Abstract
BackgroundDue to societal changes and changes in the availability of health promoting factors, explanatory factors of socioeconomic inequalities in health (SIH) may change with time. We investigate differences in the relative importance of behavioural, social and psychological factors for explaining inequalities in physical performance between three birth cohorts.MethodsData came from N = 988, N = 1002, and N = 1023 adults aged 55–64 years, collected in 1992, 2002 and 2012 as part of the Longitudinal Aging Study Amsterdam. Physical performance was measured by three performance tests. We included lifestyle factors (physical activity, smoking, alcohol use and Body Mass Index (BMI)); social factors (network size, network complexity, divorce, social support); and psychological factors (mastery, self-efficacy and neuroticism). In multi-group mediation models, we tested whether the strength of indirect effects from socioeconomic position (SEP) via the explanatory factors to health differed between birth cohorts. Stronger indirect effects indicate an increase in the importance; weaker indirect effects indicate a decrease in importance.ResultsAbsolute SIH were present and similar across cohorts. The strength of indirect effects of SEP on physical performance through smoking, binge alcohol use, emotional support and mastery increased across cohorts. The indirect effects of BMI, network size, self-efficacy and neuroticism were similar across cohorts.ConclusionsInequalities in smoking, binge alcohol use, emotional support and mastery may have become more important for explaining SIH in recent cohorts of middle-aged adults. Policies that aim to reduce socioeconomic inequalities may need to adapt their targets of intervention to changing mechanisms in order to reduce SIH.
Highlights
Recent trend studies have shown that socioeconomic inequalities in physical performance, morbidity and mortality rates have been remarkably persistent in the past decades, despite policy efforts aiming to reduce them [1,2,3,4]
Building on the observations described above, we investigate whether the roles of social, behavioural and psychological factors for explaining socioeconomic inequalities in health (SIH) have changed between three cohorts of adults aged 55–64, born in 1928–1937, 1938–1947 and 1948–1957
95% Crystallized intelligence (CI) [− 0.003, 0.008], 48/57-cohort: β = .019, 95% CI [0.004, 0.034]; Table 3). We found that this increase in the strength of the indirect effect was mainly due to an increase in socioeconomic inequalities in smoking in later cohorts
Summary
Recent trend studies have shown that socioeconomic inequalities in physical performance, morbidity and mortality rates have been remarkably persistent in the past decades, despite policy efforts aiming to reduce them [1,2,3,4]. Klokgieters et al International Journal for Equity in Health (2021) 20:252 societal developments, resulting in a persistence of SIH [6] If this is true, policies that aim to reduce SIH would need to be adjusted continually to address the mechanisms that are most important for SIH at a given time. Studies have shown that factors such as smoking, obesity, and physical inactivity have become increasingly more prevalent in the lower socioeconomic groups, and that binge alcohol use may have increased predominantly in lower socioeconomic groups [9,10,11,12] Such behavioural factors may have become more important for explaining SIH in more recent cohorts. We investigate differences in the relative importance of behavioural, social and psychological factors for explaining inequalities in physical performance between three birth cohorts
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