Abstract
The cumulative (dis)advantage hypothesis predicts education differences in health to increase with age. All previous tests of this hypothesis were based on self-reported health measures. Recent research has suggested that self-reported health measures may not adequately capture differences in key analytical constructs, including education, age, cohort, and gender. In this study, I tested the cumulative (dis)advantage hypothesis using a self-reported subjective measure (self-rated health), a self-reported semi-objective measure (PCS based on SF-12), and an objective measure (grip strength) of general physical health. Hierarchical linear models applied to five waves of panel data (SOEP, 2006–2014, N = 3,635 individuals aged 25 to 83, comprising N = 9,869 person-years) showed large differences between health measures. Among men, education differences in both self-reported measures of health widened substantially with age, consistent with the cumulative (dis)advantage hypothesis. For grip strength, education differences were small and changed little with age, inconsistent with the hypothesis. Among women, education differences in both self-reported measures of health remained stable over the life course, but they widened substantially when measured by grip strength. I conclude that evidence on the cumulative (dis)advantage hypothesis is sensitive to the choice of a health measure.
Highlights
A large literature has examined social inequality in trajectories of physical health
Several studies have shown that health gaps between education groups grow with age (Chen et al 2010; Kim 2008; Leopold 2016; Mirowsky and Ross 2008; Willson et al 2007). This evidence is consistent with the cumulativeadvantage hypothesis, which states that education differences in determinants of health—such as living and working conditions, exposure to stress, social support, and health behaviors—translate into increasing physical health differences between higher- and lower-educated people over the life course (Ross and Wu 1996)
The cumulativeadvantage hypothesis states that education structures the distribution of determinants of health, such as living and working conditions, exposure to stress, social support, and health behaviors, which translates into increasing physical health differences between higher- and lower-educated people over the life course (Ross and Wu 1996)
Summary
A large literature has examined social inequality in trajectories of physical health. Several studies have shown that health gaps between education groups grow with age (Chen et al 2010; Kim 2008; Leopold 2016; Mirowsky and Ross 2008; Willson et al 2007) This evidence is consistent with the cumulative (dis)advantage hypothesis, which states that education differences in determinants of health—such as living and working conditions, exposure to stress, social support, and health behaviors—translate into increasing physical health differences between higher- and lower-educated people over the life course (Ross and Wu 1996). The cumulative (dis)advantage hypothesis states that education structures the distribution of determinants of health, such as living and working conditions, exposure to stress, social support, and health behaviors, which translates into increasing physical health differences between higher- and lower-educated people over the life course (Ross and Wu 1996). The selection argument attributes the decline of education health differences in older age to selective mortality and selective participation in surveys (Kitagawa and Hauser 1973; Wilkinson 1986)
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