Intra-generational social mobility and mortality among older men in the Concord Health and Ageing in Men Project: A cohort study

Abstract

Objectives: We examined associations between intra-generational social mobility (reflected in life-course socioeconomic trajectories) and mortality, among older men.

Methods: Data came from a prospective Australian community-based cohort of older men. Social mobility was defined by socioeconomic indicators from three points in the life-course: educational attainment (late adolescence-early adulthood), occupation (mid-life), and current sources of income (older age). We defined indicators of social mobility trajectory (6 categories; reflecting the direction of social mobility) and social mobility status (2 categories; mobile or non-mobile). We used Cox regression to examine associations with mortality, adjusting for age, country of birth, and living arrangement.

Results: We followed 1568 men (mean age 76.8, SD 5.4) for a mean duration of 9.1 years, with 797 deaths recorded. Moving upward was the predominant social mobility trajectory (36.0%), followed by mixed trajectories (25.1%), downward (15.1%), stable low (12.2%), stable high (7.6%), and stable middle (4.0%). Men with downward (Hazard ratio 1.58, 95% CI 1.13 to 2.19) and stable low socioeconomic trajectories (1.77, 1.25 to 2.50) had higher mortality risks than men with stable high socioeconomic trajectories, while men with upward trajectories had similar risks to those with stable high trajectories. 76.2% of the participants were classified as having mobile status; no associations were evident between binary social mobility status and mortality.

Discussions: These findings suggest cumulative and persistent exposure to disadvantaged socioeconomic conditions across the life-course, rather than social mobility, is associated with increased mortality. For each stage of the life-course, addressing socioeconomic disadvantage may reduce inequities in mortality.

Keywords: Intra-generational; Life-course; Mortality; Older adults; Social mobility; Socioeconomic position.

Fig. 1

Movements between socioeconomic conditions across the life-course for different social mobility trajectories. Note: The widths of the lines are proportionate to the numbers of people in the corresponding trajectories. The height of the sections within each bar (low, middle, and high) represents the numbers of people in that category across the whole sample.

Fig. 2

Adjusted associations of theory-based social mobility trajectory, theory-based social mobility status, and data-driven social mobility trajectory with mortality. Note: n = 1568; Hazard ratios are from multivariable Cox proportional-hazards models, adjusted for age, country of birth, and living arrangement. CI: confidence interval. HR: hazard ratio.