Socioeconomic Status and Later-Life Health: Longitudinal Evidence From Europe and China

Scholars are divided as to how the protective effect of SES on health (the SES-health gradient) varies over the later-life course: The age-as-leveler perspective suggests that the SES-health gradient weakens with age, whereas the cumulative (dis)advantages perspective suggests that it strengthens with age. To clarify this, we used SHARE 2004-2017 (73,407 respondents from 19 European countries) and CHARLS 2011-2018 (8,370 Chinese respondents). Congruent with the age-as-leveler perspective, growth curve models revealed that the overall protective effect of SES on multimorbidity was weaker for older than younger adults (the country-specific effects were significant in two thirds of the case). We interpret this as a selection effect. However, the within-participant protective effect of SES on multimorbidity did not vary over the later-life course (the country-specific effects were nonsignificant in the majority of the case). Findings suggest that extant cross-sectional studies should be interpreted with caution and that longitudinal, cross-national studies are needed.

Social inequalities and the pandemic of COVID-19: the case of Rio de Janeiro

BackgroundThe novel coronavirus (SARS-CoV-2) is a global pandemic. The lack of protective vaccine or treatment led most of the countries to follow the flattening of the infection curve with social isolation measures. There is evidence that socioeconomic inequalities have been shaping the COVID-19 burden among low and middle-income countries. This study described what sociodemographic and socioeconomic factors were associated with the greatest risk of COVID-19 infection and mortality and how did the importance of key neighbourhood-level socioeconomic factors change over time during the early stages of the pandemic in the Rio de Janeiro municipality, Brazil.MethodsWe linked socioeconomic attributes to confirmed cases and deaths from COVID-19 and computed age-standardised incidence and mortality rates by domains such as age, gender, crowding, education, income and race/ethnicity.ResultsThe evidence suggests that although age-standardised incidence rates were higher in wealthy neighbourhoods, age-standardised mortality rates were higher in deprived areas during the first 2 months of the pandemic. The age-standardised mortality rates were also higher in males, and in areas with a predominance of people of colour, which are disproportionately represented in more vulnerable groups. The population also presented COVID-19 ‘rejuvenation’, that is, people became risk group younger than in developed countries.ConclusionWe conclude that there is a strong health gradient for COVID-19 death risk during the early stages of the pandemic. COVID-19 cases continued to move towards the urban periphery and to more vulnerable communities, threatening the health system functioning and increasing the health gradient.

What Explains the Socioeconomic Status-Health Gradient? Evidence from Workplace COVID-19 Infections

This paper studies the contribution of the workplace to the SES-health gradient. Our analysis is based on a unique dataset that tracks various health outcomes and workplace risks among healthcare workers during the first four months of the coronavirus 2019 (COVID-19) pandemic. The setting provides an exceptional opportunity to test for work-related disparities in health, while controlling for confounding determinants of the SES-health gradient. We find that low-SES nurses were systematically more likely to contract COVID-19 as a result of workplace exposure. These differentials existed in all healthcare institutions, but were particularly large in non-hospital settings. In contrast, we find no relationship between SES and non work-related infection rates. The differences in workplace infection rates are substantially larger than those implied by standard 'task-based' indices of transmission risk, and cannot be attributable to easily identifiable metrics of workplace risk. Together, our results show how subtle differences in work conditions or job duties can substantially contribute to the SES-health gradient.

Gender Disparities in the Education Gradient in Self-Reported Health across Birth Cohorts in China

Background: Variation in the relationship between education and health has been studied intensely over the past few decades. Although there is research on gender disparity and cohort variations in educational effect on health using samples from the U.S. and Europe, research about China’s is limited. Given the specific social changes in China, our study is designed to analyze the gender and cohort patterns in the education-health gradient. Method: The latent growth-curve modeling was used to analyze the gender and cohort variations in the education gradient in self-rated health among Chinese respondents. The study employed longitudinal and nationally representative data from the Chinese Family Panel Studies from the years 2010 to 2016. Each cohort is specified according to their distinct periods of social change in China. Following the analysis, we used latent growth-curve model to illustrate gender and cohort differences in the age-graded education and health trajectories. Results: Although Chinese men have reported to have better health than women in general, women reported 1.6 percentage points higher in self-reported health for each additional year of schooling compared to that of men (P < 0.001). The latent growth curve model showed women’s extra education benefits were persistent overtime. Compared to the people born during the “Old China” (1908-1938), the education gradient in self-rated health did not change for cohorts born before 1955 and after 1977, but the education-health gap changed significantly in the 1956-1960 (O.R.=1.038, P<0.05), 1967-1976 (O.R.=1.058, P<0.001), and 1977-1983 (O.R.=1.063, P<0.001) cohorts. There was a gender difference for the cohort variations in the education-health gradient. For women, the education effect in the 1956-1960 (O.R.=1.063, P<0.05) , 1967-1976 (O.R.=1.088, P<0.001) and 1977-1983 (O.R.=1.102, P<0.001) cohorts was significantly higher than that of the 1908-1938 cohort. On the contrary, the education-health gradient remained the same across all cohorts for men. Conclusion: Our study suggests that the education-health gradient varies across cohorts for women, but the size of education effect remains consistent for men across cohorts. The findings support the resource-substitution hypothesis and not the rising-importance hypothesis in China. We discussed the potential influences of the unique, social transformation and educational expansion in China.