Socioeconomic differences in health among older adults in Mexico
Introduction
The relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries. Individuals with lower SES experience higher rates of mortality and are more likely to suffer from numerous health conditions. This so-called “social gradient” in health has been observed across different time periods and age groups using a wide range of SES indicators, health measures, and methodologies (see Goldman, 2001; Smith, 1999). However, fewer studies have considered the linkages between SES and health in developing countries, particularly at older ages. Understanding the determinants of health among older adults is critical in developing countries where rapid population aging is requiring governments to respond to the growing health-related needs of elderly populations with limited economic resources.
Researchers have attributed SES-related differences in health to a broad set of mechanisms that include living and working conditions, exposure to stress and the availability of psychosocial coping resources, health-related knowledge and behaviors, and access to medical care (Williams, 2005). The underlying pathways are likely to vary with a country's stage of economic development as well as with social and cultural factors. For example, income level can influence epidemiological conditions, along with choices in housing, education, work, diet, medical care, and social support. As standards of living rise, variability across individuals in exposure to health-enhancing or health-damaging factors can also increase. The magnitude of resulting health inequalities at older ages will depend on social welfare policies and cultural context, such as health insurance, social security, and the availability of familial or other forms of social support. Disparities in health will also be influenced by health-related behaviors (such as diet, exercise, smoking, and drinking), which themselves are likely to change over the course of development (Kim, Symons, & Popkin, 2004; Popkin & Gordon-Larsen, 2004).
To date, research in developing countries on SES differences in health at older ages has been fragmented and few studies have considered behavioral risk factors. This paper seeks to address these gaps by using the Mexican Health and Aging Study (MHAS) to examine variations by SES in health behaviors and health outcomes among older adults in a middle-income developing country. The extensive information on SES and health collected in the MHAS permits a more comprehensive examination of the SES–health relationship than most studies previously conducted in a developing country.
Mexico has undergone a rapid demographic transition and significant socioeconomic and epidemiological change over the past six decades. Between 1940 and 2002, infant mortality fell from 126 to 21 deaths per 1000 live births, life expectancy increased from 41 to 75 years, and the total fertility rate dropped from over 7 to just above 2 (OECD 2005a; Oxford University, 2005). This is resulting in a significant change in Mexico's age structure, with the percentage of the population over age 65 estimated to increase from 5% in 2000 to 18% in 2050 (UN, 2002). In contrast to older industrialized countries, Mexico's rapid aging is taking place in the context of relatively low living standards and inadequate benefit and health care systems (Palloni, Soldo, & Wong, 2002). Approximately, 40% of Mexico's elderly are estimated to live in poverty, with only one-third of adults 60 and older covered by a public or private pension and half by health insurance (Parker & Wong, 2001). As a result, Mexicans continue to rely on familial support in old age, but such traditional support systems are weakening (De Vos, Solis, & Montes de Oca, 2004; Palloni et al., 2002).
Mexico is also characterized by vast regional differences. Most of Mexico's economic growth has occurred through urbanization, with almost one-third of the population now residing in four major metropolitan areas, and 20 million people living in Mexico City alone (OECD, 2005b). As a result, living standards, employment, consumption patterns, and access to health care and social services differ considerably between urban and rural areas. An estimated one-third of rural residents live in poverty versus one-tenth of urban residents (World Bank, 2005). In rural areas, infectious diseases and malnutrition continue to be major causes of mortality whereas mortality in urban areas is dominated by chronic disease and other health problems associated with industrialization.
In light of these regional contrasts, we investigate how the relationship between SES and health differs between more and less urban areas of Mexico, an often-neglected dimension in research on social gradients in developing countries. We also extend the previous literature by examining the extent to which the relationship between various SES and health indicators varies by age and sex among older adults in Mexico.
Section snippets
Socioeconomic status and health outcomes
In view of the rapid growth of elderly populations, considerable attention has been devoted to the social determinants of health at older ages in Western industrialized countries. Most of this research has concluded that SES gradients in health persist into old age for a broad range of health measures, including mortality (Elo & Preston, 1996; Marmot & Shipley, 1996), functional limitations (Berkman & Gurland, 1998; Camacho, Strawbridge, Cohen, & Kaplan, 1993), disease onset (Crimmins, Mayward,
Data
Data for this analysis come from the 2001 (baseline) Mexican Health and Aging Study (MHAS). Modeled after the US Health and Retirement Survey (HRS), the MHAS collected data on various SES measures, including educational attainment, 38 different components of income, and 19 types of assets. The MHAS sample is representative of the non-institutionalized population aged 50 and over in 2000. Based on a sampling frame used by the National Employment Survey, 11,000 households with at least one
Sample description and bivariate analysis
Table 1 presents (weighted) descriptive statistics for Mexicans 50 and older based on 2001 MHAS data. Statistics are presented for the full sample and separately by area of residence. Approximately 45% of older Mexicans live in a major urban area. The majority (63%) report themselves in fair or poor health, with residents in less urban areas reporting relatively worse health. The prevalence of functional limitations is similar across residential areas. On average, older Mexicans report 1.7
Discussion
We use a nationally representative sample of older adults in Mexico to examine how three components of SES are associated with a set of health outcomes and behaviors. Our results generally support our hypotheses. We find that, in large cities in Mexico, the relationship between SES and health is similar to that observed in industrialized countries: higher education and affluence are associated with better SRH and physical functioning (e.g., Berkman & Gurland, 1998; Robert & House, 1996). This
Acknowledgments
This research was supported in part by the NIA Center for Demography of Aging at the Center for Health and Wellbeing at Princeton University. We would like to thank Scott Lynch, Rebeca Wong, and Germán Rodríguez for helpful comments on earlier drafts of this manuscript.
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