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Comparative Study
. 2009 Jan;64(1):105-17.
doi: 10.1093/geronb/gbn004. Epub 2009 Feb 4.

Surprising SES Gradients in mortality, health, and biomarkers in a Latin American population of adults

Luis Rosero-Bixby  1 , William H Dow
Affiliations
Comparative Study

Surprising SES Gradients in mortality, health, and biomarkers in a Latin American population of adults

Luis Rosero-Bixby et al. J Gerontol B Psychol Sci Soc Sci. 2009 Jan.

Abstract

Background: To determine socioeconomic status (SES) gradients in the different dimensions of health among elderly Costa Ricans.

Hypothesis: SES disparities in adult health are minimal in Costa Rican society.

Methods: Data from the Costa Rican Study on Longevity and Healthy Aging study: 8,000 elderly Costa Ricans to determine mortality in the period 2000-2007 and a subsample of 3,000 to determine prevalence of several health conditions and biomarkers from anthropometry and blood and urine specimens.

Results: The ultimate health indicator, mortality, as well as the metabolic syndrome, reveals that better educated and wealthier individuals are worse off. In contrast, quality of life-related measures such as functional and cognitive disabilities, physical frailty, and depression all clearly worsen with lower SES. Overall self-reported health (SRH) also shows a strong positive SES gradient. Traditional cardiovascular risk factors such as diabetes and cholesterol are not significantly related to SES, but hypertension and obesity are worse among high-SES individuals. Reflecting mixed SES gradients in behaviors, smoking and lack of exercise are more common among low SES, but high calorie diets are more common among high SES.

Conclusions: Negative modern behaviors among high-SES groups may be reversing cardiovascular risks across SES groups, hence reversing mortality risks. But negative SES gradients in healthy years of life persist.

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Figures

Figure 1.
Figure 1.
Framework for studying health indicators in three levels.
Figure 2.
Figure 2.
Age-specific death rates. Costa Rica sample, Japan, and United States.
Figure 3.
Figure 3.
Socioeconomic status (SES) gradients in mortality and poor self-rated health (SRH). Costa Rican elderly. Rates or proportions relative to total population, controlled for age, sex, and marital status with regression: logistic for proportions and Gompertz hazard for rates.
Figure 4.
Figure 4.
Poor-health indicators odds ratio prevalence in high-socioeconomic status (SES) and low-SES individuals. See text for method to calculate odds ratios from models controlling for age, sex, and marital status with logistic regression. High SES are wealthy metro San Jose residents with postprimary education; low SES are poor lowland residents with no education. SRH = self-rated health; CRP = C-reactive protein; DHEA-S = Dehydroepiandrosterone sulfate
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