Life-course socioeconomic inequalities, social mobility and healthy aging in older adults: A multi-cohort study.

OBJECTIVE

To investigate how socioeconomic positions at different life stages, their relative importance, and social mobility influence IC across the USA, UK, Europe, China, and Japan among adults aged ≥50 years.

METHODS

We included 54,217 participants from five nationally representative cohorts in the USA, UK, Europe, China, and Japan. Life-course socioeconomic positions were assessed in early-life (childhood socioeconomic positions), early-adulthood (education), and late-adulthood (household wealth). Healthy aging was measured by intrinsic capacity including cognition, psychological health, locomotion, vitality, and sensory functions. Linear mixed models were used to estimate the associations of intrinsic capacity with each socioeconomic position indicator and social mobility.

FINDINGS

Higher levels of education and wealth were both significantly associated with better intrinsic capacity (p < 0.05 in all cohorts). Education had a stronger impact on intrinsic capacity than wealth in the USA, Europe, China, and Japan. Middle and high childhood socioeconomic positions were significantly linked to better intrinsic capacity compared with the low group (p < 0.05 in all cohorts). Compared to stable groups, upward and downward social mobility groups were associated with better and worse intrinsic capacity, respectively.

CONCLUSION

Socioeconomic measures throughout the life course can predict healthy aging in the USA, Europe, and Asia. The long-term negative impact of disadvantaged childhood socioeconomic positions on healthy aging can be partially mitigated by upward mobility later in life. Policies need to narrow the social inequalities from early life and prevent adults from experiencing downward mobility, thereby reducing disparities in healthy aging.