Abstract
BackgroundSocioeconomic mobility affects health throughout the life course. However, it is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages.MethodsParticipants were 16,690 community-dwelling adults aged 65–100 years in the Japan Gerontological Evaluation Study (JAGES). Baseline information including demographic characteristics, depression, and lifestyle factors were collected in 2010. Participants’ vital status was confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility into the following categories: ‘persistently high’, ‘downward mobility’, ‘upward mobility’, and ‘persistently low’. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-cause mortality.ResultsMortality HRs for the ‘downward’ group were 1.37 (95% confidence interval [CI], 1.08–1.74) among men and 1.27 (95% CI, 0.94–1.71) among women in comparison with the ‘persistently high’ group. Compared to the ‘persistently low’ group, the HRs for the ‘upward’ group were 0.54 (95% CI, 0.35–0.83) among women and 0.91 (95% CI, 0.73–1.24) among men. Associations were not changed after adjusting for objective socioeconomic status but were attenuated by depression.Conclusions‘Downward’ mobility was associated with mortality among men, but not among women. Depression appeared to mediate the association. A protective effect of upward mobility was observed among women but not among men.
Highlights
Subjective socioeconomic status (SSS), defined as “a person’s belief about his location in a status order”,1 has been shown to be correlated with health and illness independently from objective socioeconomic status (SES; including educational attainment, income, and occupation).[2]
After adjustment for age, the hazard ratios (HR) from the ‘downward mobility’ group was 1.37 compared to those in the ‘persistently high’ group
Even after adjustment for adult height, adult objective SES, and marital status, the HR of ‘downward mobility’ was significantly higher compared to ‘persistently high’
Summary
Subjective socioeconomic status (SSS), defined as “a person’s belief about his location in a status order”,1 has been shown to be correlated with health and illness independently from objective socioeconomic status (SES; including educational attainment, income, and occupation).[2]. People’s perceptions of their social status predict health behaviors, such as smoking[4] and sedentarism,[2] as well as some biomarkers, such as heart rate, sleep latency, cortisol habituation to stress, body fat distribution,[5] and high waist circumference.[6] SSS has been shown to be inversely related to metabolic syndrome,[6] insulin resistance,[7] coronary artery diseases, hypertension, diabetes and dyslipidemia.[8] As for older people, difficulties in instrumental activities of daily living are inversely related to SSS.[2] Presumably, through these pathways, low SSS is associated with excess risk of mortality.[9] The statistically significant associations between SSS and all outcomes above—except coronary artery disease, hypertension, and diabetes—were observed even after adjusting for objective socioeconomic status. Socioeconomic mobility affects health throughout the life course. It is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages
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