all countries and health indicators and proves education as an important correlate compared to wealth and income among the elderly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Anderson NB, Armstead CA (1995) Towards understanding the association of socio-economic status and health: a new challenge for the biopsychosocial approach. Psychosom Med 57:213–225

    CAS  PubMed  Google Scholar 

  • Bardage C, Plujim SMF, Pedersen N et al (2005) Self-rated health among older adults: a cross-national comparison. Eur J Ageing 2:149–158

    Article  Google Scholar 

  • Baron-Epel O, Kaplan G (2001) General subjective health status or age-related subjective health status: does it make a difference? Soc Sci Med 53(10):1371–1481

    Article  Google Scholar 

  • Börsch-Supan A, Jürges H (eds) (2005) The survey of health, ageing and retirement in Europe: methodology. Mannheim Research Institute for the Economics of Ageing, Mannheim

    Google Scholar 

  • Börsch-Supan A, Brugiavini A, Jürges H, Mackenbach J, Siegrist J, Weber G (eds) (2005) Health, ageing and retirement in Europe, first results from the survey of health, ageing and retirement in Europe. Mannheim Research Institute for the Economics of Ageing, Mannheim

    Google Scholar 

  • Burstrom B, Fredlund P (2001) Self rated health: is it as good a predictor of subsequent mortality among adults in lower as in higher social classes? J Epidemiol Commun Health 55(11):836–840

    Article  CAS  Google Scholar 

  • Camargos MCS, Machado CJ, Rodrigues RN (2008) Sex differences in healthy life expectancy from self-perceived assessments of health in the City of São Paolo, Brazil. Ageing Soc 28:35–48

    Article  Google Scholar 

  • CSDH (2008) Closing the gap in a generation. Health equity through action on the social determinants of health, Commission on Social Determinants of Health Final Report. World Health Organization, Geneva

    Google Scholar 

  • d’Uva TB, 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

    Article  PubMed  Google Scholar 

  • De Vogli R, Gimeno D, Kivimaki M (2008) Correspondence: socioeconomic inequalities in health in 22 European countries. New Engl J Med 359:1290

    Article  PubMed  Google Scholar 

  • Deaton A (2002) Policy implications of the gradient of health and wealth. Health Affair 21(2):13–30

    Article  Google Scholar 

  • Dowd JB, Zajacova A (2007) Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US? Int J Epidemiol 36:1214–1221

    Article  PubMed  Google Scholar 

  • Duncan GJ, Daly MC, McDonough P, Williams DR (2002) Optimal indicators of socioeconomic status for health research. Am J Public Health 92(7):1151–1157

    Article  PubMed  Google Scholar 

  • Elo IT, Preston SH (1996) Educational differences in mortality: United States 1979–1985. Soc Sci Med 42(1):47–54

    Article  CAS  PubMed  Google Scholar 

  • Freedman V, Martin L (1999) The role of education in explaining and forecasting trends in functional limitations among older Americans. Demography 36(4):461–473

    Article  CAS  PubMed  Google Scholar 

  • Geyer S, Hemström Ö, Vågerö D (2006) Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Commun Health 60:804–810

    Article  Google Scholar 

  • Goldman N (2001) Social inequalities in health disentangling the underlying mechanisms. Ann NY Acad Sci 954:118–139

    Article  CAS  PubMed  Google Scholar 

  • Grundy E, Holt G (2001) The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Commun Health 55(12):895–904

    Article  CAS  Google Scholar 

  • Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, New York

    Book  Google Scholar 

  • House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR (1994) The social stratification of aging and health. J Health Soc Behav 35(3):213–234

    Article  CAS  PubMed  Google Scholar 

  • Huisman M, Kunst AE, Mackenbach JP (2003) Socio-economic inequalities in morbidity among the elderly: a European overview. Soc Sci Med 57:861–873

    Article  PubMed  Google Scholar 

  • Huisman M, Kunst AE, Andersen O et al (2004) Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Commun Helath 58(6):475–486

    Google Scholar 

  • Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37

    Article  CAS  PubMed  Google Scholar 

  • Jürges H (2007a) Healthy minds in healthy bodies. An international comparison of education-related inequality in physical health among older adults. Mea-Mannheim Research Institute for the Economics of Aging, Mannheim, Working Paper No. 141

  • Jürges H (2007b) True health vs response styles: exploring cross-country differences in self-reported health. Health Econ 16(2):163–178

    Article  PubMed  Google Scholar 

  • Kakwani N, Wagstaff A, van Doorslaer E (1997) Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econom 77:87–103

    Article  Google Scholar 

  • Knesebeck O, von Dem Wahrendorf M, Hyde M, Siegrist J (2007) Socio-economic position and quality of life among older people in 10 European countries: results of the SHARE study. Ageing Soc 27:269–284

    Article  Google Scholar 

  • Kunst AE, Bos V, Lahelma E et al (2005) Trends in socioeconomic inequalities in mortality in self-assessed health in 10 European countries. Int J Epidemiol 34(2):295–305

    Article  PubMed  Google Scholar 

  • Liberatos P, Link BG, Kelsey JL (1988) The measurement of social class in epidemiology. Epidemiol Rev 10:87–121

    CAS  PubMed  Google Scholar 

  • Mackenbach JP, Kunst AE (1997) Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 44:757–771

    Article  CAS  PubMed  Google Scholar 

  • Mackenbach JP, Kunst AE, Cavelaars AEJM, Groenhof F, Geurts JJM (1997) The working group on socioeconomic inequalities in health socioeconomic inequalities in morbidity and mortality in western Europe. Lancet 349:1655–1659

    Article  CAS  PubMed  Google Scholar 

  • Mackenbach J, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemström O, Valkonen T, Kunst A (2003) Widening socioeconomic inequalities in mortality in six European countries. Int J Epidemiol 32(5):830–837

    Article  PubMed  Google Scholar 

  • Mackenbach JP, Stirbu I, Roskam AR et al (2008) Socioeconomic inequalities in health in 22 European countries. New Engl J Med 358:2468–2481

    Article  CAS  PubMed  Google Scholar 

  • Materia E, Cacciani L, Bugarini G et al (2005) Income inequality and mortality in Italy. Eur J Public Health 15(4):411–417

    Article  PubMed  Google Scholar 

  • Mathers CD, Sadana R, Salomon JA, Murray CJL, Lopez AD (2000) Healthy life expectancy in 191 countries, 1999. Lancet 357:1685–1691

    Article  Google Scholar 

  • Matthews RJ, Smith LK, Hancock RM, Jagger C, Spiers NA (2005) Socioeconomic factors associated with the onset of disability in older age: a longitudinal study of people aged 75 years and over. Soc Sci Med 61(7):1567–1575

    Article  PubMed  Google Scholar 

  • O’ Reilly D (2002) Standard indicators of deprivation: do they disadvantage older people? Age Ageing 31(3):197–202

    Article  Google Scholar 

  • Prince MJ, Reischies F, Beekam ATF et al (1999) Development of the EURO-D scale—a European Union initiative to compare symptoms of depression in 14 European centres. Br J Psychiatr 174:330–338

    Article  CAS  Google Scholar 

  • Robert S, House JS (1996) SES differentials in health by age and alternative indicators of SES. J Aging Health 8(3):359–388

    Article  CAS  PubMed  Google Scholar 

  • Rognerud MA, Zahl PH (2005) Social inequalities in mortality: changes in the relative importance of income, education and household size over a 27-year period. Eur J Public Health 16(1):62–68

    Article  PubMed  Google Scholar 

  • Sen A (1997) On economic inequality. Oxford University Press, Oxford

    Google Scholar 

  • SHARE (2008) Documentation on selected issues. Available on http://www.share-project.org/. Accessed 15 Dec 2008

  • Simon JG, De Boer JB, Joung IMA, Bosma H, Mackenbach JP (2005) How is your health in general? A qualitative study on self-assessed health. Eur J Public Health 15(2):200–208

    Article  CAS  PubMed  Google Scholar 

  • Singh-Manoux A, Dugravot A, Shipley MJ et al (2007) The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study. Int J Epidemiol 36:1222–1228

    Article  PubMed  Google Scholar 

  • Smith JP (1998) Socioeconomic status and health. Am Econ Rev 88(2):192–196

    Google Scholar 

  • Sonne-Holm S, Sorensen TIA, Jensen G, Schnohr P (1989) Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey. J Epidemiol Commun Health 43:369–374

    Article  CAS  Google Scholar 

  • UNDP (2006) Human Development Report 2006, beyond scarcity: power, poverty and global water crisis. Palgrave Macmillan, New York

    Google Scholar 

  • Van Doorslaer E, Gerdtham UG (2003) Does inequality in self-assessed health predicts inequality in survival by income? Evidence from Swedish data. Soc Sci Med 1621–1629

  • Van Ourti T (2003) Socio-economic inequality in ill-health amongst the elderly. Should one use current income or permanent income? J Health Econ 22:187–217

    Article  Google Scholar 

  • Verropoulou G, Tsimbos C (2007) Socio-demographic and health-related factors affecting depression of the Greek population in later life: an analysis using SHARE data. Eur J Ageing 4(3):171–181

    Article  Google Scholar 

  • Vignon J (2005) Responses to the new demographics: present and future strategies for the European Union. In: Macura M, MacDonald AL, Haug W (eds) The new demographic regime, population challenges and policy responses. United Nations, New York, pp 45–56

    Google Scholar 

  • Von dem Knesebeck O, Verde PE, Dragano N (2006) Education and health in 22 European countries. Soc Sci Med 63:1344–1351

    Article  Google Scholar 

  • Wagstaff A (2005) The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ 14:429–432

    Article  PubMed  Google Scholar 

  • Wagstaff A, van Doorslaer E (1994) Measuring inequalities in health in the presence of multiple-category morbidity indicators. Health Econ 3:281–291

    Article  CAS  PubMed  Google Scholar 

  • Wagstaff A, Paci P, van Doorslaer E (1991) On the measurement of inequalities in health. Soc Sci Med 33(5):545–557

    Article  CAS  PubMed  Google Scholar 

  • Winkleby M, Jatulis D, Frank E, Fortmann SP (1992) Socioeconomic status and health: how education, income and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 82:816–820

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The author is grateful to two anonymous referees for their constructive and helpful comments. This paper uses data from release 2 of SHARE 2004. The SHARE data collection has been primarily funded by the European Commission through the 5th framework programme (project QLK6-CT-2001-00360 in the thematic programme Quality of Life). Additional funding came from the US National Institute on Ageing (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, Y1-AG-4553-01 and OGHA 04-064). Data collection in Austria (through the Austrian Science Foundation, FWF), Belgium (through the Belgian Science Policy Office) and Switzerland (through BBW/OFES/UFES) was nationally funded. The SHARE data collection in Israel was funded by the US National Institute on Aging (R21 AG025169), by the German–Israeli Foundation for Scientific Research and Development (GIF), and by the National Insurance Institute of Israel. Further support by the European Commission through the 6th framework programme (projects SHARE-I3, RII-CT-2006-062193, and COMPARE, CIT5-CT-2005-028857) is gratefully acknowledged. For methodological details see Börsch-Supan and Jürges (2005).

Author information

Authors and Affiliations

  1. Department of Statistics and Insurance Science, University of Piraeus, 80, Karaoli & Dimitriou Str, Piraeus, 185 34, Athens, Greece

    Cleon Tsimbos

Authors
  1. Cleon Tsimbos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cleon Tsimbos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsimbos, C. An assessment of socio-economic inequalities in health among elderly in Greece, Italy and Spain. Int J Public Health 55, 5–15 (2010). https://doi.org/10.1007/s00038-009-0083-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-009-0083-1

Keywords

Search

Navigation