Associations Between Socioeconomic Status Trajectories and Health Outcomes among The Middle-aged and Elderly in Taiwan

• Main Authors: Chang, Ya-Wen, 張雅雯
• Other Authors: Lee, Miaw-Chwen
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/nsb6a5

碩士 === 國立中正大學 === 社會福利學系暨研究所 === 102 === Background: The elimination of health inequalities is an important policy around the world, In Taiwan, "Healthy People 2020" introduced in 2009 set one of the crucial health policy goals is to "improve health equality". Along with the emergence of the aged society, the health inequalities among the elderly population have gradually gained lot of attentions. The “Cumulative Inequality” theory explains that the social-environmental disadvantage experiences over the life course lead to differential life trajectory for everyone. The consequences of cumulative inequality induce premature death among those who experiencing disadvantages across life course. Few studies have focused on the effect of social trajectory and cumulative disadvantages on health outcome among the middle aged and elderly population. Objectives: The purpose of this study is to analyze the effect of social trajectory and cumulative disadvantages over early old age on health outcome among the middle aged and elderly population in Taiwan. Methods: Data for this study came from the 2003’s “Longitudinal Study on Health and Living Status of the Elderly in Taiwan” held by Health Promotion Administration, Ministry of Health and Welfare in Taiwan. The study sample included the individuals of household registration in Taiwan over the age of 50 in 2003, a total of 5,377 respondents. The socioeconomic status (SES) at early age was measured by father's occupational class (manual vs. non-manual occupation) and the education level of the respondents (primary vs. more than primary ).The socioeconomic status at the middle age was measured by the respondent’s major occupational class (manual vs. non-manual occupation). The socioeconomic status at the late age was measured by the occupational class (manual vs. non-manual occupation) and annual household income (below NT$ 300,000 vs. equal or over NT$ 300,000) at the old age. Disadvantaged SESs were defined as respondents who were manual occupations, primary only education level, and annual household income below NT$ 300,000. The accumulation of disadvantaged SES is to count the number of episodes of disadvantaged SES across three stages. Therefore, the cumulative amount ranged from 0 to 3. Socioeconomic status trajectory was measured the change of SES over early, middle and late stage. We generated eight trajectories. Then we used multiple logistic regressions to analyze the relationship between eight trajectories, the cumulative amount of disadvantaged SESs and health outcomes (self-rated health and depression) among the elderly. Control variables included the age cohorts, gender, marital status (married or not), residential arrangement (living alone or not) and health behaviors (drinking and smoking). Results and Discussion: The results demonstrate that the respondents with consistently manual occupational trajectories accounted for 54% of the sample, followed by a downward mobility (non-manual  manual  manual, 13%) and the consistently non-manual occupation trajectory accounted for 10.53% as the third. Moreover, in terms of the educational attainment - occupation - household income trajectories, the respondents with upward mobility (primary education  manual occupation  non- disadvantaged household income) accounted the most of the sample (35.52%), followed by consistently disadvantaged socioeconomic status trajectory (primary education  manual occupation  disadvantaged household income, 19.36%) and the third for the consistently non- disadvantaged socioeconomic status was 17.65%. The logistic regressions show that the odds ratios (ORs) of both poor self-rated health and depression (OR were 1.75 and 1.74, respectively) for consistently manual occupation class were higher than that for consistently non-manual occupation class. Moreover, the OR of poor self-rated health was high (OR = 1.96) when the respondents with manual occupational class at the middle stage, but the OR of depression was 1.84 when the respondents with manual occupational class both early and late stage. In terms of education - occupation - household income trajectory, compared to individuals with consistently non- disadvantaged socioeconomic status trajectory, the odds ratios of poor self-rated health and depression for those in consistently disadvantaged socioeconomic status were higher (OR were 2.19 and 2.27, respectively). The cumulative amount of socially disadvantages was positively correlated with poor self-rated health and depression among the middle-aged and elderly. Analysis of socioeconomic status trajectory can not only depict the dynamics of lifetime socioeconomic status, but also understand whether the transition of socioeconomic status will increase or reduce the effect of socially disadvantages on health outcomes. It is necessary to examine the relationship between the social mobility and health and its implication for policy regarding to reducing health inequalities. The understanding allows us to develop strategies for early interventions in order to reduce health inequalities in the aged society, particularly.