Welfare Regimes Modify the Association of Disadvantaged Adult-life Socioeconomic Circumstances with Self-rated Health in Old Age
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Original versionSieber S, Cheval B, Orsholits, Van der Linden, Guessous I, Gabriel, Kliegel, Aartsen M, Boisgontier, Courvoisier DS, Burton-Jeangros, Cullati S. Welfare Regimes Modify the Association of Disadvantaged Adult-life Socioeconomic Circumstances with Self-rated Health in Old Age. International Journal of Epidemiology. 2018 http://dx.doi.org/10.1093/ije/dyy283
Background: Welfare regimes in Europe modify individuals’ socioeconomic trajectories over their life-course, and, ultimately, the link between socioeconomic circumstances (SECs) and health. This paper aimed to assess whether the associations between life-course SECs (early life, young adult-life, middle age and old age) and risk of poor self-rated health (SRH) trajectories in old age are modified by welfare regime (Scandinavian [SC], Bismarckian [BM], Southern European [SE], Eastern European [EE]). Methods: We used data from the longitudinal SHARE survey. Early-life SECs consisted of 4 indicators of living conditions at age 10. Young adult-life, middle-age, and old-age SECs indicators were education, main occupation and satisfaction with household income, respectively. The association of life-course SECs with poor SRH trajectories was analysed by confounder-adjusted multilevel logistic regression models stratified by welfare regime. We included 24,011 participants (3,626 in SC, 10,256 in BM, 6,891 in SE, 3,238 in EE) aged 50 to 96 years from 13 European countries. Results: The risk of poor SRH increased gradually with early-life SECs from most advantaged to most disadvantaged. The addition of adult-life SECs differentially attenuated the association of early-life SECs and SRH at older age across regimes: education attenuated the association only in SC and SE regimes and occupation only in SC and BM regimes; satisfaction with household income attenuated the association across regimes. Conclusions: Early-life SEC has a long-lasting effect on SRH in all welfare regimes. Adult-life SECs attenuated this influence differently across welfare regimes.