Tracing the origins of successful aging: The role of childhood conditions and social inequality in explaining later life health

https://doi.org/10.1016/j.socscimed.2012.01.004Get rights and content

Abstract

This study investigates the role of childhood conditions and social inequality in older Europeans' propensity to age successfully, controlling for later life risk factors. Successful aging was assessed following Rowe and Kahn's conceptualization, using baseline interviews from the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). These data were merged with retrospective information on participants from 13 Continental European countries, collected as part of the SHARELIFE project. Our sample consists of 22,464 men and women, who are representative of the non-institutionalized population aged 50 or older (mean age: 63.3) in their respective country. Estimating multilevel logistic models, we controlled for demographics (age, sex), childhood conditions (SES, health, cognition), later life risk factors (various dimensions of SES and health behaviors), as well as social inequality (measured by country-specific Gini coefficients). There is an independent association of childhood living conditions with elders' odds of aging well. Higher parental SES, better math and reading skills, as well as self-reports of good childhood health were positively associated with successful aging, even if contemporary characteristics were controlled for. Later life SES and health behaviors exhibited the expected correlations with our dependent variable. Moreover, lower levels of income inequality were associated with a greater probability of meeting Rowe and Kahn's successful aging criteria. We conclude that unfavorable childhood conditions exhibit a harmful influence on individuals' chances to age well across all European welfare states considered in this study. Policy interventions should thus aim at improving the conditions for successful aging throughout the entire life course.

Highlights

► This study uses unique life history data from 13 European countries to trace the origins of successful aging. ► Childhood conditions greatly impact individuals' odds of aging successfully, independent of later life risk factors. ► Lower social inequality in a country is associated with higher odds of aging well. ► Welfare state policies have the capacity to improve conditions for healthy and active aging from early life onwards.

Introduction

In the preamble to the Constitution of the World Health Organization (WHO), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Against the background of growing concern about trends in the health of older people in particular (see Crimmins & Béltran-Sánchez, 2011, for a recent review), Rowe and Kahn, 1997, Rowe and Kahn, 1998 introduced a highly influential conceptualization of ‘successful aging’, which added a social component to merely biomedical conceptualizations of healthy aging. Rowe and Kahn's (1997: 439) definition of successful aging as “avoidance of disease and disability, maintenance of high physical and cognitive function, and sustained engagement in social and productive activities” thus corresponds well to WHO's multidimensional definition of health and has become a commonly applied “gold standard of aging” (Dillaway & Byrnes, 2009: 706).

Numerous studies have shown that current socioeconomic status (SES), health behaviors, or religious beliefs, for example, are strong predictors of successful aging (e.g., Crowther, Parker, Achenbaum, Larimore, & Koenig, 2002; Haveman-Nies, de Groot, & van Staveren, 2003; McLaughlin, Connell, Heeringa, Li, & Roberts, 2010). While these characteristics mainly describe elders' contemporary circumstances, recent research suggested that early- or midlife factors, such as family background, work characteristics, or the experience of incarceration, matter as well (e.g., Britton, Shipley, Singh-Mannoux, & Marmot, 2008; Pruchno, Wilson-Genderson, Rose, & Cartwright, 2010). Moreover, a growing body of evidence indicates that childhood SES and health, for example, exhibit long-term influences on individuals' health (e.g., Blackwell, Hayward, & Crimmins, 2001; Haas, 2008; Luo & Waite, 2005) and mortality (e.g., Frijters, Hatton, Martin, & Shileds, 2010; Galobardes, Lynch, & Smith, 2004; Hayward & Gorman, 2004). To our knowledge, though, there has been little research explicitly aimed at tracing the origins of successful aging to a broader array of childhood conditions (see Schafer & Ferraro, 2011, for an exception).

A first objective of the present study, therefore, was to explore the potential role of parental SES as well as childhood health and cognition in determining whether individuals succeed in aging well, controlling for contemporary individual characteristics. Data was drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE), including recently collected retrospective information on participants aged 50 or over from 13 Continental European countries who participated in the SHARELIFE study. We complemented this life course perspective on successful aging with a multilevel perspective. Since previous comparative research revealed significant cross-national variation in the prevalence of successful aging (Hank, 2011a), we secondly tested whether and how contemporary societal context contributes to aging well, focusing on the role of income inequality.

The remainder of this article is structured as follows: the next section provides a brief overview of previous research investigating associations between childhood conditions and social inequality with later life health. From this review we derive our hypotheses for the present study. We then describe the data and methods used in the analysis, followed by a presentation of empirical findings. We present our conclusions in the final section.

Section snippets

Studies relating childhood living conditions to adult health

Although a large number of early life circumstances may affect adult health, research indicating negative impacts of adverse childhood conditions on later life health has suggested that two aspects in particular might be important: early health and SES. These factors may affect adult health directly or indirectly. On one hand, early nutritional deprivation, for example, might directly initiate negative health trajectories during the individual's childhood, which may persist or even aggravate

Data

This study uses baseline interviews from the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE; cf. Börsch-Supan, Hank, Jürges, & Schröder, 2010), which were conducted in 2004–05 and 2006–07, respectively. These data were complemented with retrospective information on participants' childhood living conditions, collected in 2008–09 during the survey's third round as part of the SHARELIFE project (see Schröder, 2011, for methodological details). SHARELIFE data are

Results

The explanatory variables were included stepwise into the regression, that is, we started with a so called ‘empty’ model that contained only the constant and the macro-level error term (Model 1). The contemporary (i.e., later life) micro-level control variables were introduced in Model 2, which was complemented by our set of childhood variables in Model 3. Finally, we added the Gini coefficient as a macro-level variable in Model 4 (see Table 2). Note that all findings reported here are based on

Discussion

Exploiting new data from the SHARELIFE project, which allowed us to integrate life course and multilevel perspectives on successful aging, the present study had two main objectives: first, to explore the potential role of parental SES as well as childhood health and cognition in determining whether Europeans succeed in aging well; second, to test whether and how social inequality (measured by a country's Gini coefficient) relates to individuals' odds of meeting Rowe and Kahn, 1997, Rowe and

Acknowledgments

We are grateful for comments by three anonymous reviewers. This paper uses data from SHARELIFE release 1, as of November 24th 2010 and from SHARE release 2.5.0, as of May 24th 2011. The SHARE data collection has been primarily funded by the European Commission through the 5th framework program (project QLK6-CT-2001-00360 in the thematic program Quality of Life), through the 6th framework program (projects SHARE-I3, RII-CT-2006-062193, COMPARE, CIT5-CT-2005-028857, and SHARELIFE,

References (60)

  • S.V. Subramanian et al.

    Whose health is affected by income inequality? A multilevel interaction analysis of contemporary and lagged effects of state income inequality on individual self-rated health in the United States

    Health & Place

    (2006)
  • R.G. Wilkinson et al.

    Income inequality and population health: a review and explanation of the evidence

    Social Science & Medicine

    (2006)
  • J. Banks et al.

    Childhood health and differences in late-life health outcomes between England and the United States

    NBER Working Paper 17096

    (2011)
  • G.J. van den Berg et al.

    Being born under adverse economic conditions leads to a higher cardiovascular mortality rate later in life: evidence based on individuals born at different stages of the business cycle

    Demography

    (2011)
  • A. Börsch-Supan et al.

    Longitudinal data collection in continental Europe: experiences from the survey of health, ageing and retirement in Europe

  • A. Britton et al.

    Successful aging: the contribution of early-life and midlife risk factors

    Journal of the American Geriatrics Society

    (2008)
  • G. Carrin et al.

    Exploring the health impact of economic growth, poverty reduction and public health expenditure

    Tijdschrift voor Economie en Management

    (1995)
  • E. Castro-Costa et al.

    Ascertaining late-life depressive symptoms in Europe: an evaluation of the survey version of the EURO-D scale in 10 nations. The SHARE project

    International Journal of Methods in Psychiatric Research

    (2008)
  • D. Christelis et al.

    Income, wealth, and financial fragility in Europe

    Journal of European Social Policy

    (2009)
  • Commission of the European Communities

    A memorandum on lifelong learning

    (2000)
  • E.M. Crimmins et al.

    Mortality and morbidity trends: is there compression of morbidity?

    Journal of Gerontology: Social Sciences

    (2011)
  • M.R. Crowther et al.

    Rowe and Kahn's model of successful aging re-visited: positive spirituality – the forgotten factor

    The Gerontologist

    (2002)
  • A. Deaton

    Health, inequality, and economic development

    Journal of Economic Literature

    (2003)
  • M. Dewey et al.

    Cognitive function

  • H.E. Dillaway et al.

    Reconsidering successful aging. A call for renewed and expanded academic critiques and conceptualizations

    Journal of Applied Gerontology

    (2009)
  • R. Fernández-Ballesteros et al.

    Lay concept of ageing well: cross-cultural comparisons

    Journal of the American Geriatrics Society

    (2008)
  • S. Fors et al.

    Childhood living conditions, socioeconomic position in adulthood, and cognition in later life: exploring the associations

    Journal of Gerontology: Social Sciences

    (2009)
  • B. Galobardes et al.

    Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation

    Epidemiologic Reviews

    (2004)
  • A. Gelman et al.

    Data analysis using regression and multilevel/hierarchical models

    (2007)
  • S.E. Gilman et al.

    Socioeconomic status in childhood and the lifetime risk of major depression

    International Journal of Epidemiology

    (2002)
  • Cited by (105)

    • Social insurance programs and later-life mortality: Evidence from new deal relief spending

      2022, Journal of Health Economics
      Citation Excerpt :

      Hence, a considerable portion of the effects could operate through education-income channels. There is a growing body of research exploring the early-life determinants of later-life longevity (Brandt et al., 2012; Brown et al., 2020; Goodman-Bacon, 2021; Janssen et al., 2006; Karas Montez et al., 2014; Montez and Hayward, 2011; Schellekens and van Poppel, 2016). Within this literature, a narrow strand of studies explores the long-term effects of welfare spending on adult outcomes (Almond et al., 2018; Deming, 2009; Goodman-Bacon, 2021).

    • Socioeconomic position and healthy ageing: A systematic review of cross-sectional and longitudinal studies

      2021, Ageing Research Reviews
      Citation Excerpt :

      Due to the heterogenous nature of the study design, exposure and outcome measures, as well as statistical models, we present the results in narrative form. Eighteen cross-sectional studies reported a significant association between high educational level and healthy ageing (Table 2) (Bosch-Farré et al., 2018; Bosnes et al., 2017; Brandt et al., 2012; Curcio et al., 2018; Feng et al., 2015; Hamid et al., 2012; Hank, 2011; Jang, 2020; Jang et al., 2009; Liu et al., 2017; McLaughlin et al., 2010, 2012, 2020a; Ng et al., 2009; Nie et al., 2021; Perales et al., 2014; Thoma et al., 2020; Wang and Lin, 2012). Three studies found no association between educational levels (Bélanger et al., 2018; Meng and D’Arcy, 2014) or continuous years of study and healthy ageing (Chaves et al., 2009).

    View all citing articles on Scopus
    View full text