Cumulative Dis/Advantage and Health Pattern in Late Life: A Comparison between Genders and Welfare State Regimes

ABSTRACT

This study provides a cross-national perspective to apply Cumulative Dis/Advantage (CDA) in explaining health inequality between developing and developed countries in the context of Welfare State Theory. Cross-sectional data from the international Health Retirement Study (United States, China, Mexico, and England) in 2013–2014 were used (n = 97,978). Four health indicators were included: self-reported health, depressive symptoms, functional ability, and memory. Regression models were fitted to examine the moderation roles of country and gender. Results indicated older Chinese and Mexican had poorer health status than their British and American counterparts consistently except for Mexicans’ memory. Cumulative health gaps between developing and developed countries existed only for functional ability. There is no evidence of a widening gap in health status between genders in late life. CDA explains the increasing gaps of functional ability across age groups between countries. General health and mental health, may however, depend more on individuals’ intrinsic capacity and human agency.

KEYWORDS:

• Cumulative dis/advantage
• welfare state theory
• health retirement study
• cross-national study

Acknowledgments

The Gateway to Global Aging Data project is developed by Center for Economic and Social Research (CESR) at University of Southern California. It is funded by National Institute on Aging, National Institutes of Health (R01 AG030153, RC2 AG036619, R03 AG043052, R24 AG048024). For more information, please refer to www.g2aging.org.

This analysis uses data or information from the Harmonized CHARLS dataset and Codebook, Version B.4 as of February 2017 developed by the Gateway to Global Aging Data. The development of the Harmonized CHARLS was funded by the National Institute on Aging (R01 AG030153, RC2 AG036619, R03 AG043052).

This analysis uses information and programming codes from the Harmonized MHAS programming codes and Codebook, Version A developed by the Gateway to Global Aging Data in collaboration with the MHAS research team. The development of the Harmonized MHAS was funded by the National Institute on Aging (R01 AG030153, RC2 AG036619, R03 AG043052). The Harmonized MHAS data files and documentation are public use and available at www.MHASweb.org. The MHAS (Mexican Health and Aging Study) receives support from the National Institutes of Health/National Institute on Aging (R01 AG018016).

This analysis uses data or information from the Harmonized ELSA dataset and Codebook, Version D as of March 2016 developed by the Gateway to Global Aging Data. The development of the Harmonized ELSA was funded by the National Institute on Aging (R01 AG030153, RC2 AG036619, 1R03AG043052). For more information, please refer to www.g2aging.org.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical consideration

Not applicable.

Supplemental material

Supplemental data for this article can be accessed here.

Notes

1. The data we used concerned older adults in England. However, we were not able to retrieve relevant health statistics for England from the WHO yearbook. Thus, we used the health statistics of the UK as the proxy variable for similar characteristics in England.

2. The education measure in the harmonized dataset used the simplified version of 1997 International Standard Classification of Education (ISCED-97) codes: 1 = Less than lower secondary education, 2 = Upper secondary and vocational training, and 3 = Tertiary education. However, there were no observations in “Less than lower secondary education” in the harmonized ELSA. Thus we re-categorized education into two levels by combining “Less than lower secondary education” and “Upper secondary” into “0 = relatively lower education” and recoding “Tertiary education” into “1 = higher education.”