Comparing the education gradient in health deterioration among the elderly in six OECD countries. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Côté-Sergent, Aurelie; Fonseca, Raquel; Strumpf, Erin
• Is Part Of: Health policy. Volume 124:Issue 3(2020)
• Page Start: 326
• Page End: 335
• Publication Date: 2020-03
• Subjects: I1 -- I2 -- I8; Health deterioration -- Older ages -- Education; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2019.12.015
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: We examine the health deterioration-education gradient in 6 OECD countries. We find systematic differences in deterioration in terms of poor health by education levels. Adjusting for potential confounders generally diminishes the health deterioration-education gradient. Abstract: Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems.