Kyriopoulos Ilias, Machado Sara, Papanicolas Irene
Department of Health Policy, London School of Economics and Political Science, London, UK.
LSE Health, London School of Economics and Political Science, London, UK.
Health Serv Res. 2024 Dec;59(6):e14366. doi: 10.1111/1475-6773.14366. Epub 2024 Jul 26.
To examine wealth-related inequalities in self-reported health status among older population in the United States and 14 European countries.
We used secondary individual-level data from Health and Retirement Survey (HRS) and the Survey of Health, Ageing, and Retirement in Europe (SHARE) in 2011 and 2019.
In this cross-sectional study, we used two waves from HRS (wave 10 and 14) and SHARE (wave 4 and 8) to compare wealth-related health inequality across countries, age groups, and birth cohorts. We estimated Wagstaff concentration indices to measure these inequalities across three age groups (50-59, 60-69, 70-79) and two birth cohorts (1942-1947, 1948-1953) in the US and 14 European countries.
DATA COLLECTION/EXTRACTION METHODS: We performed secondary analysis of survey data.
Focusing on older population, we found evidence of wealth-related inequalities in self-reported health status across several high-income countries, with the US demonstrating higher levels of inequality than its European counterparts. The magnitude of these inequalities with respect to wealth remained unchanged over the study period across all countries. Our findings also suggest that wealth-related health inequalities differ at different stages of workforce engagement, especially in the United States. This could be explained either by potential redistributive effects of retirement or by uneven survivor effect, as less wealthy may drop out of the observations at a greater rate partly due to their poorer health.
Wealth-related inequalities in self-reported health status are strong and persistent across countries. Our results suggest that there is meaningful variation across high-income countries in health-wealth dynamics that merits further investigation to better understand whether certain health or welfare systems are more equitable. They also highlight the need to consider social policy and wealth redistribution mechanisms as strategies for improving population health among the less wealthy, in the United States and elsewhere.
研究美国和14个欧洲国家老年人口中自我报告的健康状况与财富相关的不平等情况。
我们使用了来自2011年和2019年健康与退休调查（HRS）以及欧洲健康、老龄化和退休调查（SHARE）的个体层面二手数据。
在这项横断面研究中，我们使用了HRS的两个波次（第10波和第14波）以及SHARE的两个波次（第4波和第8波），以比较不同国家、年龄组和出生队列中与财富相关的健康不平等情况。我们估计了瓦格斯塔夫集中指数，以衡量美国和14个欧洲国家三个年龄组（50 - 59岁、60 - 69岁、70 - 79岁）和两个出生队列（1942 - 1947年、1948 - 1953年）的这些不平等情况。
数据收集/提取方法：我们对调查数据进行了二次分析。
聚焦于老年人口，我们发现几个高收入国家中存在自我报告健康状况与财富相关的不平等证据，美国的不平等程度高于其欧洲同行。在整个研究期间，所有国家这些与财富相关的不平等程度保持不变。我们的研究结果还表明，与财富相关的健康不平等在劳动力参与的不同阶段有所不同，尤其是在美国。这可能是由于退休的潜在再分配效应或不均衡的幸存者效应所致，因为较贫穷的人群可能由于健康状况较差而以更高的比率退出观测。
自我报告健康状况与财富相关的不平等在各国都很强烈且持续存在。我们的结果表明，高收入国家在健康 - 财富动态方面存在有意义的差异值得进一步研究，以更好地理解某些健康或福利系统是否更公平。它们还强调了在美国和其他地方，需要将社会政策和财富再分配机制作为改善较贫穷人群健康状况的策略。
