Health differentials in the older population: An empirical investigation of the materialist, behavioural and psychosocial hypotheses

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Epidemiology and Population Health

Abstract

The projected demographic changes present a long term challenge for the UK with the costs of an ageing society being manageable provided appropriate policy responses are made now and over the coming years. This suggests a particular need to investigate health inequalities in the older population but although research on this topic is increasing it remains sparse in comparison with the volume of work on younger and middle aged people particularly middle aged men. The major aim of the proposed programme of work is to investigate the extent of health inequalities in the older population over time and to empirically compare the relative contribution to these of the materialistic (i.e. income, housing, living in safer environments, access to health care) behavioural (i.e. smoking diet alcohol consumption appropriate use of health care) and psychosocial (i.e. relative social status, social integration and exposure to stressful events) pathways in order to inform policy making and future population based interventions to promote healthy ageing.

Technical Summary

Aims The major aim of the proposed programme of work is to investigate the extent of health inequalities in the older population over time and to empirically compare the relative contribution to these of the materialistic (income, housing, living in safer environments, access to health care), behavioural (smoking, diet, alcohol consumption, appropriate use of health care) and psychosocial (empowerment, relative social status and social integration, exposure to stressful events) pathways, in order to inform policy making and future population based interventions to promote healthy ageing.
Objectives To derive longitudinal typologies of somatic and mental health in the older population, estimate the relative contribution to health inequalities of the materialist, behavioural and psychosocial pathways and compare the contribution of these pathways to health inequalities in the UK and the USA.
Design Secondary analysis of population based samples of older (age 50+) populations.
Methodology I will apply new statistical models - principally, innovations in latent variable and structural equation modelling - to define and characterise new longitudinal typologies of somatic and mental health, that take into account the heterogeneity of health status over time in the older population. Longitudinal typologies (phenotypes) of somatic and mental health will be derived with the application of Latent Class Growth Models within the finite mixture modelling framework. The most recent advances within the generalised latent variable modelling framework and the availability of specialist software will allow me to empirically test the relative contribution of material resources, behavioural styles and psychosocial factors to health differentials in the older population the proposed analysis involves the specification and estimation of a path analytic model as a predictor of the latent trajectories within a single modelling framework.
Scientific and Medical opportunities The projected demographic changes present a long term challenge for the UK with the costs of an ageing society being manageable, provided appropriate policy responses are made now and over the coming years. Findings from this study will inform policy making and future population based interventions to promote healthy ageing and reduce the cost of disease, as well as provide researchers with longitudinal somatic and mental health outcomes in the older population that may be used in future research.

Publications

10 25 50
 
Description Improved Measures of the Family Environment in Longitudinal Population Studies of Child Health in Sub-Saharan Africa
Amount £495,000 (GBP)
Funding ID ES/J021202/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 09/2013 
End 09/2015
 
Description Pathways - Biosocial influences on health
Amount £970,000 (GBP)
Funding ID ES/I025561/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 10/2011 
End 03/2015
 
Description Social mobility and health among Swedish men and women born 1915-2010: life course and intergenerational effects across the twentieth century
Amount 2,040,000 kr (SEK)
Organisation Swedish Research Council 
Sector Public
Country Sweden
Start 01/2014 
End 01/2016
 
Title Unmeasured confounding in observational data 
Description Inspired by the substantive application of the current funding agreement the team is developing (currently in the early stages of development) methods to deal with unmeasured confounding in studies of health inequalities and in studies that employ observational data. 
Type Of Material Data analysis technique 
Provided To Others? No  
Impact None yet 
 
Description Intergenerational transfer of health inequalities 
Organisation Centre for Health Equity Studies (CHESS)
Country Sweden 
Sector Academic/University 
PI Contribution Methodological/statistical contribution to the study of the intergenerational study of health inequalities in Sweden
Collaborator Contribution Access to a unique dataset, understanding of specific pathways through health inequalities are transfered through generations
Impact One paper inder review, two manuscripts under preperation
Start Year 2009
 
Description The male-female health-mortality paradox 
Organisation University of Vienna
Department Vienna Institute of Demography
Country Austria 
Sector Academic/University 
PI Contribution Statistical Innovations in causal mediation modelling, derived from my work on the MRC fellowship
Impact None, yet
Start Year 2011