Physical Exercise, Social Interaction, Access to Care, and Community Service: Mediators in the Relationship Between Socioeconomic Status and Health Among Older Patients With Diabetes.

The differences in socioeconomic status (SES) will cause a disparity in the health of the elderly. Taking diabetes as an example, previous studies have focused on risk factors of diabetes, while the relationship and mechanism between SES, multi-faceted factors, and the health of older patients with diabetes are not well-understood. This study aims to investigate the association between SES and health in older patients with diabetes and the interrelated mediators between them. Based on the data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, structural equation modeling (SEM) was used to test whether physical exercise, social interaction, access to care, and community service mediated the effect of SES on the health in older patients with diabetes. We found support for the model in which SES predicted the health in older patients with diabetes (comparative fit index = 0.910, incremental fit index = 0.911, goodness-of-fit index = 0.982, adjusted goodness-of-fit index = 0.959, standardized root mean square residual = 0.037, and root mean square error of approximation = 0.061). The total indirect effect of SES on the health accounted for 55.52% of the total effect. Results indicated that physical exercise (β = 0.108, < 0.01), social interaction (β = 0.253, < 0.001), and community service (β = 0.111, < 0.001) had significant positive effects on the health of older patients with diabetes. SES was positively associated with physical exercise (β = 0.417, < 0.001) and community service (β = 0.126, < 0.01). Although no direct effect of SES on the health was found, SES mediated the positive effect in their relationship by physical exercise (indirect effect = 0.045, < 0.01), and community service (indirect effect = 0.014, < 0.05). This study showed the health disparities of older patients with diabetes were influenced by individual-level (physical exercise, social interaction) and environmental-level (community service). It suggests that a lack of physical exercise and health-related community service may impair the health of older patients with diabetes with low SES, which recommends individuals' positive actions and environmental supports for promoting health of regarding population.