Socio-Economic Inequalities in Health Deficit Accumulation in Old Age. Cross-National Evidence from Growth Curve Models Using Share Panel Data (2004-2013) from 10 European Countries

Existing studies on the social inequality in health trajectories in old age yielded inconsistent results regarding whether or not such health inequalities converge, remain stable or widen in old age. This is likely due to the widespread usage of cross-sectional data, limited availability of high quality and long-duration panel data, and issues regarding survival bias in the latter. Furthermore, the literature is dominated by single-country studies, and cross-national differences and potential contextual effects have received little attention so far. The objectives of this study were therefore (1) to assess trajectories of health deficit accumulation regarding the impact of education, income and wealth in Europe in general, and (2) to assess country-specific deviations of these patterns. We used panel data (21,571 observations from 7,178 respondents aged 65 years or more) from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) between the years 2004-2013 from ten European countries. Health deficits were measured by a sum index constructed from 40 identical items available in all four waves of SHARE. We estimated growth curve hierarchical regression models to examine trajectories of health deficits across time and controlled for both cohort effects and panel attrition. We found older adults with high education and income, and particularly wealthy older adults to have fewer health deficits at the onset of old age compared to their less educated and poorer counterparts. These gaps then widened between older adults with primary and tertiary education and between those of low and high household wealth over time but remained constant regarding income. Countries such as Spain, Italy and Germany showed higher average levels of health deficits and stronger deficit accumulation compared to Switzerland, Netherlands, Denmark and Sweden. Finally, the latter countries also tended to show less divergence in health deficit accumulation.